Body image concerns in women with polycystic ovary syndrome: a systematic review and meta-analysis.

OBJECTIVE: To assess differences in body image concerns among women with and without polycystic ovary syndrome (PCOS). DESIGN: This is a systematic review and meta-analysis. METHODS: Electronic databases (MEDLINE, EMBASE, APA PsychInfo, PUBMED, Web-of-Science Core Collection, and Cochrane Controlled Register of Trials [CENTRAL]) were searched from inception through July 2022. Outcome measures included validated questionnaires reporting on body image concerns. Methodological quality was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system, and included studies were assessed for risk of bias. Meta-analyses were performed using the inverse variance method based on random or fixed effects models (Review Manager, Version 5). RESULTS: A total of 918 women with PCOS and 865 women without PCOS from 9 studies were included. Meta-analysis of 3 studies using Multidimensional Body-Self Relations Questionnaire Appearance Scale (MBSRQ-AS) showed those with PCOS reported higher dissatisfaction with appearance evaluation and appearance orientation compared to those without PCOS (mean difference [MD] = -0.78, I2 = 0%, P < .00001, and MD = 0.22, I2 = 54%, P = .004, respectively). Meta-analysis of 2 studies showed higher dissatisfaction with overweight preoccupation, lower body area satisfaction, and body weight classification on MBSRQ-AS subscales in those with PCOS compared to those without PCOS (all P < .001). Meta-analysis of 2 studies using the Body Esteem Scale for Adolescents and Adults (BESAA) showed significantly lower scores for the weight subscale in those with PCOS compared to those without PCOS (P = .03). CONCLUSIONS: Those with PCOS experience more significant body image concerns, emphasising the importance of awareness in the clinical care of PCOS. Considering the limited evidence, further studies are warranted to identify drivers and mitigating factors.

Internalised Weight Stigma Mediates Relationships Between Perceived Weight Stigma and Psychosocial Correlates in Individuals Seeking Bariatric Surgery: a Cross-sectional Study.

PURPOSE: Research suggests that internalised weight stigma may explain the relationship between perceived weight stigma and adverse psychological correlates (e.g. depression, disordered eating, body image disturbances). However, few studies have assessed this mechanism in individuals seeking bariatric surgery, even though depression and disordered eating are more common in this group than the general population. MATERIALS AND METHODS: We used data from a cross-sectional study with individuals seeking bariatric surgery (n = 217; 73.6% female) from Melbourne, Australia. Participants (Mage = 44.1 years, SD = 11.9; MBMI = 43.1, SD = 7.9) completed a battery of self-report measures on weight stigma and biopsychosocial variables, prior to their procedures. Bias-corrected bootstrapped mediations were used to test the mediating role of internalised weight stigma. Significance thresholds were statistically corrected to reduce the risk of Type I error due to the large number of mediation tests conducted. RESULTS: Controlling for BMI, internalised weight stigma mediated the relationship between perceived weight stigma and psychological quality of life, symptoms of depression and anxiety, stress, adverse coping behaviours, self-esteem, exercise avoidance, some disordered eating measures and body image subscales, but not physical quality of life or pain. CONCLUSION: Although the findings are cross-sectional, they are mostly consistent with previous research in other cohorts and provide partial support for theoretical models of weight stigma. Interventions addressing internalised weight stigma may be a useful tool for clinicians to reduce the negative correlates associated with weight stigma.

Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: Lifestyle management.

Lifestyle is fundamental in chronic disease prevention and management, and it has been recommended as a first-line treatment in the Australian polycystic ovary syndrome (PCOS) guideline 2011. The first international evidence-based guideline on PCOS was developed in 2018, which expanded the scope and evidence in the Australian guideline. This paper summarizes the lifestyle recommendations and evidence summaries from the guideline. International multidisciplinary guideline development groups delivered the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018. The process followed the Appraisal of Guidelines for Research and Evaluation II and The Grading of Recommendations, Assessment, Development and Evaluation framework. Extensive communication and meetings addressed six prioritized clinical questions through five reviews. Evidence-based recommendations were formulated before consensus voting within the panel. Evidence shows the benefits of multicomponent lifestyle intervention, efficacy of exercise and weight gain prevention with no specific diet recommended. Lifestyle management is the first-line management in the intervention hierarchy in PCOS. Multicomponent lifestyle intervention including diet, exercise and behavioural strategies is central to PCOS management with a focus on weight and healthy lifestyle behaviours. The translation programme optimizes reach and dissemination for health professionals and consumers.

