The role of anxiety and depression in understanding the relationship between coping and weight loss 24 months after bariatric surgery.

BACKGROUND: The relationship between coping (i.e., how a person deals with stress) and weight loss after bariatric surgery is relatively inconsistent. Anxiety and depression may contribute to the lack of consistent findings in this area. It is possible that coping, including interpersonal, intrapersonal, and maladaptive coping, predicts weight loss among individuals with higher levels of anxiety or depression but not among those with lower levels of anxiety and depression. OBJECTIVE: The aim of this study was to examine the moderating role of anxiety and depression on the association between coping and weight loss in patients 24 months after bariatric surgery. SETTING: University Hospital, West Virginia, U.S.A. METHODS: Participants included 841 patients who underwent bariatric surgery, 396 of whom had 24-month weight loss data (mean age, 43.21 yr [SD, ±11.40 yr]). We ran 3 moderation models to test whether the relationship between various coping styles and postoperative weight loss was moderated by anxiety and depression symptoms. RESULTS: There was a statistically significant interaction between anxiety and depression on the association between interpersonal coping and percent excess weight loss (%EWL). Anxiety and depression also moderated the relationship between maladaptive coping and %EWL. Anxiety and depression did not moderate the association between intrapersonal coping and %EWL, but intrapersonal coping positively predicted %EWL at 24 months after bariatric surgery. CONCLUSIONS: Maladaptive coping predicted less weight loss for patients with high levels of anxiety and/or depression. Interpersonal coping predicted more weight loss for patients with low levels of anxiety and/or depression. Clinicians should take patient levels of anxiety and depression into account when making recommendations to promote weight loss among patients pursuing bariatric surgery.

Psychometric Properties of the Brief Coping Orientation to Problems Experienced Inventory Among Patients Pursuing Bariatric Surgery.

The Brief COPE Inventory is a widely used scale that measures how a person copes with a specific situation. Despite its widespread use, the factor structure of this scale is somewhat unclear and has not been tested among patients pursuing bariatric surgery. We tested competing factor analytic models of the Brief COPE Inventory among patients pursuing bariatric surgery to identify the best fitting factor model for use in pre-surgical psychological evaluations. We also examined reliability and validity of the subscales from the best fitting model of coping. Participants included 1984 patients pursuing bariatric surgery (Mage = 42.58 years, SD = 10.89, 81.39% female). The best fitting model of the Brief COPE Inventory among patients pursuing bariatric surgery was a three-factor model including interpersonal, intrapersonal, and maladaptive coping strategies. These results were replicated in a subset of the original sample and demonstrated appropriate convergent and discriminant validity with several key outcomes. The Brief COPE Inventory can be conceptualized as a multidimensional scale assessing interpersonal coping, intrapersonal coping, and maladaptive coping among patients pursuing bariatric surgery. Future work should examine how these subscales are related to surgical outcomes among people receiving treatment for excess weight.

Intrapersonal coping predicts greater weight loss 24 months after bariatric surgery.

PURPOSE: Coping is related to numerous health outcomes, including weight loss. However, the relationship between coping and weight loss after bariatric surgery remains unclear. OBJECTIVES: The first objective of this study was to examine cross-sectional relationships between coping, anxiety, and depression. The second objective was to determine whether baseline anxiety and depression predicted weight loss 24 months after bariatric surgery. The final objective was to identify which aspects of coping are related to weight loss 24 months after bariatric surgery. MATERIALS AND METHODS: Participants included 1203 adults who completed a pre-surgical bariatric evaluation, including 841 patients who underwent bariatric surgery, 396 of whom had 24-month weight data. Psychological variables were collected during a pre-surgical psychological evaluation. Weight-related variables were obtained through patients' electronic medical records 24 months after surgery. RESULTS: Baseline intrapersonal coping (e.g., problem-solving, acceptance) predicted both weight loss variables at 24 months after surgery. However, baseline interpersonal and maladaptive coping were not related to weight loss. Baseline anxiety and depression similarly did not predict weight loss after surgery. CONCLUSION: Use of intrapersonal coping strategies at baseline predicted weight loss 24 months after bariatric surgery. Clinicians should assess and bolster these self-reliant coping strategies prior to surgery to improve patient outcomes.

Addressing Adverse Childhood Experiences and Psychological Symptoms Among Bariatric Patients.

