Psychopathology predicts mental but not physical bariatric surgery outcome at 3-year follow-up: a network analysis study.

PURPOSE: This study aimed to explore the psychopathological variables that may predict bariatric surgery outcomes after 3 years. METHODS: One hundred ninety-six candidates for bariatric surgery completed self-report questionnaires to assess eating attitudes, eating disorder (ED)-related psychopathology, affective symptoms, interpersonal and psycho-social functioning. One-hundred patients repeated this assessment 3 years after bariatric surgery. A network analysis was run including the pre-surgical measurements in the network. A composite score derived from the combination of the most central network nodes, as well as clinical and socio-demographical variables, was included in a multivariate regression analysis with weight loss, ED psychopathology and psycho-social functioning as outcomes. RESULTS: Depression, stress, and shape concerns were the most central network nodes. The composite network score predicted higher ED psychopathology and worse psycho-social functioning at 3-year follow-up, but not weight loss. Higher age, restricting type of bariatric surgery and higher pre-operative BMI were further predictors of reduced weight loss and greater ED psychopathology. CONCLUSIONS: Affective symptoms and shape concern play a central role in the psychopathology of candidates to bariatric surgery and predict post-surgery ED psychopathology and psycho-social functioning. These variables may allow to identify patients with higher pre-operative risk and in need of further psycho-social interventions. LEVEL OF EVIDENCE: III, evidence obtained from well-designed cohort study.

Comparison of Interview to Questionnaire for Assessment of Eating Disorders after Bariatric Surgery.

The Eating Disorder Examination Interview Bariatric Surgery Version (EDE-BSV) assesses eating pathology after bariatric surgery but requires significant training and time to administer. Consequently, we developed a questionnaire format called the Eating Disorders After Bariatric Surgery Questionnaire (EDABS-Q). This study evaluates the consistency of responsiveness between the two formats. After surgery, 30 patients completed the EDE-BSV and EDABS-Q in a restricted randomized design. Patient reported behavior for each item which was converted to a score following the Eating Disorder Examination-Questionnaire (EDE-Q) scoring scheme. Responses fell into three distributions: (1) dichotomous, (2) ordinal, or (3) unimodal. Distributions of items were not different between the two formats and order did not influence response. Tests of agreement (normal approximation of the binomial test) and association (χ2 analyses on binary data and spearman rank order correlations on ordinal items) were performed. Percent concordance was high across items (63-100%). Agreement was significant in 31 of 41 items (Bonferroni-P < 0.001). Association was significant in 10 of 21 in χ2-appropriate items (Bonferroni-P < 0.002), and the ordinal items had highly significant correlations between formats (Bonferroni-P < 0.0125). The EDABS-Q is an adequate substitute for the EDE-BSV and may be useful for research and clinical evaluation of eating pathology after bariatric surgery.

Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice.

Bariatric surgery (BS) has proven to be highly efficacious in the treatment of obesity and its comorbidities. However, careful patient selection is critical for its success. Thus, patients should undergo medical, behavioral, and nutritional assessment by a multidisciplinary team. From the nutritional point of view, BS candidates should undergo nutritional assessment, preparation, and education by a registered dietitian in the preoperative period. Currently, detailed specified and comprehensive information on these topics is lacking. The present narrative review aimed to summarize the available literature concerning both the preoperative nutritional assessment components and the preoperative nutritional preparation and education components of patients planning to undergo BS. Current literature indicates that proper management before BS should include a comprehensive nutritional assessment, in which it is advisable to perform a clinical interview to assess patients' medical background, weight management history, eating patterns and pathologies, oral health, physical activity habits, nutritional status, supplementation usage, BS knowledge, surgery expectations and anthropometric measurements. Nutritional preparation and educational strategies should include an individualized preoperative weight-loss nutrition program, improvement of glycemic control, micronutrients deficiencies correction, eating and lifestyle habits adaptation, physical activity initiation, and strengthening knowledge on obesity and BS. At this stage, more well-designed intervention and long-term cohort studies are needed in order to formulate uniform evidence-based nutritional guidelines for patients who plan to undergo BS, including populations at higher nutritional risk. Moreover, postoperative outcomes of presurgical nutritional intervention programs should be studied.

Effects of Early Parent Training on Mother-Infant Feeding Interactions.

OBJECTIVE: This study examined whether professional behavioral and nutritional training for first-time mothers can improve feeding interaction at age 12 months. METHODS: Participants were 128 mother-infant dyads: 86 in the intervention group and 42 in the control group. The mean mothers' age was 30 years (±2.6). The intervention group received Mother-Infant Feeding Interaction (MI-FI) training: 4 weekly workshops for mothers when infants were aged 4 to 6 months old, followed by internet-based support by a dietitian and social worker until infants reached age 12 months. The control group received municipal well-baby clinic's standard mother-infant support. We assessed the mothers' tolerance to ambiguity and feeding-related reports. Blinded coders evaluated videotaped home mealtime interactions (age 12 months) using the Chatoor Feeding Scale (CFS). RESULTS: Significant intergroup differences emerged in mealtime interactions for 4 of the 5 CFS dimensions: dyadic conflict (MI-FI = 4.69 vs control = 8.38), talk and distraction (3.75 vs 4.90), struggle for control (2.30 vs 4.88), and maternal noncontingency (1.61 vs 2.75). Findings indicated significantly more positive mother-infant mealtime interactions and maternal responses to infant cues in the MI-FI group than in the control group. CONCLUSION: Very early maternal training may support the development of more positive mother-infant feeding interactions. This may contribute to preserved internal hunger and satiety cues and improved eating habits.

Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice.

Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1) presurgery nutritional evaluation and presurgery diet and supplementation; 2) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications.