Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity.

IMPORTANCE: The variability and durability of improvements in pain and physical function following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) are not well described. OBJECTIVES: To report changes in pain and physical function in the first 3 years following bariatric surgery, and to identify factors associated with improvement. DESIGN, SETTING, AND PARTICIPANTS: The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study at 10 US hospitals. Adults with severe obesity undergoing bariatric surgery were recruited between February 2005 and February 2009. Research assessments were conducted prior to surgery and annually thereafter. Three-year follow-up through October 2012 is reported. EXPOSURES: Bariatric surgery as clinical care. MAIN OUTCOMES AND MEASURES: Primary outcomes were clinically meaningful presurgery to postsurgery improvements in pain and function using scores from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (ie, improvement of ≥5 points on the norm-based score [range, 0-100]) and 400-meter walk time (ie, improvement of ≥24 seconds) using established thresholds. The secondary outcome was clinically meaningful improvement using the Western Ontario McMaster Osteoarthritis Index (ie, improvement of ≥9.7 pain points and ≥9.3 function points on the transformed score [range, 0-100]). RESULTS: Of 2458 participants, 2221 completed baseline and follow-up assessments (1743 [78.5%] were women; median age was 47 years; median body mass index [BMI] was 45.9; 70.4% underwent RYGB; 25.0% underwent LAGB). At year 1, clinically meaningful improvements were shown in 57.6% (95% CI, 55.3%-59.9%) of participants for bodily pain, 76.5% (95% CI, 74.6%-78.5%) for physical function, and 59.5% (95% CI, 56.4%-62.7%) for walk time. Additionally, among participants with severe knee or disability (633), or hip pain or disability (500) at baseline, approximately three-fourths experienced joint-specific improvements in knee pain (77.1% [95% CI, 73.5%-80.7%]) and in hip function (79.2% [95% CI, 75.3%-83.1%]). Between year 1 and year 3, rates of improvement significantly decreased to 48.6% (95% CI, 46.0%-51.1%) for bodily pain and to 70.2% (95% CI, 67.8%-72.5%) for physical function, but improvement rates for walk time, knee and hip pain, and knee and hip function did not (P for all ≥.05). Younger age, male sex, higher income, lower BMI, and fewer depressive symptoms presurgery; no diabetes and no venous edema with ulcerations postsurgery (either no history or remission); and presurgery-to-postsurgery reductions in weight and depressive symptoms were associated with presurgery-to-postsurgery improvements in multiple outcomes at years 1, 2, and 3. CONCLUSIONS AND RELEVANCE: Among a cohort of participants with severe obesity undergoing bariatric surgery, a large percentage experienced improvement, compared with baseline, in pain, physical function, and walk time over 3 years, but the percentage with improvement in pain and physical function decreased between year 1 and year 3. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00465829.

Eating behavior and eating disorders in adults before bariatric surgery.

OBJECTIVE: To describe eating patterns, prevalence of problematic eating behaviors, and determine factors associated with binge eating disorder (BED), before bariatric surgery. METHOD: Before surgery, 2,266 participants (median age 46 years; 78.6% female; 86.9% white; median body mass index 45.9 kg/m(2) ) of the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study completed eating behavior survey items in the self-administered LABS-2 Behavior form. Other measures included the Alcohol Use Disorder Identification Test, the LABS-2 Psychiatric and Emotional Test Survey, the Beck Depression Inventory, the Interpersonal Support Evaluation List-12, the Short Form-36 Health Survey, and Impact of Weight Quality of Life-Lite Survey. RESULTS: The majority (92.1%) of participants reported eating dinner regularly, whereas just over half (54.0%) reported eating breakfast regularly. Half of the participants reported eating at least four meals/week at restaurants; two meals/week were fast food. Loss of control eating was reported by 43.4%, night eating syndrome by 17.7%; 15.7% satisfied criteria for binge eating disorder (BED), 2% for bulimia nervosa. Factors that independently increased the odds of BED were being a college graduate, eating more times per day, taking medication for psychiatric or emotional problems, and having symptoms of alcohol use disorder, lower self-esteem and greater depressive symptoms. DISCUSSION: Before undergoing bariatric surgery a substantial proportion of patients report problematic eating behaviors. Several factors associated with BED were identified, most suggesting other mental health problems, including higher levels of depressive symptomotology. The strengths of this study include the large sample size, the multi-center design and use of standardized assessment practices.