Adverse Childhood Experiences (ACEs) have been shown to be prevalent in bariatric surgery candidates with comorbid psychological symptoms. While bariatric patients who have mental illness or a history of ACEs are less likely to lose weight, presence of a support system has been reported to mitigate ACEs' effects and to maintain long-term weight loss. The current study aims to examine the association between ACEs and psychological symptoms and the effect of potential protective factors on the association among bariatric patients. The study included a total of 199 subjects seeking bariatric surgery who completed a psychological evaluation including ACEs, psychological symptoms, and presence of support system as part of the presurgical multidisciplinary weight management consultations at a large university hospital. Multivariate regression models were used to examine the association between ACEs and psychological symptoms and potential effect of support system on the association. The study found that there is a significant association between ACEs and psychological symptoms. The study also revealed that patients who reported having a childhood supportive person were significantly associated with a lower BMI, while those who reported having adulthood supportive person showed significantly less symptoms of depression, anxiety, and binge eating. The findings have significant implications that addressing ACEs in preoperative surgical process in relation to psychological conditions and therapeutic interventions within their close environmental system will be beneficial for patients to achieve optimal surgical outcomes.

Cardiovascular Outcomes and Mortality After Bariatric Surgery in Patients With Nonalcoholic Fatty Liver Disease and Obesity.

Importance: Bariatric surgery (BS) is associated with significantly reduced incidence of cardiovascular diseases and mortality in patients with obesity. However, whether BS can decrease major adverse cardiovascular events in patients with nonalcoholic fatty liver disease (NAFLD) remains poorly understood. Objective: To investigate the association of BS with the incidence of adverse cardiovascular events and all-cause mortality in patients with NAFLD and obesity. Design, Setting, and Participants: This was a large, population-based, retrospective cohort using data from the TriNetX platform. Adult patients with a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 35 or greater and NAFLD (without cirrhosis) who underwent BS between January 1, 2005, and December 31, 2021, were included. Patients in the BS group were matched with patients who did not undergo surgery (non-BS group) according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. Patient follow-up ended on August 31, 2022, and data were analyzed in September 2022. Exposures: Bariatric surgery vs nonsurgical care. Main Outcomes and Measures: The primary outcomes were defined as the first incidence of new-onset heart failure (HF), composite cardiovascular events (unstable angina, myocardial infarction, or revascularization, including percutaneous coronary intervention or coronary artery bypass graft), composite cerebrovascular disease (ischemic or hemorrhagic stroke, cerebral infarction, transient ischemic attack, carotid intervention, or surgery), and a composite of coronary artery procedures or surgeries (coronary stenting, percutaneous coronary intervention, or coronary artery bypass). Cox proportional hazards models were used to estimate hazard ratios (HRs). Results: Of 152 394 eligible adults, 4693 individuals underwent BS; 4687 patients who underwent BS (mean [SD] age, 44.8 [11.6] years; 3822 [81.5%] female) were matched with 4687 individuals (mean [SD] age, 44.7 [13.2] years; 3883 [82.8%] years) who did not undergo BS. The BS group had significantly lower risk of new-onset of HF (HR, 0.60; 95% CI, 0.51-0.70), cardiovascular events (HR, 0.53; 95% CI, 0.44-0.65), cerebrovascular events (HR, 0.59; 95% CI, 0.51-0.69), and coronary artery interventions (HR, 0.47; 95% CI, 0.35-0.63) compared with the non-BS group. Similarly, all-cause mortality was substantially lower in the BS group (HR, 0.56; 95% CI, 0.42-0.74). These outcomes were consistent at follow-up duration of 1, 3, 5, and 7 years. Conclusions and Relevance: These findings suggest that BS was significantly associated with lower risk of major adverse cardiovascular events and all-cause mortality in patients with NAFLD and obesity.

How Soon Do Depression and Anxiety Symptoms Improve after Bariatric Surgery?

