Psychosocial predictors of intentions to comply with bariatric surgery guidelines The Impact of a Preoperative Cognitive Behavioural Therapy (CBT) on Dysfunctional Eating Behaviours, Affective Symptoms and Body Weight 1 Year after Bariatric Surgery: A Randomised Controlled Trial When is the best time to deliver behavioral intervention to bariatric surgery patients: before or after surgery? Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study. Effectiveness of a Cognitive Behavioral Therapy for Dysfunctional Eating among Patients Admitted for Bariatric Surgery: A Randomized Controlled Trial Eating pathology before and after bariatric surgery: a prospective study. Grazing and loss of control related to eating: two high-risk factors following bariatric surgery. Discordance between self-report and behavioral pain measures in children aged 3-7 years after surgery. A comparison of functional brain changes associated with surgical versus behavioral weight loss Eating behavior in humans, characterized by cumulative food intake curves—a review Psychological outcomes and predictors of initial weight loss outcomes among severely obese adolescents receiving laparoscopic adjustable gastric banding. Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT. Preoperative Lifestyle Intervention in Bariatric Surgery: Initial Results from a Randomized, Controlled Trial Patient profiling for success after weight loss surgery (GO Bypass study): An interdisciplinary study protocol A case series evaluation of guided self-help for bulimia nervosa using a cognitive manual. Personality as a predictor of weight loss maintenance after surgery for morbid obesity. Validation of the yale-brown obsessive compulsive scale modified for binge eating.
An increasing body of research suggests that many patients have difficulty adopting the eating guidelines after weight-loss surgery , thereby reducing the long-term success of the procedure . Given such difficulties , it is possible that the typical preoperative education regarding post-surgical eating behavior guidelines is ineffective in motivating some individuals to comply . Presently , no accurate predictors of intentions to comply with post-bariatric surgery guidelines have been identified . In the present pilot study , a psychosocial intervention based on protection motivation theory ( PMT ) was presented to patients undergoing bariatric surgery .  PMT is a well-established preventive health model that has been utilized in a variety of health domains . Participants for this study were recruited before undergoing bariatric surgery , and were r and omly assigned to one of two groups : PMT group vs. control . In addition to routine messages from the bariatric surgeon , participants in the PMT group received an intervention based in PMT that focused on the importance of adhering to post-surgical eating behavior guidelines and how best to adhere to these guidelines . Participants in the control group received st and ard of care information from the bariatric surgeon . Results indicated that the PMT intervention did not have a significant impact . However , follow-up analyses revealed that two aspects of PMT , perceived self-efficacy and perceived threat of not following the guidelines , predicted patients ' intentions to comply with post-surgical guidelines . Findings are discussed in terms of the method ological compromises that result ed from the applied research setting as well as promising avenues for future investigation Background To examine whether a preoperative cognitive behavioural therapy ( CBT ) intervention exceeds usual care in the improvements of dysfunctional eating behaviours , mood , affective symptoms and body weight 1 year after bariatric surgery . Methods This is a 1-year follow-up of a single centre parallel-group r and omised controlled trial ( http:// clinical trials.gov/ct2/show/NCT01403558 ) . A total of 80 ( 55 females ) patients mean ( SD ) age 44 ( 10 ) years were included . The intervention group received 10 weeks of CBT prior to bariatric surgery , and the control group received nutritional support and education . Both groups were assessed at baseline ( T0 ) , post CBT intervention/preoperatively ( T1 ) , and 1 year postoperatively ( T2 ) . Using a mixed modelling statistical approach , we examined if the CBT group improved more across time than the control group . Results Our hypothesis was not supported as both groups had comparable improvements in all outcomes except for anxiety symptoms . Body weight declined by 30.2 % ( 37.3 kg ) in the CBT group and by 31.2 % ( 40.0 kg ) in the control group from baseline to follow-up , p = 0.82.There were statistically significant reductions in