Behavioral assessment of candidates for bariatric surgery: a patient-oriented approach.

This paper discusses the behavioral evaluation of patients who seek bariatric surgery and the psychosocial complications most frequently observed in these individuals. The effects of such complications on surgical outcome are briefly examined, as is the challenge of predicting therapeutic response on the basis of preoperative variables. The paper concludes with a description of the goals and methods of a behavioral assessment used at the University of Pennsylvania.

A comparison of weight histories in women with class III vs. class I-II obesity.

Objective: To describe the weight histories of women with extreme or class III obesity (BMI >or= 40 kg/m2) in comparison with a sample of women with class I-II obesity (BMI < 40 kg/m2) and to provide reliability data for a clinical instrument that assesses weight history.

Research Methods And Procedures: Female patients (N = 149) with extreme obesity seeking bariatric surgery and 90 class I-II obese women seeking behavioral treatment completed the Weight and Lifestyle Inventory (WALI), a self-report instrument that assesses age of onset of obesity, maximum weight at different ages, family weight history, and weight changes related to pregnancy. Test-retest reliability data were obtained by administering the WALI to a subsample (n = 58) of class I-II obese participants at their initial visit and at another pretreatment visit 1 to 2 weeks later.

Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery?

Objective: To describe the dieting histories of bariatric surgery candidates.

Research Methods And Procedures: One hundred seventy-seven individuals with extreme obesity who sought bariatric surgery completed the Weight and Lifestyle Inventory, a self-report instrument that assesses several variables, including weight and dieting history. Patients' dieting histories were further explored with an aided recall during a preoperative behavioral/psychological evaluation performed by a mental health professional.

Night eating syndrome and binge eating disorder among persons seeking bariatric surgery: prevalence and related features.

Objective: To assess the prevalence of night eating syndrome (NES) and binge eating disorder (BED) and their related behavioral and psychological correlates in persons who sought bariatric surgery.

Research Methods And Procedures: A consecutive series of 215 persons with extreme obesity (82% women, 70% European American) completed the Weight and Lifestyle Inventory and a semistructured interview as part of a pre-surgery behavioral/psychological assessment. Diagnoses for NES and BED were based on graded diagnostic criteria.

Self-reported eating behaviors of extremely obese persons seeking bariatric surgery: a factor analytic approach.

Objective: To summarize the self-reported eating behaviors of persons seeking bariatric surgery and to provide reliability data for a clinical instrument that assesses those eating behaviors.

Research Methods And Procedures: Adults (552) with extreme obesity (mean +/- standard deviation BMI = 52.4 +/- 10.

Comparison of psychosocial status in treatment-seeking women with class III vs. class I-II obesity.

Objective: This study compared the psychosocial status and weight loss expectations of women with extreme (class III) obesity who sought bariatric surgery with those of women with class I-II obesity who enrolled in a research study on behavioral weight control.

Research Methods And Procedures: Before treatment, all participants completed the Beck Depression Inventory-II and the Weight and Lifestyle Inventory. This latter questionnaire assesses several domains including symptoms of depression and low self-esteem, history of psychiatric complications, current stressors, and weight loss expectations.

Pregnancy and obesity: a review and agenda for future research.

At present, more than 60% of American women of childbearing age are either overweight or obese. As the obesity epidemic in the United States and many other countries continues to grow unchecked, there is greater interest in the relationship between obesity and other major health issues. This paper reviews the literature on the relationship between obesity and pregnancy.

How do mental health professionals evaluate candidates for bariatric surgery? Survey results.

Background: The prevalence of extreme obesity and the popularity of bariatric surgery have increased dramatically in recent years. Many surgery programs require that candidates undergo a preoperative psychological evaluation, but no consensus exists for guiding mental health professionals in the conduct of these evaluations.

Method: A survey was sent to bariatric surgeons, who were asked to distribute the surveys to the mental health professionals to whom they refer surgery candidates for preoperative evaluations.

Comparison of psychosocial status in treatment-seeking women with class III vs. class I-II obesity.

Objective: This study compared the psychosocial status and weight loss expectations of women with extreme (class III) obesity who sought bariatric surgery with those of women with class I-II obesity who enrolled in a research study on behavioral weight control.

Research Methods And Procedures: Before treatment, all participants completed the Beck Depression Inventory-II and the Weight and Lifestyle Inventory. This latter questionnaire assesses several domains including symptoms of depression and low self-esteem, history of psychiatric complications, current stressors, and weight loss expectations.

Self-reported eating behaviors of extremely obese persons seeking bariatric surgery: a factor analytic approach.

Objective: To summarize the self-reported eating behaviors of persons seeking bariatric surgery and to provide reliability data for a clinical instrument that assesses those eating behaviors.

Research Methods And Procedures: Adults (552) with extreme obesity (mean +/- standard deviation BMI = 52.4 +/- 10.

Night eating syndrome and binge eating disorder among persons seeking bariatric surgery: prevalence and related features.

Objective: To assess the prevalence of night eating syndrome (NES) and binge eating disorder (BED) and their related behavioral and psychological correlates in persons who sought bariatric surgery.

Research Methods And Procedures: A consecutive series of 215 persons with extreme obesity (82% women, 70% European American) completed the Weight and Lifestyle Inventory and a semistructured interview as part of a pre-surgery behavioral/psychological assessment. Diagnoses for NES and BED were based on graded diagnostic criteria.

Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery?

Objective: To describe the dieting histories of bariatric surgery candidates.

Research Methods And Procedures: One hundred seventy-seven individuals with extreme obesity who sought bariatric surgery completed the Weight and Lifestyle Inventory, a self-report instrument that assesses several variables, including weight and dieting history. Patients' dieting histories were further explored with an aided recall during a preoperative behavioral/psychological evaluation performed by a mental health professional.