Pre-operative Restraint and Post-operative Hunger, Disinhibition and Emotional Eating Predict Weight Loss at 2 Years Post-laparoscopic Adjustable Gastric Banding.

INTRODUCTION: A principal mechanism of action in bariatric surgery is reduction in calorie consumption due to decreased hunger and increased satiety. Patients' ability to perceive post-operative changes to their hunger is therefore central to optimal results. This study examined factors that may impact how patients perceive post-operative hunger and how perception of hunger impacts eating and subsequent weight loss after laparoscopic adjustable gastric banding (LAGB). METHODS: Patients undertaking LAGB (n = 147) provided pre-surgery and 2-year weight loss data and pre-surgery and 12-month psychological data (perception of hunger, disinhibition related to eating, emotional eating). RESULTS: Path analysis demonstrated that patients with lower levels of pre-surgery cognitive restraint over eating experienced significantly greater reduction in perception of hunger at 12 months post-surgery. Perceived reduction in hunger was significantly associated with lower levels of both emotional eating and disinhibited eating. Finally, reduced emotional eating at 12 months significantly predicted 9% of the variance in percentage of total weight loss (%TWL) at 2 years after surgery. CONCLUSION: These initial findings suggest that preparation for bariatric surgery may be enhanced by psychoeducation regarding cognitive restraint over eating and its effect on hunger perception. In addition, psychological treatment that focuses on identifying and responding to changes in hunger may contribute to improved outcomes for those who have difficulty adjusting to post-operative eating behaviours.

Exercise Recommendations for Women with Polycystic Ovary Syndrome: Is the Evidence Enough?

In this opinion piece, we summarize, discuss implications of implementation, and critically evaluate our 2018 evidence-based guideline recommendations for exercise and physical activity in women with polycystic ovary syndrome (PCOS). We developed recommendations as part of a larger international guideline development project. The overall guideline scope and priorities were informed by extensive health professional and consumer engagement. The lifestyle guideline development group responsible for the exercise recommendations included experts in endocrinology, exercise physiology, gynecology, dietetics, and obstetrics, alongside consumers. Extensive online communications and two face-to-face meetings addressed five prioritized clinical questions related to lifestyle, including the role of exercise as therapy for women with PCOS. The guideline recommendations were formulated based on one narrative and two evidence-based reviews, before consensus voting within the guideline panel. The development process was in accordance with the Appraisal of Guidelines for Research and Evaluation (AGREE) II, and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework to assess evidence quality, desirable and undesirable consequences, feasibility, acceptability, cost, implementation, and recommendation strength. Given the evidence for exercise as therapy in PCOS being of low quality, a consensus recommendation was made based on current exercise guidelines for the general population. Women with PCOS and clinicians are forced to adopt generic approaches when recommending exercise therapy that perpetuates clinical management with pharmacological solutions. The current status of evidence highlights the need for greater international co-operation between researchers and funding agencies to address key clinical knowledge gaps around exercise therapy in PCOS to generate evidence for appropriate, scalable, and sustainable best practice approaches.

Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding.