Depression and anxiety are prevalent among bariatric surgery candidates, yet little is known about the course of symptoms after surgery. This study aimed to identify how soon changes in depression and anxiety occur after surgery. A retrospective review of patients treated at a university hospital was conducted. Participants attended a presurgical psychological evaluation, completed surgery, and attended follow-up visits with bariatric medical providers (2 weeks, 6 weeks, 3 months, and 6 months postoperatively). Depression and anxiety symptoms were assessed at all time points by the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety. Generalized estimating equations models with repeated measures by person over time were used to examine change in depression and anxiety symptoms across time. Among 27 patients, anxiety (incident rate ratio (IRR) = 0.81, p = 0.04) and depression (IRR = 0.78, p = 0.05) significantly improved both 6 weeks and 3-6 months after bariatric surgery, after controlling for education, marital status, surgery type, age, and baseline body mass index. This is the first known study to show faster improvement in anxiety compared to depression after bariatric surgery. Understanding reductions in anxiety and depression symptoms may be important for postoperative care and timing of weight maintenance interventions.

Preoperative Weight Loss as a Predictor of Short and Midterm Postoperative Weight Loss in Patients Undergoing Bariatric Surgery.

Objective: To examine if preoperative weight loss correlates to postoperative weight loss 2 and 3 years after surgery. Methods: A review was conducted of bariatric surgery patients who underwent either gastric bypass or sleeve gastrectomy during 2015-2018 and had 3-year follow-up data. Demographic and outcome data were collected. A best-fit regression model for weight loss was constructed. Results: Eight hundred fifty-nine patients underwent surgery during the selected period, of which 199 patients (23%) were analyzed. Eighty-two percent of patients had gastric bypass and 82% were female. Preoperative percent excess weight loss (%EWL) was not significantly associated with 2- and 3-year postoperative %EWL (p = 0.18). Patients demonstrated significant weight regain at 3 years postoperatively versus 1 year (p < 0.01). Higher preoperative weight loss was associated with lower %EWL 3 years postoperatively versus 1 year (p = 0.04). Postoperative %EWL had a significant negative association with higher preoperative weight, diabetes, baseline use of a mobility device, and sleeve gastrectomy. Conclusions: In a cohort of bariatric surgery patients, there was no statistically significant association between preoperative and midterm postoperative %EWL. Postoperative %EWL was negatively associated with several patient-specific factors and increasing time since operation.

Preoperative and early adjuvant weight loss medications in bariatric surgery patients with body mass index over 60 or suboptimal initial response to surgery.

BACKGROUND: Few studies have examined the adjuvant use of antiobesity medications with surgery, especially in the pre- and early postoperative periods. OBJECTIVE: Evaluate the impact of adjuvant pharmacotherapy on bariatric surgery outcomes. SETTING: University hospital, United States. METHODS: A retrospective chart review of patients receiving adjuvant pharmacotherapy for obesity treatment and bariatric surgery. Patients received pharmacotherapy either preoperatively if their body mass index was >60, or in the first or second postoperative years for suboptimal weight loss. Outcome measures included percentage of total body weight loss as well as comparison with the expected weight loss curve as determined by the Metabolic and Bariatric Surgery Risk/Benefit Calculator. RESULTS: A total of 98 patients were included in the study, with 93 (94.9%) undergoing sleeve gastrectomy and 5 (5.1%) undergoing Roux-en-Y gastric bypass surgery. During the study period, patients were prescribed phentermine and/or topiramate. At postoperative year 1, patients who received pharmacotherapy preoperatively lost 31.3% of their total body weight (TBW) compared with 25.3% TBW for patients with suboptimal weight loss who received medication in the first postoperative year, and 20.8% TBW for patients who did not receive any antiobesity medication in the first postoperative year. Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) curve for comparison, patients receiving medication preoperatively weighed 2.4% less than expected, whereas patients receiving medication during the first postoperative year weighed 4.8% higher than expected. CONCLUSION: For patients having bariatric surgery who fall below the expected MBSAQIP weight loss curve, early initiation of antiobesity medications can improve the weight loss, with preoperative pharmacotherapy having the greatest effect.

Binge eating in patients pursuing bariatric surgery: understanding relationships with food insecurity and adverse childhood experiences.

