Psychosocial factors associated with binge eating among overweight and obese male veterans.

The study's primary objective is to compare psychosocial characteristics of overweight/obese male Veterans who report binge eating with those who do not report binge eating. Participants include 111 overweight/obese male Veterans who completed questionnaires assessing binge eating, depression, stress, body image, self-efficacy for healthy eating and physical activity, and barriers to physical activity. Of the study sample, 25.2% are classified as binge eaters. Binge eating status is not significantly associated with age, race/ethnicity, weight, or BMI. Binge eating is associated with higher scores on measures of depression, barriers to exercise, self-classified weight, and lower self-efficacy for both healthy eating and exercise, but is not associated with body satisfaction or recent stress. Findings suggest that a sizable minority of overweight/obese male Veterans engage in binge eating. Depressive symptoms, self-efficacy, and perceived barriers all significantly predicted binge eating. These findings have implications both for identification of overweight/obese men at risk for binge eating disorder as well as for weight loss treatment in the Veteran population.

BMI trajectory groups in veterans of the Iraq and Afghanistan wars.

OBJECTIVE: The study sought to determine BMI trajectories in Iraq/Afghanistan veterans over 6 years and to examine sociodemographic factors associated with BMI trajectory membership. METHODS: Our study sample included 16,656 veterans post-deployment and entering the Veteran Healthcare Administration (VHA) healthcare system. We used national VHA administrative sociodemographic data, tracked veteran BMI for 6 years, and used trajectory modeling to identify BMI trajectories and sociodemographic characteristics associated with trajectory membership. RESULTS: Five trajectory groups determined in the full sample were primarily differentiated by their post-deployment initial BMI: "healthy" (14.1%), "overweight" (36.3%), "borderline obese" (27.9%), "obese" (15.7%), and "severely obese" (6.0). Being female, younger, and white were associated with lower initial BMI trajectory group membership (p's<.05). Greater observed BMI increase was associated with higher initial BMI across groups (0.6, 0.8, 1.5, 1.9, 2.7). Gender specific trajectory models found that male Veterans with higher education and white female Veterans were associated with the lowest initial BMI group (p's<.05). CONCLUSIONS: Higher post-deployment BMI was associated with greater BMI gain over time for both male and female veterans. Older age is associated with higher BMI regardless of gender. Education level and racial status are differentially related to BMI trajectory by gender.

Physical activity in gastric bypass patients: associations with weight loss and psychosocial functioning at 12-month follow-up.

BACKGROUND: This study examined self-reported frequency and intensity of physical activity in gastric bypass patients, and the relationship between physical activity and weight loss and psychosocial outcomes during 12-month postoperative follow-up. METHODS: Participants were 131 obese patients who underwent gastric bypass surgery and completed psychometrically established measures assessing physical activity, depression, and physical and mental health preoperatively and at a 12-month follow-up assessment. RESULTS: Preoperatively, 62.6% of patients reported at least one episode of a minimum of 15 minutes of physical activity per week. This figure increased to 92.4% at 12-month postoperative follow-up. Both the frequency and intensity levels of physical activity episodes increased significantly from preoperative to 12-month postoperative assessments. Hierarchical regression analyses, controlling for demographic variables and preoperative body mass index (BMI), revealed that the intensity of physical activity was significantly associated with postoperative weight loss at 12-month follow-up. Both the frequency and intensity of physical activity were significantly associated with depression, and physical and mental well-being at the 12-month postoperative follow-up. CONCLUSION: Gastric bypass patients increase both the frequency and intensity of their physical activity during the first 12 months postoperatively. Higher postoperative intensity levels of physical activity are associated with better weight loss outcomes while both increased frequency and intensity levels of physical activity are associated with better psychosocial outcomes.

MOVE! multidisciplinary programs: Challenges and resources for weight management treatment in VHA.

The MOVE! program has been a successful weight management and physical activity initiative from the Veteran's Health Administration. While it embraces a multicomponent approach to weight management, local facilities have primarily focused on the implementation of delivery of MOVE! educational materials to groups or individuals. We discuss additional MOVE!-related weight management efforts within VHA that reflect treatment strategies beyond delivery of these educational materials. First, we present a case study that highlights the special challenges associated with the Veteran overweight/obese population. Second, we describe the implementation of our local, multidisciplinary, individualized weight management clinic as an example of on-the-ground provision of a higher treatment intensity program as part of MOVE!'s multicomponent model. Third, we present program outcomes and consider challenges to program sustainability.

Implementation of the veterans health administration national pain management strategy.