INTRODUCTION: Durability is a key requirement for the broad acceptance of bariatric surgery. We report on durability at and beyond 10 years with a systematic review and meta-analysis of all reports providing data at 10 or more years and a single-centre study of laparoscopic adjustable gastric banding (LAGB) with 20 years of follow-up. METHODS: Systematic review with meta-analysis was performed on all eligble reports containing 10 or more years of follow-up data on weight loss after bariatric surgery. In addition, a prospective cohort study of LAGB patients measuring weight loss and reoperation at up to 20 years is presented. RESULTS: Systematic review identified 57 datasets of which 33 were eligible for meta-analysis. Weighted means of the percentage of excess weight loss (%EWL) were calculated for all papers included in the systematic review. Eighteen reports of gastric bypass showed a weighted mean of 56.7%EWL, 17 reports of LAGB showed 45.9%EWL, 9 reports of biliopancreatic bypass +/- duodenal switch showed 74.1%EWL and 2 reports of sleeve gastrectomy showed 58.3%EWL. Meta-analyses of eligible studies demonstrated comparable results. Reoperations were common in all groups. At a single centre, 8378 LAGB patients were followed for up to 20 years with an overall follow-up rate of 54%. No surgical deaths occurred. Weight loss at 20 years (N = 35) was 30.1 kg, 48.9%EWL and 22.2% total weight loss (%TWL). Reoperation rate was initially high but reduced markedly with improved band and surgical and aftercare techniques. CONCLUSION: All current procedures are associated with substantial and durable weight loss. More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy. Reoperation is likely to remain common across all procedures.

Psychosocial Predictors of Change in Depressive Symptoms Following Gastric Banding Surgery.

OBJECTIVE: The aim of this study is to identify psychosocial variables associated with the relationship between weight loss and change in depressive symptoms following gastric banding surgery. METHODS: Ninety-nine adults completed self-report questionnaires assessing depressive symptoms and other psychosocial variables (self-esteem, body image dissatisfaction, perceived physical health, and perceived weight-based stigmatisation) prior to gastric-band surgery and monthly for 6-month post-surgery. RESULTS: Weight, depressive symptoms, and other psychosocial variables improved significantly 1-month post-surgery and remained lower to 6 months. Weight loss from baseline to 1- and 6-months post-surgery significantly correlated with change in depressive symptoms. Body image dissatisfaction and self-esteem accounted for some of the variance in change in depressive symptoms from baseline to 1-month and baseline to 6-months post-surgery. CONCLUSIONS: Depressive symptoms improved significantly and rapidly after bariatric surgery, and body image dissatisfaction and self-esteem predicted change in depressive symptoms. Interventions targeting body image and self-esteem may improve depressive symptoms for those undergoing weight loss interventions.

Neuropsychological Functioning in Mid-life Treatment-Seeking Adults with Obesity: a Cross-sectional Study.

OBJECTIVE: The aim of this study is to compare cognitive functioning between treatment-seeking individuals with obesity and healthy-weight adults. DESIGN AND METHODS: Sixty-nine bariatric surgery candidates (BMI > 30 kg/m2) and 65 healthy-weight control participants (BMI 18.5-25 kg/m2) completed a neuropsychological battery and a self-report psychosocial questionnaire battery. RESULTS: Hierarchical regression analyses indicated that obesity was predictive of poorer performance in the domains of psychomotor speed (p = .043), verbal learning (p < .001), verbal memory (p = .002), complex attention (p = .002), semantic verbal fluency (p = .009), working memory (p = .002), and concept formation and set-shifting (p = .003), independent of education. Obesity remained a significant predictor of performance in each of these domains, except verbal memory, following control for obesity-related comorbidities. Obesity was not predictive of visual construction, visual memory, phonemic verbal fluency or inhibition performance. Individuals with obesity also had significantly poorer decision-making compared to healthy-weight controls. CONCLUSIONS: Findings support the contribution of obesity to selective aspects of mid-life cognition after controlling for obesity-related comorbidities, while addressing limitations of previous research including employment of an adequate sample, a healthy-weight control group and stringent exclusion criteria. Further investigation into the functional impact of such deficits, the mechanisms underlying these poorer cognitive outcomes and the impact of weight-loss on cognition is required.