BACKGROUND: Positive relationships exist between adult food insecurity and binge eating, and between adverse childhood experiences and binge eating. However, the nature of these relationships remains to be determined. OBJECTIVES: The current study sought to examine the association between binge eating and childhood abuse and/or neglect and household dysfunction and to explore whether the strength of the relationship between adverse childhood experiences and binge eating differs across levels of food insecurity in patients seeking bariatric surgery. SETTING: University Hospital in the Appalachian region of United States. METHODS: A total of 366 adults seeking bariatric surgery completed validated questionnaires as a component of a routine psychological evaluation prior to surgery. RESULTS: Only childhood experiences of abuse and/or neglect were positively related to adult binge eating, r(363) = .13, P = .011. Food insecurity moderated the relationship between adverse childhood experiences and binge eating, F(4, 358) = 242.98, P < .001, such that the relationship was stronger for individuals who endorsed the presence of both food insecurity and adverse childhood experiences (M = 15.90; standard deviation [SD] = 8.38), relative to individuals who endorsed the absence of both food insecurity and adverse childhood experiences (M = 11.19; SD = 7.91; Tukey P = .005; d = .58). CONCLUSIONS: Food insecurity strengthens the relationship between adverse childhood experiences and adult binge eating. Results suggest that healthcare providers should include assessments of both adverse childhood experiences and food insecurity to identify patients who may be at risk for disordered eating prior to surgery, as these individuals may require additional interventions to address binge eating and related factors.

The Roles of Depression and Binge Eating in the Relationship Between Adverse Childhood Experiences (ACEs) and Obesity.

OBJECTIVE: Research has demonstrated that adverse childhood experiences (ACEs) were related to elevated lifetime risk of developing obesity, but the underlying mechanisms between ACEs and development of obesity are yet to be fully elucidated. The current study aims to extend exiting evidence on underlying mechanisms between ACEs and development of obesity by examining whether depressive symptom and binge eating symptom have independently significant mediating effects on the association. METHODS: The study used data from a total of 473 patients seeking bariatric surgery who completed psychological evaluation including ACEs, depressive symptom, and binge eating scale as a part of presurgical multidisciplinary weight management consultations. Mediation analyses were conducted using the PROCESS macro for SPSS to examine the research objective. RESULTS: The study found that depressive symptom uniquely mediated the relationship between ACEs and obesity, but binge eating symptom did not significantly mediate the relationship independently of depression. CONCLUSIONS: The unique role of depression in relation to childhood trauma in this study argues for more focus on a mental health intervention with bariatric patients during the preoperative period. Addressing ACEs for bariatric patients who present psychiatric symptoms during preoperative process could have potential benefits to patient care.

Anxiety predicts reduced weight loss 30 months after bariatric surgery.

BACKGROUND: Though psychosocial factors are routinely examined in presurgical psychological evaluations, the predictive value of some psychosocial factors on postsurgical weight loss is still relatively unknown. Additional research examining the predictive value of psychological constructs preoperatively and long-term weight outcomes is needed to enhance the clinical utility of the presurgical psychological evaluations. OBJECTIVE: This study aimed to examine psychosocial factors as predictors of weight outcomes 30 months after bariatric surgery. SETTING: University hospital in the Appalachian region of United States. METHODS: Participants included 196 adults who underwent bariatric surgery. Psychosocial data were collected as part of a routine psychological evaluation prior to bariatric surgery. Objective weight was obtained through patients' medical records at 12, 24, and 30 months after surgery. RESULTS: Linear mixed models was used to examine presurgical psychosocial factors predicting postsurgical weight loss (n at 12 months = 153, n at 24 months = 130, n at 30 months = 92). Anxiety had a significant interaction effect with time (estimate = -.01, P = .013), indicating that higher anxiety was associated with less weight loss over time. Those with severe anxiety before surgery lost the most weight 12 months after surgery but also regained the most weight 30 months after surgery. Other predictors were not statistically significant. CONCLUSION: Anxiety assessed prior to surgery predicted reduced weight loss 30 months after bariatric surgery, after controlling for surgery type, baseline weight, sex, and age. Results highlight the importance of evaluation and treatment of anxiety in presurgical bariatric candidates.