Loss of control over eating is associated with eating disorder psychopathology in a community sample of Latinas.

This study examined the association between loss of control and eating disorder psychopathology in a community sample of women of Hispanic origin. Seventy-seven monolingual Spanish-speaking Latinas recruited from the community were administered the Spanish language version of the Eating Disorders Examination (S-EDE). Latinas who reported regular (at least once weekly) loss of control-through objective bulimic episodes (OBEs) and/or subjective bulimic episodes (SBEs)-were compared with Latinas who did not report regular loss of control. Latinas who reported LOC did not differ significantly from Latinas who denied LOC in age, current body mass index, or highest adult weight. Latinas who reported LOC had significantly more frequent weight cycling and significantly higher scores on all S-EDE subscales. The findings suggest that regular loss of control over eating-regardless of the amount of food consumed-may be a marker for the presence of eating disorder psychopathology.

Smoking prevention and cessation interventions for cancer survivors.

OBJECTIVES: To provide a systematic review of smoking prevention and cessation interventions that have been conducted with cancer survivors. DATA SOURCES: Published research studies and government reports. CONCLUSION: Although few interventions have been developed to improve smoking prevention and cessation rates in cancer survivors, existing studies suggest that it is possible to decrease tobacco use in this high-risk population. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are in a unique position to build on the current literature to address cancer survivors' tobacco use as part of clinical care.

Self-Cleaning Nanocomposite Membranes with Phosphorene-Based Pore Fillers for Water Treatment.

Phosphorene is a two-dimensional material exfoliated from bulk phosphorus and it possesses a band gap. Specifically, relevant to the field of membrane science, the band gap of phosphorene provides it with potential photocatalytic properties, which could be explored in making reactive membranes that can self-clean. The goal of this study was to develop an innovative and robust membrane that is able to control and reverse fouling with minimal changes in membrane performance. To this end, for the first time, membranes have been embedded with phosphorene. Membrane modification was verified by the presence of phosphorus on membranes, along with changes in surface charge, average pore size, and hydrophobicity. After modification, phosphorene-modified membranes were used to filter methylene blue (MB) under intermittent ultraviolet light irradiation. Phosphorene-modified and unmodified membranes displayed similar rejection of MB; however, after reverse-flow filtration was performed to mimic pure water cleaning, the average recovered flux of phosphorene-modified membranes was four times higher than that of unmodified membranes. Furthermore, coverage of MB on phosphorene membranes after reverse-flow filtration was four times lower than that of unmodified membranes, which supports the hypothesis that phosphorene membranes operated under intermittent ultraviolet irradiation can become self-cleaning.

The Spanish language version of the Eating Disorder Examination Questionnaire: comparison with the Spanish language version of the eating disorder examination and test-retest reliability.

This study compared the Spanish language questionnaire (S-EDE-Q) and interview (S-EDE) versions of the Eating Disorder Examination and examined the short-term test-retest reliability of the questionnaire version. Seventy-seven monolingual Spanish-speaking Latina women recruited from the community completed the S-EDE-Q and were then administered the S-EDE by fully bilingual doctoral-level research clinicians. The same assessment was repeated after approximately one week (5-14 days). The S-EDE-Q and the S-EDE were significantly correlated on frequencies of binge eating and all four subscales. Mean differences in the frequency of binge eating and the Restraint subscale were not significant, but scores on the Eating Concern, Weight Concern, and Shape Concern subscales differed significantly, with the S-EDE-Q yielding higher scores. Test-retest reliability for the S-EDE-Q was modest for binge eating but was excellent for the subscales (Spearman rho ranged 0.71-0.81), albeit somewhat variable for the individual items. Overall, the acceptable convergence between the S-EDE-Q and the S-EDE for many features of eating disorders and the good short-term test-retest findings provide preliminary support for the use of the S-EDE-Q. These findings, derived using a non-clinical sample of monolingual Spanish-speaking Latina women, require replication and extension. Evaluation with a clinical sample is necessary to further establish the reliability of the S-EDE-Q with an eating disordered group.

Emotional Appeals in HIV Prevention Campaigns: Unintended Stigma Effects.