anxiety and depression symptoms in the CBT group between T0 and T1 and between T1 and T2 for depression only . However , in the control group , the anxiety score did not change significantly . The CBT group showed an earlier onset of improvements in all eating behaviours and affective symptoms than the control group . Conclusion The 10-week CBT intervention showed beneficial effects preoperatively , but the non-significant group differences postoperatively indicate a genuine effect of surgery BACKGROUND Many comprehensive bariatric surgery programs have implemented preoperative behavioral interventions for patients presenting with problematic eating behaviors in an effort to enhance postoperative weight loss and improve psychosocial adjustment . However , it is unknown whether these interventions are best delivered pre- or postoperatively . The purpose of this study was to determine when bariatric surgery patients are most receptive to a behavioral intervention , before or after surgery . METHODS A total of 32 pre- and postoperative patients were referred to a 10-week intervention design ed to reduce eating behaviors associated with postoperative weight gain ( e.g. ,  loss  of control while eating , grazing )  . The sample was 78.1 % female and 84.4 % white , with an average age of 49.43 + /- 9.13 years and a body mass index of 44.22 + /- 6.48 kg/m(2 ) . Of the 32 patients , 21 were referred preoperatively and 11 were referred postoperatively ( 5.63 + /- 2.91 months after surgery ) . These patients were tracked prospect ively to determine whether pre- or postoperative patients were more likely to attend and complete the behavioral intervention . RESULTS Compared with the preoperative patients , the postoperative patients were more likely to follow-up with their referral and initiate treatment [ chi(2)(1 ) = 10.06 , P = .002 ] . Of the postoperative patients , 100 % attended the first intervention session  compared with only 43 % of preoperative patients . The postoperative patients also attended more intervention sessions [ t(18 ) = 2.51 , P = .02 ] and were more likely to complete the intervention [ chi(2)(1 ) = 7.21 , P = .007 ] . Only 14 % of the preoperative referral patients completed the program compared with 91 % of the postoperative patients . CONCLUSION Comprehensive bariatric surgery programs ought to consider balancing the needs of the preoperative patients presenting with maladaptive eating behavior with the likelihood of them participating in a behavioral intervention before surgery BACKGROUND ( Extreme ) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences . Bariatric surgery is an effective intervention for obesity , but approximately 20 to 30 % of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies . This study examines the added value of pre-operative cognitive behavioral therapy ( CBT ) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style . We hypothesize that pre-operative CBT will result in better weight loss maintenance , reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone . METHODS One hundred and twenty eight patients that are on a waiting list for bariatric surgery are r and omly assigned to the control or treatment condition . Patients in the treatment condition receive 10 sessions of CBT before surgery aim ed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery . Weight loss , eating behavior , eating disorders , depression , quality of life and psychological distress are assessed before and after treatment , as well as 1 , 3 , and 5 year following surgery Objective . To examine whether cognitive behavioral therapy ( CBT ) alleviates dysfunctional eating ( DE ) patterns and symptoms of anxiety and depression in morbidly obese patients planned for bariatric surgery . Design and Methods . A total of 98 ( 68 females ) patients with a mean ( SD ) age of 43 ( 10 ) years and BMI 43.5 ( 4.9 ) kg/m2 were r and omly assigned to a CBT-group or a control group receiving usual care ( i.e. , nutritional support and education ) . The CBT-group received ten weekly intervention sessions . DE , anxiety , and depression were assessed by the TFEQ R-21 and HADS , respectively . Results . Compared with controls , the CBT- patients showed significantly less DE , affective symptoms , and a larger weight loss at follow-up . The effect sizes were large ( DE-cognitive restraint , g = −.92 , P ≤ .001 ; DE-uncontrolled eating , g = −.90 , P ≤ .001 ) , moderate ( HADS-depression , g = −.73 , P ≤ .001 ; DE-emotional eating , g = −.67 , P ≤ .001 ; HADS-anxiety , g = −.62 , P = .003 ) , and low ( BMI , g = −.24 , P = .004 ) . Conclusion . This study supports the use of CBT in helping patients preparing for bariatric