Since its introduction in 1998, the VHA National Pain Management Strategy has introduced and implemented a series of plans for promoting systems improvements in pain care. We present the milestones of VHA efforts in pain management as reflected by the work of the Strategy. This includes the development of the Strategy and its current structure as well as a review of important initiatives such as "pain as the fifth vital sign" and the stepped care model of pain management.

Sex differences in factors influencing recovery from arthroscopic knee surgery.

BACKGROUND: Many factors affect recovery from arthroscopic partial meniscectomy, including patient sex. However, sex differences in time to maximal recovery of knee function and factors influencing differential rates of recovery are unknown. QUESTIONS/PURPOSES: We determined (1) preoperative sex differences, (2) sex differences in rate and extent of recovery through 1 year postoperatively, and (3) clinical and fitness variables that could explain potential sex differences in recovery from partial meniscectomy. PATIENTS AND METHODS: The study sample consisted of 180 patients undergoing arthroscopic partial meniscectomy. Sex, age, body mass index, history of prior injury, length of time between knee injury/impairment and surgical evaluation, weekly exercise frequency, and self-reported fitness were assessed preoperatively, and extent of osteoarthritis was recorded postoperatively. We used the Tegner-Lysholm scale to assess knee function preoperatively and postoperatively at weeks 1, 3, 8, 16, 24, and 48 followups. RESULTS: Females had worse knee function and delayed maximal recovery, requiring 1 year, compared with males, who required only 4 months. History of prior knee injury and lower self-reported fitness were associated with slower recovery in females but not in males. Osteoarthritis was associated with slower recovery but not related to sex. Body mass index, length of time between injury/impairment and surgical evaluation, and weekly exercise frequency did not influence rate of recovery. CONCLUSIONS: Females have delayed recovery after arthroscopic partial meniscectomy. Prior knee injury and self-reported low fitness are associated with delayed recovery for females but not for males.

The moderating effect of obesity on cognitive-behavioral pain treatment outcomes.

OBJECTIVE: To assess the effects of body mass index on cognitive-behavioral pain treatment outcomes for chronic low back pain. DESIGN: Retrospective analyses of data from a clinical trial were performed, with body mass index used to divide patients into obese and non-obese groups for comparison. SETTING: VA medical center outpatient clinic. PATIENTS: Veterans (N = 74) receiving outpatient care through the VA. INTERVENTIONS: Delivery of a 10-week cognitive-behavioral pain treatment intervention. OUTCOME MEASURES: The Numerical Rating Scale (pain intensity), Roland Morris Disability Questionnaire (disability), Veteran's SF-36 (health-related quality of life), and Beck Depression Inventory (emotional functioning) were administered pre- and post-treatment. RESULTS: The study included 42 obese and 32 non-obese participants, most of whom were male (89%). The average body mass index was 32.44 kg/m², with average pain intensity rated as 6.59 out of 10. There were no pre-treatment differences in outcome measures between the groups. Repeated measures ANOVAs revealed main effects of Time on all but one outcome (Mental Component score), indicating that the cognitive-behavioral interventions were largely effective. However, Time-body mass index (BMI) group interactions revealed that non-obese participants showed greater improvement following treatment than did their obese counterparts on measures of disability (P < 0.05), physical aspects of quality of life (P < 0.01), and emotional functioning (P < 0.05). CONCLUSIONS: Standard cognitive-behavioral pain treatment did not yield comparable outcomes for obese and non-obese participants. Results suggest a potential moderating role of BMI in low back pain outcomes. Future work with other pain conditions, including examination of potential mechanisms through which BMI impacts treatment outcomes, is recommended.

Surgical stress-induced immune cell redistribution profiles predict short-term and long-term postsurgical recovery. A prospective study.

BACKGROUND: The experience of undergoing surgery is known to induce a short-term, fight-or-flight physiological stress response. As an optimum immune response at the site of surgery would enhance tissue repair, we examined surgical stress-induced immune cell redistribution profiles as predictors, and potential mediators, of short and long-term postoperative recovery. We tested the a priori hypothesis that predefined adaptive immune cell redistribution profiles observed during surgery will predict enhanced postoperative recovery. METHODS: This prospective longitudinal study involved fifty-seven patients undergoing meniscectomy. Knee function was assessed preoperatively and at one, three, eight, sixteen, twenty-four, and forty-eight weeks postoperatively with use of the clinically validated Lysholm scale, which assesses mechanical function, pain, mobility, and the ability to perform daily activities. Surgery-induced immune cell redistribution was measured in the blood at baseline, before surgery, and after surgery. RESULTS: Mixed-model repeated-measures analyses revealed a main effect of immune cell redistribution: patients who showed the predefined "adaptive" lymphocyte and monocyte redistribution profiles during surgery showed enhanced recovery. Interesting differences were also observed between the sexes: women as a group showed less adaptive redistribution and correspondingly showed significantly delayed maximum recovery, requiring forty-eight weeks, compared with men, who required only sixteen weeks. Inter-individual differences in leukocyte redistribution predicted the rate of recovery across both sexes. CONCLUSIONS: Immune cell redistribution that is induced by the stress of undergoing surgery can predict (and may partially mediate) postoperative healing and recovery. These findings may provide the basis for identifying patients (either prospectively or during surgery) who are likely to show good as opposed to poor recovery following surgery and for designing interventions that would maximize protective immune responses and enhance the rate and extent of recovery.

