Disordered eating following bariatric surgery: a review of measurement and conceptual considerations.

Eating disorders are associated with significant medical morbidity and mortality and serious psychological impairment. Individuals seeking bariatric surgery represent a high-risk group for evidencing disordered eating and eating disorders, with some patients experiencing the persistence or onset of disordered eating postsurgery. This review synthesizes the available literature on problematic or disordered eating in the bariatric field, followed by a review of measurement and conceptual considerations related to the use of eating disorder assessment tools within the bariatric population.

Substance Use, Gambling, Binge-Eating, and Hypersexuality Symptoms Among Patients Receiving Opioid Agonist Therapies.

BACKGROUND AND OBJECTIVES: Patients receiving opioid agonist therapies have high rates of psychiatric comorbidity. Some data suggest that comorbidity is associated with poorer treatment outcomes. The current study assessed predictors of multiple putative addictive behaviors among patients receiving opioid agonist therapies. METHODS: Adults (N = 176) recruited from an outpatient clinic providing opioid agonist therapy completed self-report measures of depression, anxiety, impulsivity, adverse childhood events, and the Recognizing Addictive Disorders (RAD) scale, which includes seven subscales assessing symptoms related to alcohol use, drug use, tobacco use, gambling, binge-eating, hypersexual behavior, and excessive video-gaming. Linear regression and hurdle models identified significant predictors of RAD subscales. Hurdle models included logistic regression estimation for the presence/absence of symptoms and negative binomial regression for estimation of the severity of symptoms. RESULTS: Most patients did not report significant symptoms beyond drug or tobacco use. However, 7% to 47% of participants reported some symptoms of other addictive behaviors (subscale score > 0). Higher impulsivity predicted the presence and/or increased severity of symptoms of drug use, gambling, binge-eating, and hypersexuality. Higher depression significantly predicted increased severity of drug use and binge-eating symptoms. Increased anxiety predicted lower severity of alcohol use and binge-eating and higher severity of smoking symptoms. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: A broader range of potentially addictive symptoms may be present among patients engaged in treatment for opioid use disorder. Few studies have assessed symptoms of binge-eating, hypersexuality, and excessive video-gaming among patients receiving opioid agonist therapy. This study contributes to preliminary findings and highlights important future directions. (Am J Addict 2021;00:00-00).

Psychometric properties of the eating loss of control scale among postbariatric patients.

BACKGROUND: Assessing the complexities of eating behaviors in patients who undergo bariatric surgery is challenging. The Eating Loss of Control Scale (ELOCS), a measure of loss-of-control (LOC) eating, has not yet been evaluated psychometrically among bariatric surgery patients. OBJECTIVE: This study presents a psychometric examination of the ELOCS in postoperative bariatric surgery patients. SETTING: Academic medical center in the United States. METHODS: One hundred seventy-one postbariatric treatment-seeking adults (82.5% female, 52.4% white) with LOC eating completed the ELOCS and measures assessing eating psychopathology and mood. Confirmatory factor analysis (CFA) was used to test fit for a 1-factor solution. Exploratory factor analysis (EFA) examined alternative factor structures. RESULTS: CFA revealed poor fit for a 1-factor structure (χ2 = 220.375, degrees of freedom = 135, P < .001, comparative fit index = .917, Tucker-Lewis index = .906, root mean square error of approximation = .067). EFA data suggested an alternative factor solution (χ2 = 157.76, degrees of freedom = 118, P = .009, comparative fit index = .965, Tucker-Lewis index = .955, root mean square error of approximation = .047). Factor 1 (α = .88) reflected behavioral aspects and factor 2 (α = .92) reflected cognitive/emotional aspects of LOC eating. Bivariate correlations with measures of eating and other psychopathology suggested good construct validity for factors. CONCLUSIONS: Findings suggest possible differences in the construct validity of the ELOCS among postbariatric patients. The 1-factor solution previously supported in clinical and nonclinical groups demonstrated poor fit. EFA revealed a possible alternative 2-factor solution that aligns with emerging literature, suggesting that LOC eating presents differently in postbariatric patients. Researchers interested in LOC eating among bariatric patients should consider use of the ELOCS and testing the proposed alternative factor structure.

Examining Sleep Quality Following Sleeve Gastrectomy Among Patients with Loss-of-Control Eating.

BACKGROUND: Sleep is associated with post-bariatric surgical outcomes; however, little is known about sleep in bariatric patients with loss-of-control (LOC) eating, a consistent predictor of poorer weight outcomes. This study examined sleep quality and clinical correlates in sleeve gastrectomy patients with LOC eating. METHODS: Participants (N = 145) were treatment-seeking post-operative sleeve gastrectomy patients with LOC eating. Eating-disorder features were assessed with the Eating Disorder Examination-Bariatric Surgery Version Interview (EDE-BSV) and participants completed established measures assessing sleep, health-related quality of life, perceived stress, depression, and night eating. RESULTS: 58.6% of participants were characterized with "poor" sleep. Poor sleep quality was significantly associated with greater eating-disorder psychopathology, physical and mental functioning, night eating, perceived stress, and less % excess weight loss (EWL); these findings remained significant after controlling for %EWL and race. Regression analyses, adjusting for correlated variables, revealed that sleep quality significantly predicted mental functioning. CONCLUSIONS: Poor sleep quality was common among post-operative sleeve gastrectomy patients with LOC eating. Sleep quality was significantly associated with eating-disorder psychopathology, less post-operative weight loss, and psychosocial and physical functioning problems. These findings suggest the importance of assessment and treatment of sleep problems following sleeve gastrectomy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02259322.

Examining physical activity and correlates in adults with healthy weight, overweight/obesity, or binge-eating disorder.

OBJECTIVE: To examine physical activity and correlates among three subgroups of adults: healthy weight without binge eating (HW), overweight/obesity without binge eating (OW/OB), and core features of binge-eating disorder (BED). METHOD: Participants (N = 2,384) completed an online survey with established measures of physical activity, eating psychopathology, and health. Most participants were White (82.6%) women (66.7%). Participants were categorized into three study groups: HW (n = 948; 39.9%), OW/OB (n = 1,308; 55.1%), and BED (n = 120; 5.1%). RESULTS: The BED group had the highest proportion of self-reported insufficiently active individuals (63.8%), followed by OW/OB (41.7%), and HW (29.2%). Associations between self-reported physical activity, eating pathology, and health were generally small in HW and OW/OB groups, whereas associations were moderate in the BED group. Self-reported weekly bouts of physical activity were more strongly, positively related to self-reported physical health for OW/OB than HW, and this effect was even more pronounced for BED compared with HW or OW/OB. DISCUSSION: This is the first study, to our knowledge, to demonstrate a stronger association between self-reported physical activity and physical health for individuals with BED compared with OW/OB alone. The high rate of physical inactivity and the strong association between physical activity and health among participants with BED suggest physical activity as an important treatment target for individuals with BED.

Contingency management interventions for tobacco and other substance use disorders in pregnancy.

Contingency management (CM) is an effective intervention for reducing use of licit and illicit substances in a variety of populations. Pregnant women are a vulnerable population with much to gain from effective interventions for substance use disorders, and for whom CM interventions may be especially well-suited. We reviewed the literature on CM interventions among pregnant women with tobacco and other substance use disorders with 3 aims: (a) describe the effectiveness of CM for reducing use of tobacco and other substances during pregnancy, (b) describe the effects of CM interventions on infant outcomes, and (c) identify needs for future research on CM in pregnancy. Our search strategy revealed 27 primary studies of CM in pregnancy. CM was effective in the majority of studies targeting nicotine abstinence, and results were mixed in studies targeting illicit substances. A variety of methodologies were used within the relatively small number of studies making it difficult to identify underlying mechanisms. Also, very few studies reported maternal and infant outcomes, and significant effects of CM were only apparent when secondary analyses pooled data from multiple studies. Furthermore, there is extremely limited data on the cost effectiveness of CM interventions in pregnancy. Future research should address these 3 areas to better determine the ultimate value of CM as an efficacious treatment for pregnant women with substance use disorders. (PsycINFO Database Record

A qualitative analysis of men's experiences of binge eating.

Binge eating disorder (BED) is characterized by recurrent overeating episodes, accompanied by loss of control (LOC), in the absence of compensatory behaviors. The literature supports that men overeat as often or more often than do women, but they are less likely to endorse LOC and other BED symptoms. Thus, rates of BED are lower among men. However, differences in prevalence rates may reflect gender bias in current conceptualizations of eating disorders and BED diagnostic criteria, not necessarily truly lower rates of disordered eating among men. The purpose of this study was to gather detailed information about how men experience overeating and related body image concerns, to identify common themes. The grounded theory approach was utilized to examine narratives from 11 overweight/obese male college students about their experiences with overeating, with results suggesting that overeating is consistent with male gender role, but LOC is not. Other overeating themes included mindless eating, emotional antecedents, negative consequences, unintentional dietary restriction, and social encouragement to overeat. Participants also reported dissatisfaction with their bodies, a desire for their bodies to be both muscular and thin, concerns related to their physical functioning and health, and a distinction between body image and self-worth. Collectively, these themes suggest further study to more fully explore the features and consequences of how disordered eating and body image concerns may manifest among men.