Lifestyle and Behavioral Management of Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a common condition with serious physiological and psychological health consequences. It affects women across their reproductive lifespan and is associated with pregnancy complications, including gestational diabetes, preeclampsia, and large gestational-age babies. PCOS is associated with excess weight gain, which, in turn, exacerbates the health burden of PCOS. Therefore, weight management, including a modest weight loss, maintenance of weight loss, prevention of weight gain, and prevention of excess gestational weight gain, is a first-line treatment for women with PCOS during and independent of pregnancy. Despite evidence-based guidelines, international position statements, and Cochrane reviews promoting lifestyle interventions for PCOS, the optimal complexity, intensity, and behavioral components of lifestyle interventions for women with PCOS are not well understood. The focus of this narrative review is the evidence supporting the use of behavioral strategies in weight management interventions for reproductive-aged women to apply to PCOS. Behavioral theories, behavior change strategies, and psychological correlates of weight management have been thoroughly explored in weight loss interventions in the general population, reproductive-aged women, and peri-natal women. This article uses this parallel body of research to inform suggestions regarding lifestyle interventions in women with PCOS. Outcomes of weight management programs in women with PCOS are likely to be improved with the inclusion of behavioral and psychological strategies, including goal setting, self-monitoring, cognitive restructuring, problem solving, and relapse prevention. Strategies targeting improved motivation, social support, and psychological well-being are also important. These can be applied to the clinical management of women with PCOS at different reproductive life stages.

Patient and Parent Perspectives of Adolescent Laparoscopic Adjustable Gastric Banding (LAGB).

BACKGROUND: Adolescent obesity is a significant global health challenge and severely obese adolescents commonly experience serious medical and psychosocial challenges. Consequently, severe adolescent obesity is increasingly being treated surgically. The limited available research examining the effectiveness of adolescent bariatric surgery focuses primarily on bio-medical outcomes. There is a need for a more comprehensive understanding of the behavioural, emotional and social factors which affect adolescents' and parents' experience of weight loss surgery. METHODS: Patient and parents' perspectives of adolescent LAGB were examined using a qualitative research methodology. Individual, semi-structured interviews were conducted with eight adolescent patients and five parents. Thematic analysis was used to identify key themes in the qualitative data. RESULTS: Patients and parents generally considered adolescent laparoscopic adjustable gastric banding (LAGB) to be a life-changing experience, resulting in physical and mental health benefits. Factors considered to facilitate weight loss following surgery included parental support and adherence to treatment guidelines. Many adolescents reported experiencing surgical weight loss stigma and challenging interpersonal outcomes after weight loss for which they felt unprepared. CONCLUSIONS: Patients and parents perceived LAGB positively. There are opportunities to improve both the experience and outcomes of adolescent LAGB through parental education and enhancements to surgical aftercare programmes.

Development of a Measure of Barriers to Laparoscopic Adjustable Gastric Banding (LAGB) Aftercare Attendance.

BACKGROUND: Regular aftercare attendance following laparoscopic adjustable gastric banding (LAGB) is associated with greater weight loss and fewer post-surgical complications. Despite high reported rates of attrition from LAGB aftercare, the reasons for non-attendance have not been thoroughly explored. The aim of the current study was to describe the scale development, explore the factor structure and evaluate the psychometric properties of the Gastric Banding Aftercare Attendance Questionnaire (GBAAQ)-a tool that measures barriers to aftercare attendance in LAGB patients. METHODS: One hundred and eighty-three participants completed the GBAAQ; 107 regular attendees and 76 non-attendees. RESULTS: A factor analysis identified four factors (Treatment Approach, Time Constraints, Stress and Pressures, Uncomfortable Participating) that demonstrated good known-groups validity and internal consistency. CONCLUSIONS: Although further validation is needed, the results of the present study provide preliminary support for the validity of the GBAAQ. Knowledge about the barriers to LAGB aftercare attendance can be used to identify those most at risk of non-attendance and can inform strategies aimed at reducing non-attendance.

The Effect of Weight Loss on Indigenous Australians with Diabetes: a study of Feasibility, Acceptability and Effectiveness of Laparoscopic Adjustable Gastric Banding.