surgery to reduce DE and to improve mental health . This clinical trial is registered with NCT01403558 OBJECTIVE The objectives of the study were ( 1 ) to determine the prevalence of eating pathology in patients before bariatric surgery and at follow-up ; ( 2 ) to assess the relationship of presurgical eating pathology to various measures of psychopathology ; and ( 3 ) to assess the relationship between presurgical eating pathology and outcome . METHOD One hundred sixteen patients were evaluated prior to surgery and at follow-up an average of 5.5 years after surgery . RESULTS Preoperative binge eating occurred in 52 % of patients , 16 % met criteria for binge eating disorder , and 10 % had the night eating syndrome . All three forms of presurgical eating pathology were statistically associated with cognitive distortions . At follow-up , 33 % of patients were vomiting at least weekly . There was no relationship between presurgical eating pathology and weight outcome or presence of vomiting at follow-up . DISCUSSION Although postoperative vomiting usually does not represent purge behavior , it may represent failed attempts to binge BACKGROUND  Gastric restrictive surgery  induces a marked change in eating behavior . However , the relationship between preoperative and postoperative eating behavior and weight loss outcome has received limited attention . OBJECTIVE This study assessed a range of eating behaviors before and 1 year after laparoscopic adjustable gastric b and ing ( LAGB )  and explored the nature and extent of change in eating patterns , their clinical associates , and impact on weight loss . METHODS AND PROCEDURES A 12-month observational study assessed presurgical and postsurgical binge eating disorder ( BED ) , uncontrolled eating , night eating syndrome ( NES ) , grazing , nutrient intake and eating-related behaviors , and markers of psychological distress .  A total of 129 subjects ( 26 male and 103 female , mean age 45.2 + /- 11.5 and BMI 44.3 + /- 6.8 ) participated in this study . RESULTS Presurgical BED , uncontrolled eating , and NES occurred in 14 % , 31 % , and 17.1 % of subjects , which reduced after surgery to 3.1 % , 22.5 % , and 7.8 % , respectively ( P = 0.05 for all ) . Grazing was prevalent before ( 26.3 % ) and after surgery ( 38.0 % ) . Preoperative BED most frequently became grazers ( P = 0.029 ) . The average percentage weight loss ( % WL ) was 20.8 + /- 8.5 % ; range -0.67 to 50.0 % and percentage of excess weight loss ( % EWL ) 50.0 + /- 20.7 % ; range -1.44 to 106.9 % ( P < 0.001 ) . Uncontrolled eating and grazing after surgery showed high overlap and were associated with poorer % WL ( P = 0.008 and P < 0.001 , respectively ) and elevated psychological distress . DISCUSSION Consistent with recent studies , uncontrolled eating and grazing were identified as two high-risk eating patterns after surgery . Clearer characterization of favorable and unfavorable postsurgical eating behaviors , reliable methods to assess their presence , and empirically tested postsurgical intervention strategies are required to optimize weight loss outcomes and facilitate psychological well-being in at-risk groups This study examined concurrent self-reports of pain intensity  and behavioral responses in 25 children aged 3 - 7 yr .  Behavioral (  Children 's Hospital of Eastern Ontario Pain Scale , CHEOPS ) and self-report ( the Oucher and Analogue Chromatic Continuous Scale ) measures of pain were obtained following major surgery . The two self-report measures were strongly and significantly correlated , and the pattern of scores over the 36-hr observation period was as expected . There was little relationship between the scores for the self-report and the behavioral measures . Many children who reported severe pain manifested few of the behavioral indicators of distress used in the CHEOPS . This behavioral response pattern may occur commonly in children experiencing pain after surgery and may limit the applicability of current behavioral scales as sole measures of pain intensity in younger children Objective Few studies have examined brain changes in response to effective weight loss ; none have compared different methods of weight-loss intervention . We compared functional brain changes associated with a behavioral weight loss intervention to those associated with bariatric surgery . Methods 15 obese participants were recruited prior to adjustable gastric b and ing surgery and 16 obese participants were recruited prior to a behavioral diet intervention .  