OBJECTIVES: The purpose of this study was to determine whether HIV/AIDS public service announcements (PSAs) that use emotional appeals have unintended effects of creating stigmatizing attitudes in their viewers. METHODS: We analyzed data for 240 respondents located in the United States who were recruited online. Respondents were randomly assigned to one of 3 conditions, where they viewed a PSA with hope appeals, fear appeals, or non-emotional appeals. Respondents then answered a series of questions about their attitudes about HIV/AIDS; testing behavior; engagement with HIV/AIDS-related people, organizations, and issues; and HIV/AIDS knowledge. We then performed MANOVA analyses and Pearson correlations. RESULTS: There were no significant differences in stigmatizing attitudes and behavior across the 3 conditions. However, once the data were split by sex, men exposed to the hope condition had significantly higher stigmatizing attitudes towards people living with HIV/AIDS than men in the other 2 conditions. CONCLUSIONS: This result was unexpected and suggests that further research needs to be conducted with a more robust sample size to account for any moderating influences that might explain why a hopeful message that communicates togetherness would have a negative attitudinal impact on male viewers.

Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates.

This study compared two self-report methods for assessing binge eating in severely obese bariatric surgery candidates. Participants were 249 gastric bypass candidates who completed the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and the Eating Disorder Examination-Questionnaire (EDE-Q) prior to surgery. Participants were classified by binge eating status (i.e., no or recurrent binge eating) with each of the measures. The degree of agreement was examined, as well as the relationship between binge eating and measures of convergent validity. The two measures identified a similar number of patients with recurrent binge eating (i.e., at least 1 binge/week); however, overlap was modest (kappa=.26). Agreement on twice weekly binge eating was poor (kappa=.05). The QEWP-R and EDE-Q both identified clinically meaningful groups of binge eaters. The EDE-Q appeared to differentiate between non/infrequent bingers and recurrent bingers better than the QEWP-R, based on measures of convergent validity. In addition, the EDE-Q demonstrated an advantage because it identified binge eaters with elevated weight and shape overconcern. Using the self-report measures concurrently did not improve identification of binge eating in this study. More work is needed to determine the construct validity and clinical utility of these measures with gastric bypass patients.

Inter-rater and test-retest reliability of the Spanish language version of the eating disorder examination interview: clinical and research implications.

BACKGROUND: To examine the inter-rater and test-retest reliability of the Spanish Language version of the Eating Disorder Examination (S-EDE) in monolingual Latina women. Established measures are needed to study Latino groups, and short-term test-retest reliability findings are needed to provide context for clinical treatment and outcome studies. METHODS: Inter-rater reliability (IRR) and short-term (5-14 days) test-retest reliability (TRR) of the S-EDE (using intraclass correlation coefficients [ICCs]) were examined in a non-clinical study group of 60 monolingual Latina women. RESULTS: IRR was excellent for objective bulimic episodes (ICC = 0.99) but was modest for subjective bulimic episodes (ICC = 0.55). TRR was good for objective bulimic episodes (ICC = 0.79) but was unacceptable for subjective bulimic episodes (ICC = 0.22). IRR and TRR kappa coefficients (0.56 and 0.37, respectively) for identifying the presence or absence of objective bulimic episodes were modest. For the S-EDE subscales, both IRR (ICCs ranged from 0.80 to 0.98) and TRR (ICCs ranged from 0.67 to 0.90) were good to excellent. CONCLUSIONS: These findings provide preliminary support for the reliability of the S-EDE for use with Latina women. The constructs of eating disorder psychopathology measured by the S-EDE subscales (restraint, eating concern, weight concern, and shape concern) and the core feature of binge eating (objective bulimic episodes) show high short-term consistency. The results for subjective bulimic episodes are consistent with previous studies that have questioned whether these eating behaviors are reliable indicators of eating disorders. Additional evaluation is needed with clinical groups.

Addictive disorders after Roux-en-Y gastric bypass.