BACKGROUND/OBJECTIVES: Diabetes and obesity are common and serious health challenges for indigenous people worldwide. The feasibility of achieving substantial weight loss, leading to remission of diabetes, was evaluated in a regional indigenous Australian community. SUBJECTS/METHODS: A prospective cohort study of 30 obese indigenous adults from the Rumbalara Aboriginal Co-operative in Central Victoria was performed. Inclusion criteria included aboriginality, BMI > 30 kg/m(2) and diabetes diagnosed within the last 10 years. Weight loss was achieved using laparoscopic adjustable gastric banding (LAGB). Participants were treated in their community and followed for 2 years. Outcomes were compared with those of non-indigenous Australians from an earlier randomized controlled trial (RCT) using a similar protocol. RESULTS: 30 participants (26 females, mean age 44.6 years; mean BMI 44.3) had LAGB at the regional hospital. Twenty-six participants completed diabetes assessment at 2 years follow-up. They showed diabetes remission (fasting blood glucose < 7.0 mmol/L and haemoglobin A1c (HbA1c) < 6.2 % while off all therapy except metformin) in 20 of the 26 and a mean weight loss (SD) of 26.0 (14) kilograms. Based on intention-to-treat, remission rate was 66 %. Quality of life improved. There was one early event and 12 late adverse events. The outcomes for weight loss and diabetes remission were not different from the LAGB group of the RCT. CONCLUSIONS: For obese indigenous people with diabetes, a regionalized model of care centred on the LAGB is an effective approach to a serious health problem. The model proved feasible and acceptable to the indigenous people. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN 12609000319279).

Quality of Life Outcomes of Bariatric Surgery: A Systematic Review.

Bariatric surgery is often pursued to improve quality of life (QOL). This paper systematically reviews the literature examining QOL following bariatric surgery. Fifteen controlled trials examined changes in QOL in obese (BMI > 30) adults (18­65 years) following bariatric surgery; seven compared bariatric surgery to non-surgical interventions and six compared different types of bariatric surgery. Bariatric surgery resulted in greater improvements in QOL than other obesity treatments. Significant differences in QOL improvements were found between different types of bariatric surgery. QOL improvements were more likely to occur within the first 2 years following surgery, with greater improvements in physical QOL than mental QOL. Bariatric surgery improves QOL. Future research is needed to investigate changes in QOL in different domains in the short- and long-term following bariatric surgery.

Psychometric Evaluation of Disordered Eating Measures in Bariatric Surgery Candidates.

INTRODUCTION: Assessment of disordered eating is common in bariatric surgery candidates, yet psychometric properties of disordered eating measures in this population are largely unknown. METHODS: Measures were completed by 405 adult bariatric surgery candidates at pre-surgical consultation. Fit of the original scale structures was tested using confirmatory factor analysis (CFA) and alternative factor solutions were generated using exploratory factor analysis (EFA). Reliability (internal consistency), construct validity (convergent and divergent) and criterion validity (with the EDE as criterion) were assessed. MATERIALS: The measures prioritised for evaluation are the following: Eating Disorder Examination Questionnaire (EDE-Q; n = 405), Three-Factor Eating Questionnaire (TFEQ; n = 405), Questionnaire of Eating and Weight Patterns Revised (QEWP-R; n = 204), Clinical Impairment Assessment (CIA; n = 204) and the Eating Disorder Examination clinical interview (EDE; n = 131). RESULTS: CFA revealed adequate fit for only the CIA in its current form (CFI = 0.925, RMSEA = 0.096). EFA produced revised scales with improved reliability for the EDE, EDE-Q and TFEQ. Reliability of revised subscales was improved (original scales α = 0.43-0.82; revised scales α = 0.67-0.93). Correlational analyses of the CIA and revised versions of remaining scales with measures of psychological wellbeing and impairment revealed adequate convergent validity. All measures differentiated an EDE-classified disordered eating group from a non-disordered eating group (criterion validity). Diagnostic concordance between the EDE, EDE-Q and QEWP-R was low, and identification of disordered eating behaviours was inconsistent across measures. CONCLUSIONS: Findings highlight the limitations of existing disordered eating questionnaires in bariatric surgery candidates. Results suggest revised assessments are required to overcome these limitations and ensure that measures informing clinical recommendations regarding patient care are reliable and valid.

Psychometric evaluation of disordered eating measures in bariatric surgery patients.