Mood and attitude predict pain outcomes following arthroscopic knee surgery.

BACKGROUND: Decreased pain represents a clinically important outcome following arthroscopic knee surgery. However, little is known about preoperative mood and attitudinal factors and their potential relationship with pain outcomes. PURPOSE: This prospective, longitudinal study investigated the influence of preoperative depression, stress, and optimism on pain severity and interference with functioning, controlling for relevant demographic and clinical factors 1 year postoperatively. METHODS: Participants (N = 180, mean age = 48.2 years) completed scales assessing pain severity and interference both preoperatively and postoperatively. Demographics, depression, stress, optimism, and body mass index were assessed preoperatively. Physicians assessed extent of knee osteoarthritis during surgery. RESULTS: Hierarchical regression analyses controlling for relevant demographic and clinical variables revealed that optimism and stress were significant predictors of pain severity at 1 year but not pain interference. Extent of osteoarthritis predicted pain interference. CONCLUSIONS: These findings support that optimism and stress are important predictors of patient-rated pain severity. They do not, however, predict the extent to which pain interferes with daily functioning.

Predictors of short-term recovery differ from those of long-term outcome after arthroscopic partial meniscectomy.

PURPOSE: The purpose of this study was to determine which patient clinical and demographic factors are associated with the short-term rate of recovery from arthroscopic partial meniscectomy in the year after surgery and how they differ from previously published associations with long-term outcome. METHODS: Depth of meniscal excision, involvement of 1 or both menisci, extent of meniscal tear, and extent of osteoarthritis were determined during surgery, and age, body mass index, and gender were recorded. Mixed-model repeated-measures analyses were used longitudinally to identify independent predictors of recovery, measured by prospectively assessing knee pain, knee function, and overall physical knee status preoperatively and at regular intervals throughout postoperative recovery. RESULTS: Neither advanced age nor increased body mass index had any influence on patient recovery over time, whereas gender was implicated, with women having significantly poorer recovery scores than men (P < .04). In addition, differences in variables indicating extent of meniscal tear and resection did not influence recovery scores over time, and the only surgical factor that impacted all 3 recovery variables was extent of osteoarthritis (P < .02). CONCLUSIONS: We have shown that female gender and worse osteoarthritis are associated with a slower rate of short-term recovery from arthroscopic partial meniscectomy whereas age, obesity, and amount of meniscal tear/resection showed no association with rate of recovery throughout the first year postoperatively. LEVEL OF EVIDENCE: Level I, high-quality prognostic prospective study (all patients were enrolled at the same point in their disease with more than 80% follow-up of enrolled patients).

Associations of weight-based teasing history and current eating disorder features and psychological functioning in bariatric surgery patients.

BACKGROUND: The study investigated associations between childhood history of being negatively teased (i.e., being made fun of) about weight with psychiatric history, weight and eating concerns, and psychological functioning in 174 bariatric surgery candidates. METHODS: Bariatric surgery candidates participating in a comprehensive psychiatric evaluation completed a structured diagnostic interview, a psychosocial history interview, and a battery of established self-report measures assessing broad aspects of functioning. Patients who reported a history of being teased during childhood about weight were compared with those who denied having been teased in demographic features, obesity history, dietary and eating patterns and psychological functioning. RESULTS: Of the study group, 88 participants (50.6%) reported a weight-based childhood teasing history and 86 (49.4%) denied such a history. Teasing was not significantly associated with demographic features or current obesity level. As expected, analyses revealed that teasing was associated with younger age of onset of both obesity and dieting. Teasing was significantly associated neither with the frequency of lifetime psychiatric disorders, including eating disorder diagnoses, nor with binge eating. Analyses of covariance controlling for childhood onset of obesity, however, revealed that teasing history was associated with significantly higher current levels of weight and shape concerns, depression, body dissatisfaction, and shame, and with lower levels of self-esteem. CONCLUSION: Health-care providers should recognize the importance of a history of having been teased or made fun of about weight in bariatric surgery candidates. Although the prognostic significance of a history of such negative teasing for bariatric surgery outcomes is unknown, our findings suggest that such experiences are prevalent in this patient group and are associated with negative sequelae.