A comparison of weight histories in women with class III vs. class I-II obesity.

Objective: To describe the weight histories of women with extreme or class III obesity (BMI >or= 40 kg/m(2)) in comparison with a sample of women with class I-II obesity (BMI < 40 kg/m(2)) and to provide reliability data for a clinical instrument that assesses weight history.

Research Methods And Procedures: Female patients (N = 149) with extreme obesity seeking bariatric surgery and 90 class I-II obese women seeking behavioral treatment completed the Weight and Lifestyle Inventory (WALI), a self-report instrument that assesses age of onset of obesity, maximum weight at different ages, family weight history, and weight changes related to pregnancy. Test-retest reliability data were obtained by administering the WALI to a subsample (n = 58) of class I-II obese participants at their initial visit and at another pretreatment visit 1 to 2 weeks later.

Behavioral assessment of candidates for bariatric surgery: a patient-oriented approach.

This paper discusses the behavioral evaluation of patients who seek bariatric surgery and the psychosocial complications most frequently observed in these individuals. The effects of such complications on surgical outcome are briefly examined, as is the challenge of predicting therapeutic response on the basis of preoperative variables. The paper concludes with a description of the goals and methods of a behavioral assessment used at the University of Pennsylvania.

Randomized trial of lifestyle modification and pharmacotherapy for obesity.

Background: Weight-loss medications are recommended as an adjunct to a comprehensive program of diet, exercise, and behavior therapy but are typically prescribed with minimal or no lifestyle modification. This practice is likely to limit therapeutic benefits.

Methods: In this one-year trial, we randomly assigned 224 obese adults to receive 15 mg of sibutramine per day alone, delivered by a primary care provider in eight visits of 10 to 15 minutes each; lifestyle-modification counseling alone, delivered in 30 group sessions; sibutramine plus 30 group sessions of lifestyle-modification counseling (i.

Psychosocial and behavioral aspects of bariatric surgery.

Bariatric surgery has become an increasingly popular treatment option for individuals with extreme obesity (defined as a BMI > or = 40 kg/m2) or those with less severe obesity accompanied by significant comorbidities. Sustained postoperative weight loss and improvements in obesity-related health problems make bariatric surgery the most effective treatment for this population. Nevertheless, most experts agree that psychosocial and behavioral factors contribute to successful postoperative outcomes.

A prospective, multi-site investigation of patient satisfaction and psychosocial status following cosmetic surgery.

Background: Although several studies have investigated patient satisfaction and changes in body image following aesthetic plastic surgery, few have investigated more specific dimensions of body image, including dysphoric emotions that occur in specific social situations or body image quality of life. In addition, few studies have investigated changes in body image that may occur in concert with changes in more general areas of psychosocial functioning, such as depressive symptoms and self-esteem.

Objective: This prospective, multi-site study investigated postoperative satisfaction and changes in psychosocial status following cosmetic surgery.

Health-related quality of life and symptoms of depression in extremely obese persons seeking bariatric surgery.

Background: Extreme obesity, defined by a body mass index (BMI) > or =40 kg/m2, is associated with increased risk of depression and with impairments in healthrelated quality of life (HRQoL). This study examined the relationships among BMI, HRQoL, and symptoms of depression in persons with extreme obesity.

Method: Participants were 306 patients who sought bariatric surgery (mean +/- SD age 43.

Female college students and cosmetic surgery: an investigation of experiences, attitudes, and body image.

This large, multisite study investigated female college students' experiences with and attitudes about cosmetic surgery. The study also assessed the relationship between several aspects of body image, including appearance satisfaction and investment and symptoms of body dysmorphic disorder, and interest in cosmetic surgery. Thirty (5 percent) of the 559 women surveyed reported that they had undergone cosmetic surgery.

Mental health histories and psychiatric medication usage among persons who sought cosmetic Surgery.

This retrospective chart review study examined the mental health histories and psychiatric medication usage of persons who sought cosmetic surgery. The medical records of 232 patients who had undergone a consultation for a cosmetic procedure were reviewed. The rates of self-reported psychiatric disorders and of psychiatric medication usage of these patients were compared with those of 200 patients who underwent noncosmetic procedures.

Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates.

Background: This study investigated the psychiatric diagnoses and psychiatric treatment histories of 90 bariatric surgery candidates.

Methods: Prior to surgery, all participants completed the Weight and Lifestyle Inventory, the Questionnaire on Eating and Weight Patterns, and the Beck Depression Inventory-II. Participants also underwent a behavioral/psychological evaluation with a psychologist, which reviewed responses to the measures and provided further assessment of participants' psychiatric status.

Dieting and the development of eating disorders in obese women: results of a randomized controlled trial.

Background: Some investigators fear that dieting may precipitate binge eating and other adverse behavioral consequences.

Objective: The objective of the study was to examine whether dieting would elicit binge eating and mood disturbance in individuals free of these complications before treatment.

Design: A total of 123 obese women were randomly assigned to 1) a 1000 kcal/d diet that included 4 servings/d of a liquid meal replacement (MR); 2) a 1200-1500 kcal/d balanced deficit diet (BDD) of conventional foods; or 3) a nondieting (ND) approach that discouraged energy restriction.

Childhood sexual abuse and obesity.

The causes of the current obesity epidemic are multifactorial and include genetic, environmental, and individual factors. One potential risk factor may be the experience of childhood sexual abuse. Childhood sexual abuse is remarkably common and is thought to affect up to one-third of women and one-eighth of men.