INTRODUCTION: Bariatric surgery is considered the most effective weight loss intervention for obese persons. However, accurate assessment is essential to identify disordered eating that may impair achievement of optimal post-surgical outcomes. Measures of disordered eating are yet to be thoroughly psychometrically evaluated in bariatric surgery patients, therefore their utility is unknown. METHODS: Participants were 108 adults who completed psychological measures approximately 12 months after bariatric surgery. The fit of the original scale structures was tested using Confirmatory Factor Analysis (CFA) and alternative factor solutions were generated using Exploratory Factor Analysis (EFA). Reliability (internal consistency) and construct validity (convergent and divergent) were also assessed. MATERIALS: Eating Disorder Examination Questionnaire (EDE-Q), Questionnaire of Eating and Weight Patterns Revised (QEWP-R), Three Factor Eating Questionnaire (TFEQ) and Clinical Impairment Assessment (CIA). RESULTS: CFA revealed none of the original disordered eating measures met adequate fit statistics. EFA produced revised scales with improved reliability (original scales α=0.47-0.94; revised scales α=0.76-0.98) and correlational analyses with measures of psychological wellbeing and impairment demonstrated adequate convergent validity. Reported prevalence of disordered eating behaviours differed between the EDE-Q and QEWP-R. CONCLUSIONS: Psychometric evaluation did not support the use of the commonly used disordered eating measures in bariatric patients in their original form. The revised version of the EDE-Q replicates findings from recent research in bariatric surgery candidates. The alternate structures of the CIA and TFEQ suggest differences in the manifestation of disordered eating following surgery. Results suggest that revised measures are required to overcome the limitations of existing measures.

Measurement of disordered eating in bariatric surgery candidates: a systematic review of the literature.

Symptoms of disordered eating are common among patients seeking bariatric surgery, and assessment of eating pathology is typical in pre-surgical evaluations. A systematic review was conducted to evaluate the definitions, diagnostic criteria and measures used to assess disordered eating in adults seeking bariatric surgery. The review identified 147 articles featuring 34 questionnaires and 45 interviews used in pre-surgical assessments. The Questionnaire on Eating and Weight Patterns Revised and the Structured Clinical Interview for DSM were the most frequently used questionnaire and interview respectively. Variations to pre-surgical diagnostic criteria included changes to the frequency and duration criteria for binge eating, and inconsistent use of disordered eating definitions (e.g., grazing). Results demonstrate a paucity of measures designed specifically for an obese sample, and only 24% of questionnaires and 4% of interviews used had any reported psychometric evaluation in bariatric surgery candidates. The psychometric data available suggest that interview assessments are critical for accurately identifying binge episodes and other diagnostic information, while self-report questionnaires may be valuable for providing additional information of clinical utility (e.g., severity of eating, shape and weight-related concerns). Findings highlight the need for consensus on disordered eating diagnostic criteria and psychometric evaluation of measures to determine whether existing measures provide a valid assessment of disordered eating in this population. Consistent diagnosis and the use of validated measures will facilitate accurate identification of disordered eating in the pre-surgical population to enable assessment of suitability for surgery and appropriate targeting of treatment for disordered eating to optimise treatment success.

Laparoscopic Adjustable Gastric Banding (LAGB) Aftercare Attendance and Attrition.

BACKGROUND: Regular aftercare attendance following laparoscopic adjustable gastric banding (LAGB) is associated with greater weight loss and fewer post-surgical complications. Despite high reported rates of attrition from LAGB aftercare, the reasons for non-attendance have not been previously explored. The present study aimed to explore patient-reported barriers to LAGB aftercare attendance, and the perceived helpfulness of potential attrition-reducing strategies, in both regular attendees and non-attendees of aftercare. METHODS: One hundred and seventy-nine participants (107 regular attendees and 72 non-attendees) completed a semi-structured questionnaire, assessing barriers to attrition (101 items) and usefulness of attrition prevention strategies (14 items). RESULTS: Findings indicate that both regular attendees and non-attendees experience multiple barriers to aftercare attendance. Non-attendees generally reported that barriers had a greater impact on their aftercare attendance. There was evidence for some level of acceptability for attrition-reducing strategies suggesting that LAGB patients may be receptive to such strategies. CONCLUSIONS: Current findings highlight the importance of assessing barriers to treatment in both attendees and non-attendees. It is proposed that addressing barriers that differentiate non-attendees from attendees may be most effective in reducing attrition from aftercare.