Metabolic bone disease and fracture risk after gastric bypass and sleeve gastrectomy: comparative analysis of a multi-institutional research network.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most performed bariatric procedures. Multiple studies have investigated the metabolic bone complications after bariatric surgery, but there is a paucity of data comparing bone health after RYGB and SG. OBJECTIVES: To compare the rates of major fractures and osteoporosis after Roux-en-Y gastric bypass and sleeve gastrectomy. SETTING: Data from TriNetX multi-institutional research network that includes data from multiple health care organizations in the USA was analyzed at West Virginia University. METHODS: We conducted a retrospective cohort study using TriNetX, a federated multi-institutional research network. We identified patients who underwent RYGB or SG. Primary outcome was the rate of major fractures at 3 years after the procedure. Other outcomes included the rate of spine fracture, femur fracture, osteoporosis, and vitamin D deficiency at follow-up. RESULTS: In unmatched analysis, patients with SG were less likely to have major fractures or an osteoporosis diagnosis than RYGB patients at 3 years after the procedure (P < .05). After propensity-score matching, similar results were noted; patients with SG were less likely to have major fractures than RYGB patients at 3 years after procedure (2.85% versus 3.66%, risk ratio [RR]: .78, 95% confidence interval [CI]: .71-.85), and a lower rate of osteoporosis diagnosis was noted in the SG group. High rates of vitamin D deficiency were noted in both cohorts. The incidence of spine fractures was significantly lower in the SG group than in the RYGB group (.76% versus 1.18%, RR: .65, 95% CI: .54-.77). Similarly, the incidence of femur fracture was significantly lower after SG (RR: .62, 95% CI: .44-.88). Female sex, higher age, smoking history, and diabetes were independently associated with osteoporosis diagnosis during follow-up (all P values <.05). CONCLUSION: Our analyses showed that RYGB is associated with a higher risk of osteoporosis, vitamin D deficiency, and osteoporotic fractures. Thus, in patients with a higher baseline osteoporotic risk, SG may be preferred option; however, further studies are needed.

Hunger mediates the relationship between food insecurity and binge eating among bariatric surgery candidates.

BACKGROUND: The food insecurity-obesity paradox suggests that people lacking access to adequately nutritious foods are more susceptible to disordered eating. However, the mechanisms underlying the relationship between food insecurity and binge eating are not well understood. OBJECTIVES: This study sought to assess the role of eating behaviors (i.e., cognitive restraint, disinhibition, and hunger) as mediators between food insecurity and binge eating among a sample of preoperative bariatric candidates. SETTING: University hospital in the Appalachian region of the United States. METHODS: A total of 369 adults seeking bariatric surgery were included in this cross-sectional study. Patients completed validated measures of food insecurity and eating behaviors as part of a routine psychological evaluation prior to bariatric surgery. RESULTS: Food insecurity was significantly related to binge eating symptoms (r[369] = .14, P < .01) and hunger (r[369] = .11, P < .05). Hunger mediated the relationship between food insecurity and binge eating (b = 1.23, standard error = .62, 95% confidence interval .08-2.54). Food insecurity was not associated with restraint (r[369] = .06, P = .27) or disinhibition (r[369] = .02, P = .69). CONCLUSIONS: Food insecurity presents a unique pathway to binge eating that has several implications for intervention prior to bariatric surgery. Identification of food insecurity and the subsequent effects on eating behaviors is crucial to understanding the factors relevant to disordered eating prior to bariatric surgery.

Gene therapy with Pellino-1 improves perfusion and decreases tissue loss in Flk-1 heterozygous mice but fails in MAPKAP Kinase-2 knockout murine hind limb ischemia model.

OBJECTIVES: In the United States, over 8.5 million people suffer from peripheral arterial disease (PAD). Previously we reported that Pellino-1(Peli1) gene therapy reduces ischemic damage in the myocardium and skin flaps in Flk-1 [Fetal Liver kinase receptor-1 (Flk-1)/ Vascular endothelial growth factor receptor-2/VEGFR2] heterozygous (Flk-1+/--) mice. The present study compares the angiogenic response and perfusion efficiency following hind limb ischemia (HLI) in, Flk-1+/- and, MAPKAPKINASE2 (MK2-/-) knockout (KO) mice to their control wild type (WT). We also demonstrated the use of Peli1 gene therapy to improve loss of function following HLI. STUDY DESIGN AND METHODS: Femoral artery ligation (HLI) was performed in both Flk-1+/- and MK2-/- mice along with their corresponding WT. Another set of Flk-1+/- and MK2-/- were injected with either Adeno-LacZ (Ad.LacZ) or Adeno-Peli1 (Ad.Peli1) after HLI. Hind limb perfusion was assessed by laser doppler imaging at specific time points. A standardized scoring scale is used to quantify the extent of ischemia. Histology analysis performed includes capillary density, fibrosis, pro-angiogenic and anti-apoptotic proteins. RESULTS: Flk-1+/- and MK2-/- had a slower recovery of perfusion efficiency in the ischemic limbs than controls. Both Flk-1+/- and MK2-/- KO mice showed decreased capillary density and capillary myocyte ratios with increased fibrosis than their corresponding wild types. Ad.Peli1 injected ischemic Flk-1+/- limb showed improved perfusion, increased capillary density, and pro-angiogenic molecules with reduced fibrosis compared to Ad.LacZ group. No significant improvement in perfusion was observed in MK2-/- ischemic limb after Ad. Peli1 injection. CONCLUSION: Deletion of Flk-1 and MK2 impairs neovascularization and perfusion following HLI. Treatment with Ad. Peli1 results in increased angiogenesis and improved perfusion in Flk-1+/- mice but fails to rectify perfusion in MK2 KO mice. Overall, Peli1 gene therapy is a promising candidate for the treatment of PAD.