Groups were matched for demographics and amount of weight lost . fMRI scans ( visual food motivation paradigm while hungry and following a meal ) were conducted before , and 12 weeks after surgery/behavioral intervention . Results When compared to bariatric patients in the pre-meal analyses , behavioral dieters showed increased activation to food images in right medial PFC and left precuneus following weight loss . When compared to behavioral dieters , bariatric patients showed increased activation in in bilateral temporal cortex following the weight loss . Conclusions Behavioral dieters showed increased responses to food cues in medial PFC – a region associated with valuation and processing of self-referent information – when compared to bariatric patients . Bariatric patients showed increased responses to food cues in brain regions associated with higher level perception — when compared to behavioral dieters . The method of weight loss determines unique changes in brain function Cumulative food intake curves have been obtained by monitoring eating from a plate , placed on a scale built into a table , and connected to a digital computer . They describe and integrate parameters of consumption of an ad lib single course meal , i.e. meal size , meal duration , eating rate , change in eating rate , bite size and bite frequency . It is concluded that they are an adequate tool for analyzing dietary and clinical interventions on meal size , because the cumulative food intake curve parameters : are stable and consistent within subjects ; show a clear relationship with the subject characteristics dietary restraint and obesity ; show a clear relationship with the physiological parameters satiation , diet-induced thermogenesis and body-temperature near the liver , and with the cognitive parameter : estimating forthcoming ingestion ; are sensitive to instructions , clinical and dietary interventions ( preloads , palatability , energy density , macronutrient composition ) , and to a state of negative energy balance . Because of possible compensatory post-pr and ial effects , it is suggested that assessment of meal size should be part of a 24 h appetite profile and food intake observation OBJECTIVE Elevated rates of psychopathology are noted among severely obese youth presenting for weight loss surgery . The role of mental health providers in this population is not well defined , and the selection of c and i date s is often the result of clinical judgment alone . The purpose of this study was to comprehensively evaluate psychiatric symptoms among a large sample of adolescents receiving laparoscopic adjustable gastric b and ing ( LAGB )  by ( 1 ) examining changes in depressive symptoms and quality of life in the year following surgery ; ( 2 ) evaluating the interaction between patterns of change in depression , quality of life , and weight postsurgery ; and ( 3 ) identifying presurgical psychological predictors of initial weight change . METHOD Participants were 101 severely obese adolescents aged 14 to 18 years receiving LAGB at the Center for Adolescent Bariatric Surgery at the Morgan Stanley Children 's Hospital of New York Presbyterian/Columbia University Medical Center between August 2006 and December 2009 . Measures of height , weight , depressive symptoms , and quality of life were obtained in the first year following surgery . Changes in the Beck Depression Inventory ( BDI ) , Pediatric Quality of Life Inventory ( PedsQL ) , and body mass index were analyzed using latent growth curve modeling . RESULTS Short-term changes in psychiatric symptoms and weight were analyzed using latent growth curve modeling . Significant changes in total BDI ( βslope = -0.885 , SE = 0.279 , P < .01 ; βquadratic = 0.054 , SE = 0.021 , P < .001 ) and PedsQL ( βslope = -0.885 , SE = 0.279 , P < .001 ) scores were observed following LAGB , and comparable postoperative changes between psychosocial variables and body mass index were also noted ( BDI : covariance [ COV ] = 0.21 , SE = 0.06 , P < .001 ; PedsQL : COV = -0.41 , SE = 0.10 , P < .01 ) . Two variables ( family conflict/loss of control eating ) were found to be significant predictors of weight change over the year following surgery ( P < .05 ) . CONCLUSIONS Adolescents experienced notable improvements in initial depressive symptoms and quality of life after LAGB , and measures of preoperative binge eating and family conflict affected postsurgery body mass index among youth . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01045499 SUMMARY Bariatric surgery ( BS ) is rated as the best evidence based treatment for obesity with regard to weight loss and maintenance of weight loss evaluated to date . Although BS interventions are effective , 20 - 30 % of BS patients start to regain weight within 24 months . Emotional eating is a behavior pattern which has been found to predict poor outcome . The aim of this study is to evaluate the effects of acceptance and commitment therapy  ( ACT ) for patients who underwent BS  , with regard to emotional eating , body dissatisfaction and quality of life . This study is a r and omized controlled trial ( n = 39 ) with two conditions ( 1 ) ACT including two face-to-face sessions and support via an Internet application and ( 2 ) treatment as usual ( TAU ) comprising the st and ard follow-up used by the BS team . Results show that participants in the ACT condition significantly improve on eating disordered behaviors , body dissatisfaction , quality of life and acceptance for weight related thoughts and feelings , as compared to those in the TAU group . This study shows that it is possible to improve effects of  BS  by specifically targeting emotional eating behavior . OBJECTIVE To document preoperative outcomes of a behavioral lifestyle intervention delivered to patients prior to bariatric surgery in comparison to treatment as usual ( insurance-m and ated physician supervised diet ) . DESIGN AND METHODS After completing a baseline assessment , c and i date s for surgery were r and omized to a 6-month , evidence -informed , manualized lifestyle intervention ( LIFESTYLE , n = 121 ) or to preoperative care as usual ( USUAL CARE , n = 119 ) . At 6 months , 187 participants remained c and i date s for bariatric surgery and were included in the analyses . RESULTS LIFESTYLE participants  lost significantly more weight than those receiving USUAL CARE [ 8.3 ± 7.8 kg vs. 3.3 ± 5.5 kg , F(1,183 ) = 23.6 , P < 0.0001 ] , with an effect size of 0.72 . Additionally , logistic regression modeling indicated that LIFESTYLE patients were significantly more likely to lose at least 5 % of initial body weight than those in USUAL CARE [ OR ( 95 % CI ) = 2.94 ( 1.253 , 6.903 ) ] , as were participants who were heavier [ OR ( 95 % CI ) = 1.07 ( 1.001 - 1.14 ) for each unit increase in BMI ] or with larger improvements in eating behaviors [ OR ( 95 % CI ) = 1.1 ( 1.049 , 1.145 ) for each unit increase on the Eating Behavior Inventory ) . CONCLUSIONS A behavioral lifestyle intervention for severely overweight individuals leads to clinical ly significant weight loss prior to bariatric surgery . Post-surgery follow-up will allow us to examine the impact of the preoperative intervention on postoperative outcomes Despite substantial research efforts , the mechanisms proposed to explain weight loss after gastric bypass ( RYGB ) and sleeve gastrectomy ( SL ) do not explain the large individual variation seen after these treatments . A complex set of factors are involved in the onset and development of obesity and these may also be relevant for the underst and ing of why success with treatments vary considerably between individuals . This calls for explanatory models that take into account not only biological determinants but also behavioral , affective and context ual factors . In this prospect i ve study , we recruited 47 women and 8 men , aged 25–56 years old , with a BMI of 45.8 ± 7.1 kg/m2 from the waiting list for RYGB and SL at Køge hospital , Denmark . Pre-surgery and 1.5 , 6 and 18 months after surgery we assessed various endpoints spanning multiple domains . Endpoints were selected on basis of previous studies and include : physiological measures : anthropometrics , vital signs , biochemical measures and appetite hormones , genetics , gut microbiota , appetite sensation , food and taste preferences , neural sensitivity , sensory perception and movement behaviors ; psychological measures : general psychiatric symptom-load , depression , eating disorders , ADHD , personality disorder , impulsivity , emotion regulation , attachment pattern , general self-efficacy , alexithymia , internalization of weight bias , addiction , quality of life and trauma ; and sociological and anthropological measures : sociodemographic measures , eating behavior , weight control practice s and psycho-social factors . Joining these many endpoints and method ologies from different scientific disciplines and creating a multi-dimensional predictive model has not previously been attempted . Data on the primary endpoint are expected to be published in 2018 . Trial registration Clinical trials . gov ID NCT02070081 OBJECTIVE The current study examined the usefulness of a new , cognitive-based self-help manual for bulimia nervosa . METHOD Twenty people were provided with assessment and six sessions of guided self-help using the manual . Participants were assessed for eating-related behaviors and attitudes and psychopathology at pretreatment , posttreatment , and at the 3-month follow-up . Assessment instruments included the