A cluster randomised controlled trial of a telephone-based intervention targeting the home food environment of preschoolers (The Healthy Habits Trial): the effect on parent fruit and vegetable consumption.

BACKGROUND: The home food environment is an important setting for the development of dietary patterns in childhood. Interventions that support parents to modify the home food environment for their children, however, may also improve parent diet. The purpose of this study was to assess the impact of a telephone-based intervention targeting the home food environment of preschool children on the fruit and vegetable consumption of parents. METHODS: In 2010, 394 parents of 3-5 year-old children from 30 preschools in the Hunter region of Australia were recruited to this cluster randomised controlled trial and were randomly assigned to an intervention or control group. Intervention group parents received four weekly 30-minute telephone calls and written resources. The scripted calls focused on; fruit and vegetable availability and accessibility, parental role-modelling, and supportive home food routines. Two items from the Australian National Nutrition Survey were used to assess the average number of serves of fruit and vegetables consumed each day by parents at baseline, and 2-, 6-, 12-, and 18-months later, using generalised estimating equations (adjusted for baseline values and clustering by preschool) and an intention-to-treat-approach. RESULTS: At each follow-up, vegetable consumption among intervention parents significantly exceeded that of controls. At 2-months the difference was 0.71 serves (95% CI: 0.58-0.85, p < 0.0001), and at 18-months the difference was 0.36 serves (95% CI: 0.10-0.61, p = 0.0067). Fruit consumption among intervention parents was found to significantly exceed consumption of control parents at the 2-,12- and 18-month follow-up, with the difference at 2-months being 0.26 serves (95% CI: 0.12-0.40, p = 0.0003), and 0.26 serves maintained at 18-months, (95% CI: 0.10-0.43, p = 0.0015). CONCLUSIONS: A four-contact telephone-based intervention that focuses on changing characteristics of preschoolers' home food environment can increase parents' fruit and vegetable consumption. (ANZCTR12609000820202).

Biopsychosocial outcomes of laparoscopic adjustable gastric banding in adolescents: a systematic review of the literature.

Adolescent obesity is a significant global health challenge. Severely obese adolescents commonly experience one or more serious medical comorbidities, such as type 2 diabetes mellitus and hypertension as well as psychosocial comorbidities such as depression, disordered eating behaviour, anxiety and low self-esteem. The aims of this review are to examine the literature on biopsychosocial (e.g. weight loss, medical comorbidities, mental health, and complications) outcomes of adolescent bariatric surgery and to identify areas where current data are deficient and a need for further research is indicated. A systematic review was conducted to examine the biopsychosocial outcomes of adolescent gastric banding. Eleven studies published before May 2013 examining outcomes of adolescent laparoscopic adjustable gastric banding (LAGB) surgery were identified. Available reported data indicate that LAGB surgery was effective in achieving significant weight loss. There is also evidence of the resolution of medical comorbidities; however, reporting of medical comorbidities assessment criteria is limited. Limited consideration was given to the psychosocial outcomes of LAGB surgery. The psychosocial outcomes of adolescent LAGB are not well researched. The current literature on adolescent LAGB is limited by a focus on weight loss and biomedical outcomes. There is currently little understanding of the behavioural, emotional or social factors that influence adolescents' experience of LAGB surgery. Further research is required to examine the specific psychosocial needs and experiences of adolescent LAGB patients, so appropriate treatment approaches may be developed to ensure optimal outcomes for adolescents from LAGB surgery.

Measurement of disordered eating following bariatric surgery: a systematic review of the literature.

Disordered eating is elevated in bariatric surgery patients and is a risk factor for poor surgical outcomes. A systematic review evaluated the definitions and measurement methods used to identify and assess disordered eating in patients following bariatric surgery. One hundred articles were identified featuring 35 questionnaires and 23 interviews. There were numerous variations to diagnostic criteria and amendments to measures to account for the post-surgical eating context. Only 20% of questionnaires and 4% of interviews had reported psychometric evaluation in post-surgery samples. Results highlight the need for a consistent definition of disordered eating and for current assessment measures to be (a) adapted to account for the altered gastrointestinal system in patients following surgery and (b) psychometrically evaluated in bariatric surgery patients.