Prior Bariatric Surgery is Associated with a Reduced Risk of Poor Outcomes in COVID-19: Propensity Matched Analysis of a Large Multi-institutional Research Network.

PURPOSE: Through sustained weight loss and improvement in metabolic co-morbidities, bariatric surgery is hypothesized to reduce the risk of severe COVID-19. Small studies have suggested favorable outcomes; however, large population-based studies are lacking. MATERIALS AND METHODS: We conducted a retrospective cohort study utilizing the multi-institutional research network TriNeTx platform. Participants diagnosed with COVID-19 were identified and divided into cohorts based on prior bariatric surgery (BS). Primary study outcome was a composite event of death or requirement for mechanical ventilation up to 30-day following the diagnosis of COVID-19. Other outcomes included death, hospitalization, critical care need, and acute kidney injury in the 30-day follow-up period. Outcomes were compared in BS and non-BS cohorts after propensity score matching. RESULTS: There were significant differences in patient demographics and co-morbidities between the BS and non-BS groups. In the propensity score-matched analysis, there was a lower risk of reaching the primary endpoint of mechanical ventilation or mortality at 30 days after COVID-19 diagnosis in the BS cohort compared to the non-BS cohort (risk ratio (RR) 0.40, 95% CI 0.25-0.65). Mortality rate was lower in the BS cohort (RR 0.42, 95% CI 0.22-0.80), and patients in the BS group were less likely to require critical care (RR 0.54, 95% CI 0.38-0.77), mechanical ventilation (RR 0.43, 95% CI 0.24-0.78) or develop acute kidney injury (RR 0.57, 95% CI 0.43-0.76) after COVID-19 diagnosis. CONCLUSION: Prior bariatric surgery is associated with a reduced risk of poor outcomes of COVID-19. Furthermore, large prospective studies are needed.

The role of body appreciation, weight bias internalization, and disordered eating behaviors among presurgical bariatric patients.

BACKGROUND: Body appreciation and internalized weight bias have consistently been associated with eating behaviors. However, research has yet to examine the role of these variables among presurgical bariatric patients. OBJECTIVES: The present study sought to assess the relationships between body appreciation and weight bias internalization, binge eating, disinhibited eating, and symptoms of depression and anxiety among a sample of presurgical bariatric patients. The study also sought to examine the extent to which body appreciation and weight bias internalization account for unique variance in disordered eating even when controlling for depression and anxiety. SETTING: Academic medical center in the United States. METHODS: Data were collected on body appreciation, weight bias internalization, eating behaviors, depression, and anxiety as part of a standard presurgical psychological evaluation for bariatric surgery (n = 319). Pearson correlations were used to assess relationships between all study variables. Multiple regressions were conducted to assess the roles of body appreciation and weight bias internalization on disordered eating. RESULTS: Significant associations were found between low levels of body appreciation and high levels of weight bias internalization, disordered eating, and symptoms of depression and anxiety. Results indicated that body appreciation and weight bias internalization each significantly accounted for unique variance in symptoms of binge eating and disinhibited eating. Depressive symptoms were also statistically significant in all analyses. CONCLUSION: Findings indicate the importance of conducting future positive body image research, as well as continuing to examine weight-related constructs, such as internalized weight bias, among bariatric surgery patients.