Eating Disorder Examination , Symptom Checklist-90-Revised , Rosenberg Self-Esteem Scale , Screening Test for Co-morbid Personality Disorders , and The University of Rhode Isl and Change Assessment . Data from 15 people were available at posttreatment and from 13 people at follow-up . RESULTS Using intention-to-treat analyses , binge eating , vomiting , four of the five eating attitudes and self-esteem significantly improved between pretreatment and posttreatment . At follow-up , there was continued improvement on all measures , with the exception of binge eating . DISCUSSION Guided self-help using cognitive techniques is a promising first-line treatment for bulimia nervosa , with further evaluation required in a r and omized , controlled trial with long-term follow-up OBJECTIVE Personality characteristics are assumed to underlie health behaviors and , thus , a variety of health outcomes . Our aim was to examine prospect ively whether personality traits predict short- and long-term weight loss after  laparoscopic adjustable gastric b and ing .  RESEARCH METHODS AND PROCEDURES Of patients undergoing laparoscopic adjustable gastric b and ing  , 168 ( 143 women , 25 men , 18 to 58 years old , mean 37 years , preoperative BMI 45.9 + /- 5.6 kg/m(2 ) ) completed the Dutch Personality Question naire on average 1.5 years before the operation . The relationship between preoperative personality and short- and long-term postoperative weight loss was determined using multilevel regression analysis . RESULTS The average weight loss of patients progressively increased to 10 BMI points until 18 months after surgery and stabilized thereafter . A lower baseline BMI , being a man , and a higher educational level were associated with a lower weight loss . None of the personality variables was associated with weight outcome at short-term follow-up . Six of seven personality variables did not predict long-term weight outcome . Egoism was associated with less weight loss in the long-term postoperative period . The effect sizes of the significant predictions were small . DISCUSSION None of the personality variables predicted short-term weight outcome , and only one variable showed a small and unexpected association with long-term weight outcome that needs confirmation . This suggests that personality assessment as intake psychological screening is of little use for the prediction of a poor or successful weight outcome after bariatric surgery OBJECTIVE Establish the Yale-Brown obsessive compulsive scale modified for binge eating ( YBOCS-BE ) as a fit for purpose measure of treatment benefit in clinical trials of binge eating disorder ( BED ) . METHODS YBOCS-BE psychometric properties were evaluated with data from a Phase 2 r and omized controlled trial of lisdexamfetamine dimesylate in 260 adults with BED . Assessment s included : Cohen 's effect size estimates of item-level sensitivity and scale-level external responsiveness ; item-to-total correlations ; Cronbach 's alpha for internal consistency reliability ; Spearman correlations against reference measures for construct validity ; known-groups analyses for discriminating ability ; t tests of within-group differences between baseline and post baseline visits for internal responsiveness ; and multiple anchor-based approaches to estimate minimum clinical ly important change ( MCIC ) . RESULTS No significant distribution anomalies were seen . Items appear sensitive to treatment group differences . Item-to-total correlations were positive . Internal consistency is 0.81 . Large correlations ( > 0.50 ) were seen between YBOCS-BE score change and the Clinical Global Impression-Improvement ( CGI-I ; 0.58 ) and score changes for the following ; number of binge days ( 0.38 ) , Clinical Global Impression-Severity ( CGI-S ; 0.57 ) , the disinhibition ( 0.57 ) and hunger ( 0.52 ) subscales of the Three-Factor Eating Question naire ( TFEQ ) , and the Barratt Impulsiveness Scale ( BIS-11 ; 0.58 ) . MCIC estimates range from -4 to -17 . DISCUSSION The YBOCS-BE was found to be a reliable and valid measure of an important and unique concept in BED-related clinical studies . Study limitations include using protocol -defined BED severity level and the exclusion of psychiatric comorbidities
Validity varied extensively and there was a widespread lack of information regarding measurement of change over time and patient burden .
According to the evaluation criteria , there was adequate support for two tools .
The present study aims to identify the range of  eating behavior self- assessment tools reported in the adult bariatric surgery literature and evaluate the measurement properties of these tools using pre-established criteria .