Correlates of body image dissatisfaction in extremely obese female bariatric surgery candidates.

BACKGROUND: This study investigated correlates of body image dissatisfaction in 131 extremely obese female bariatric surgery candidates. METHODS: Female gastric bypass surgery candidates participating in a comprehensive psychiatric evaluation completed a battery of established self-report measures of body image and psychosocial functioning. Nine predictors of body image dissatisfaction were considered: body mass index (BMI), ethnicity, childhood onset of obesity, childhood teasing about weight, binge eating, depression, self-esteem, shame, and perfectionism. RESULTS: Stepwise multiple regression analysis revealed that the nine variables jointly accounted for 48% of the variance; three variables, depression, self-esteem and perfectionism, made significant independent contributions. CONCLUSION: Our findings highlight the importance of adult psychological functioning (depression, self-esteem and perfectionism) for predicting body image dissatisfaction in extremely obese female bariatric surgery candidates.

Psychiatric disorder comorbidity and association with eating disorders in bariatric surgery patients: A cross-sectional study using structured interview-based diagnosis.

OBJECTIVE: This study examined the prevalence of DSM-IV Axis I psychiatric disorders in severely obese bariatric surgery candidates and explored whether eating disorders were associated with psychiatric comorbidity. METHOD: The Structured Clinical Interview for DSM-IV Axis I Disorders was administered to a study group of 174 consecutively evaluated bariatric surgery candidates. All evaluations were completed between September 2002 and November 2004. RESULTS: Overall, 36.8% of the participants met criteria for at least one lifetime psychiatric disorder, with 24.1% meeting criteria for a current disorder. The most commonly observed lifetime psychiatric diagnoses were affective disorders (22.4%), anxiety disorders (15.5%), and eating disorders (13.8%). Participants with eating disorders were significantly more likely than those without eating disorders to meet criteria for psychiatric disorders overall (66.7% vs. 26.7%) and specifically for anxiety disorders (45.8% vs. 10.7%). CONCLUSIONS: Psychiatric disorders are not uncommon among severely obese patients who present for bariatric surgery. The observed prevalence rates based on structured diagnostic interviews are lower than previously reported based on questionnaire, clinical, and chart review methods but are similar to those reported for nationally representative samples. Among bariatric surgery candidates, the presence of eating disorders is associated with higher rates of other psychiatric disorders. The findings highlight the importance of systematic diagnostic assessment using a structured diagnostic interview for determining the full spectrum of Axis I disorders.

Psychosocial factors and surgical outcomes: an evidence-based literature review.

The influence of psychosocial factors on clinical outcomes after surgery has been investigated in several studies. This review is limited to surgical outcomes studies published between 1990 and 2004 that include (1) psychosocial variables (eg, depression, social support) as predictors of outcome and that focus on (2) clinical outcomes (eg, postoperative pain, functional recovery) using (3) specific multivariate analytic techniques with (4) relevant clinical variables (eg, presurgical health status) included as covariates. Twenty-nine studies met these criteria. Results indicate that psychosocial factors play a significant role in recovery and are predictive of surgical outcome, even after accounting for known clinical factors. Attitudinal and mood factors were strongly predictive; personality factors were least predictive. The results suggest that preoperative consideration of attitudinal and mood factors will assist the surgeon in estimating both the speed and extent of postoperative recovery.

Shared decision making, preoperative expectations, and postoperative reality: differences in physician and patient predictions and ratings of knee surgery outcomes.

PURPOSE: The present study was performed to determine the extent to which physicians and patients rate preoperative and postoperative knee pain and function differently, and to determine whether physicians or patients more accurately predict postoperative knee pain and function. TYPE OF STUDY: Longitudinal, prospective study. METHODS: Ninety-eight patients requiring either anterior cruciate ligament reconstruction surgery or meniscectomy and related surgery were interviewed 1 week before surgery, as well as 3 and 24 weeks postoperatively. Patients and their physicians completed ratings on knee pain and function at each time point. In addition, at their preoperative visit, patients and physicians completed ratings predicting their postoperative pain and functional status. RESULTS: Physicians rated patients as having less pain and greater knee function preoperatively and at 24 weeks postoperatively. Patients had more significant differences between predicted and actual ratings. CONCLUSIONS: Physicians tended to underestimate knee pain and overestimate knee function compared with patients. However, physicians better predicted postoperative knee pain and function ratings than did patients. These findings suggest that physician-patient discussions about preoperative expectations and postoperative reality might be an important part of clinical care. LEVEL OF EVIDENCE: Level II, Prospective Longitudinal Study.