BACKGROUND: Recent literature suggests that some patients may develop addictive disorders after bariatric surgery, in particular after Roux-en-Y gastric bypass (RYGB). These may include traditional addictions and so called "behavioral addictions," although prevalence data on the latter have not been published. The objective of this study was to establish the prevalence of addictive behaviors in adults after RYGB. METHODS: Participants from a large observational study of bariatric surgery who had undergone RYGB were recruited to complete additional measures. Of 241 consented participants, 201 provided data (i.e., Structured Clinical Interview for DSM-IV Axis I [SCID], additional Impulsive Control Disorder Modules, and various self-report measures, including the Alcohol Use Disorder Identification Test [AUDIT]) to assess status before surgery and in the first 3 postoperative years. RESULTS: Based on the SCID, 16 (8.0%) developed alcohol use disorder [AUD] within 3 years post-RYGB, 7 (43.8%) of whom had no history of AUD. When both the SCID and AUDIT were used to identify AUD, the corresponding numbers/percentages were 32 (18.4%) and 13 (40.6%). Data on other behavioral addictive disorders indicated 19 (9.5%) had a postsurgery disorder, 6 (31.6%) of whom had no history. CONCLUSION: These data add to a growing literature suggesting there is a substantial risk for the development of AUD after bariatric surgery. Understanding the risk for nondrug-related addictive disorders requires more data from larger studies before clear conclusions can be drawn.

Associations between physical activity and mental health among bariatric surgical candidates.

OBJECTIVE: To examine associations between physical activity (PA) and mental health among adults undergoing bariatric surgery. METHODS: Cross sectional analysis was conducted on pre-operative data of 850 adults with ≥class 2 obesity. PA was measured with a step activity monitor; mean daily steps, active minutes, and high-cadence minutes (proxy for moderate-vigorous intensity PA) were determined. Mental health functioning, depressive symptoms and treatment for depression or anxiety were measured with the medical outcomes study 36-item short form, Beck depression inventory, and a study-specific questionnaire, respectively. Logistic regression analyses tested associations between PA and mental health indicators, controlling for potential confounders. Receiver operative characteristic analysis determined PA thresholds that best differentiated odds of each mental health indicator. RESULTS: Each PA parameter was significantly (p<.05) associated with a decreased odds of depressive symptoms and/or treatment for depression or anxiety, but not with impaired mental health functioning. After controlling for sociodemographics and physical health, only associations with treatment for depression and anxiety remained statistically significant. PA thresholds that best differentiated those who had vs. had not recently received treatment for depression or anxiety were <191 active minutes/day, <4750 steps/day, and <8 high-cadence minutes/day. Utilizing high-cadence minutes, compared to active minutes or steps, yielded the highest classification accuracy. CONCLUSION: Adults undergoing bariatric surgery who meet relatively low thresholds of PA (e.g., ≥8 high-cadence minutes/day, representative of approximately 1h/week of moderate-vigorous intensity PA) are less likely to have recently received treatment for depression or anxiety compared to less active counterparts.

Walking capacity of bariatric surgery candidates.

BACKGROUND: This study characterizes the walking limitations of bariatric surgery candidates by age and body mass index (BMI) and determines factors independently associated with walking capacity. The setting was multi-institutional at research university hospitals in the United States. METHODS: Participants of the Longitudinal Assessment of Bariatric Surgery study (n=2458; age 18-78 yr, BMI 33-94 kg/m(2)) attended a preoperative research visit. Their walking capacity was measured by self-report and the 400 m Long Distance Corridor Walk (LDCW). RESULTS: Almost two thirds (64%) of subjects reported limitations with walking several blocks, 48% had an objectively defined mobility deficit, and 16% reported at least some walking aid use. In multivariate analysis, BMI, older age, lower income, and greater bodily pain were independently associated (P < .05) with walking aid use, physical discomfort during the LDCW, an inability to complete the LDCW, and a slower time to complete the LDCW. Female gender, Hispanic ethnicity (but not race), greater heart rate at rest, a history of smoking, several co-morbidities (history of stroke, ischemic heart disease, diabetes, asthma, sleep apnea, venous edema with ulcerations), and depressive symptoms were also independently related (P < .05) to at least one measure of reduced walking capacity. CONCLUSIONS: Walking limitations are common in bariatric surgery candidates, even among the least severely obese and youngest patients. Physical activity counseling must be tailored to individuals' abilities. Although several factors identified in the present study (eg, BMI, age, pain, co-morbidities) should be considered, directly assessing the patient's walking capacity will facilitate appropriate goal setting.

Psychopathology before surgery in the longitudinal assessment of bariatric surgery-3 (LABS-3) psychosocial study.