Disinhibition and Subjective Hunger as Mediators Between Weight Bias Internalization and Binge Eating Among Pre-Surgical Bariatric Patients.

PURPOSE: Weight bias internalization, or the process of applying negative weight-related attitudes and beliefs to oneself, is an important construct in regard to patients pursuing bariatric surgery. Weight bias internalization (or internalized weight bias) has been previously associated with depressive symptoms and binge eating among pre-surgical bariatric patients. However, a gap in the literature exists pertaining to how certain eating behaviors may mediate the relationship between weight bias internalization and binge eating. The present study assessed the role of eating behaviors (i.e., cognitive restraint, disinhibition, and hunger) as mediators between weight bias internalization and binge eating symptoms when controlling for depression. MATERIALS AND METHODS: A total of 708 adults (Mage = 42.91; White = 95.3%; women = 79.4%) seeking bariatric surgery at a tertiary academic medical center in the Appalachia region of the USA were included in this retrospective study. Patients completed validated measures of weight bias internalization, eating behaviors, and depression as part of a routine, psychological evaluation in order to determine surgical clearance. RESULTS: Disinhibition and hunger were significant mediators in the relationship between weight bias internalization and binge eating beyond the role of depressive symptoms alone. CONCLUSION: Disinhibited eating, or the tendency to experience a loss of control and eating in response to negative emotions, as well as subjective feelings of hunger are important dimensions of eating, particularly as related to weight bias internalization and binge eating. Weight bias internalization is an important factor to consider among pre-surgical bariatric patients and warrants additional treatment considerations.

The use of an activity tracker to objectively measure inpatient activity after bariatric surgery.

BACKGROUND: Early postoperative ambulation reduces length of stay and prevents postoperative complications after bariatric surgery. Rarely is postoperative inpatient activity objectively measured despite readily available commercial activity trackers. OBJECTIVES: Evaluate the impact of using activity trackers to record number of inpatient steps taken after bariatric surgery and assess how patient characteristics may affect the number of steps recorded. SETTING: University Hospital, United States. METHODS: Using an activity tracker, the number of steps taken during the postoperative hospital stay was recorded for 235 patients undergoing either laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy. Patients were randomly assigned to either being informed about the devices' ability to record the number of steps taken or blinded to the purpose of the devices. Descriptive statistics were used to summarize study sample, a t test was used to compare number of steps recorded between groups, and a multivariate regression model was used to examine the effect of age, sex, preoperative body mass index (BMI), types of surgery, and length of stay on number of steps recorded. RESULTS: One hundred twenty-five patients (52.8%) were randomized to the blinded group while 111 (47.2%) were informed that the device would record the number of steps taken. There were no differences in the number of steps recorded between the 2 groups. Patients with prolonged length of stay recorded lower numbers of steps taken on postoperative day 0. Increasing age was seen to reduce the number of steps recorded on postoperative day number 1. There were no significant differences in number of steps recorded based on sex, preoperative BMI, or surgery type. CONCLUSION: The present study found that knowledge of an activity tracker being used did not affect the patient's activity level as measured by steps recorded. Increasing age correlated to reduced number of steps recorded on postoperative day 1 after bariatric surgery.

Emergency Laparoscopic Repair of an Iatrogenic Gastric Perforation in a Hiatal Hernia following a Failed Endoscopic Closure.

Iatrogenic gastrointestinal perforation is a rare, life-threatening complication of endoscopic procedures, which requires either endoscopic or surgical repair. We report the account of an 82-year-old woman with an iatrogenic gastric perforation of a hiatal hernia secondary to an endoscopic retrograde cholangiopancreatography (ERCP) procedure. Despite immediate recognition of the complication and endoscopic closure with through-the-scope (TTS) clips, the patient developed mediastinitis, peritonitis, and sepsis. She subsequently underwent an emergency laparoscopic hiatal hernia dissection and repair of the perforation with mediastinal and peritoneal washout. Given the patient's age and the degree of insult, subdiaphragmatic anchoring with abdominal drain placement was performed, and the hiatus was left open for additional drainage. The use of a side-viewing duodenoscope with the presence of a large hiatal hernia contributed to the risk of gastric perforation. We conclude that performing endoscopic procedures in patients with a known hiatal hernia should be carefully undertaken. If a perforation in such patients occurs, laparoscopic repair of such complications is feasible as demonstrated in this case video.