BACKGROUND: Current and previous psychopathology in bariatric surgery candidates is believed to be common. Accurate prevalence estimates, however, are difficult to obtain given that bariatric surgery candidates often wish to appear psychiatrically healthy when undergoing psychiatric evaluation for approval for surgery. Also, structured diagnostic assessments have been infrequently used. METHODS: The present report concerned 199 patients enrolled in the longitudinal assessment of bariatric surgery study, who also participated in the longitudinal assessment of bariatric surgery-3 psychopathology substudy. The setting was 3 university hospitals, 1 private not-for-profit research institute, and 1 community hospital. All the patients were interviewed independently of the usual preoperative psychosocial evaluation process. The patients were explicitly informed that the data would not be shared with the surgical team unless certain high-risk behaviors, such as suicidality, that could lead to adverse perioperative outcomes were reported. RESULTS: Most of the patients were women (82.9%) and white (nonwhite 7.6%, Hispanic 5.0%). The median age was 46.0 years, and the median body mass index was 44.9 kg/m2. Of the 199 patients, 33.7% had ≥1 current Axis I disorder, and 68.8% had ≥1 lifetime Axis I disorder. Also, 38.7% had a lifetime history of a major depressive disorder, and 33.2% had a lifetime diagnosis of alcohol abuse or dependence. All these rates were much greater than the population-based prevalence rates obtained for this age group in the National Comorbidity Survey-Replication Study. Also, 13.1% had a lifetime diagnosis and 10.1% had a current diagnosis of a binge eating disorder. CONCLUSION: The current and lifetime rates of psychopathology are high in bariatric surgery candidates, and the lifetime rates of affective disorder and alcohol use disorders are particularly prominent. Finally, binge eating disorder is present in approximately 1 in 10 bariatric surgery candidates.

Bariatric surgery: a review of procedures and outcomes.

The prevalence of obesity has increased in recent decades, and obesity is now one of the leading public health concerns on a worldwide scale. There is accumulating agreement that bariatric surgery is currently the most efficacious and enduring treatment for clinically severe obesity, and as a result, the number of bariatric surgery procedures performed has risen dramatically in recent years. This review will summarize historic and contemporary bariatric surgical techniques, including gastric bypass (open and laparoscopic), laparoscopic adjustable gastric banding, and biliopancreatic diversion (with or without duodenal switch). Data are presented on bariatric surgery outcomes, focusing on weight loss and obesity-related comorbidities. We also review possible complications from surgery. Bariatric surgery patients undergo many dramatic lifestyle changes, and comprehensive presurgical screening conducted by a multidisciplinary team is important to prepare patients for the numerous changes necessary for successful outcome. In addition, comprehensive presurgical screening can aid the treatment team in identifying patients who would benefit from additional services prior to or following surgery. Further research focused on presurgical variables that predict outcome-especially the longer term outcome-of bariatric surgery is needed. At present, approximately 1% of eligible individuals with morbid obesity receive bariatric surgery. In addition, there appears to be inequity in access to weight loss surgery. Given the accumulating evidence that bariatric surgery is efficacious in producing significant and durable weight loss, improving obesity-related comorbidities, and extending survival, the U.S. healthcare system should examine ways to improve access to this treatment for obesity.

The utility of the NEO-PI-R validity scales to detect response distortion: a comparison with the MMPI-2.

In this psychometric study, we compared the recently developed Validity Scales from the Revised NEO Personality Inventory (NEO PI-R; Costa & McCrae, 1992b) with the MMPI-2 (Butcher, Dahstrom, Graham, Tellegen, & Kaemmer, 1989) Validity Scales. We collected data from clients (n = 74) who completed comprehensive psychological evaluations at a university-based outpatient mental health clinic. Correlations between the Validity Scales of the NEO-PI-R and MMPI-2 were significant and in the expected directions. The relationships provide support for convergent and discriminant validity of the NEO-PI-R Validity Scales. The percent agreement of invalid responding on the two measures was high, although the diagnostic agreement was modest (kappa = .22-.33). Finally, clients who responded in an invalid manner on the NEO-PI-R Validity Scales produced significantly different clinical profiles on the NEO-PI-R and MMPI-2 than clients with valid protocols. These results provide additional support for the clinical utility of the NEO-PI-R Validity Scales as indicators of response bias.