Long-term Engagement in Physical Activity Among Bariatric Surgery Patients: Associations with Treatment Outcomes at 5-Year Follow-up.

PURPOSE: Physical activity studies involving bariatric surgery patients tend to be short-term or cross-sectional investigations. Longer-term studies are limited and typically consist of relatively brief objective measurement periods used to generalize activity patterns. Very little research combines objective measurements with structured interviews to determine both the patterns and related factors of long-term physical activity among patients undergoing bariatric surgery. MATERIALS AND METHODS: Previous volunteers in a perioperative physical activity study were invited to participate in a mixed methods study investigating physical activity among bariatric patients over a 5-year postoperative period. Fifty-one patients (Mage = 45.4 years; 76.5% female, 90.2% White; 86.3% Roux-en-Y procedure) provided interview, survey, accelerometer, and anthropometric data. RESULTS: Participants were divided into four exercise quartiles, based on self-report of their length of regular exercise involvement from 1 year before through 5 years after surgery. Those reporting the most periods of regular exercise took the most measured steps per day, had greater moderate-to-vigorous physical activity and more bout-related activity, experienced the largest decrease in BMI, and reported the most adherence to nutritional guidelines. Participants reporting the most and least physical activity found the measurement periods to be most similar to their normal activity patterns. While physical activity increased significantly after surgery, measured physical activity did not reach recommended levels for steps or exercise bout minutes. CONCLUSIONS: Measured physical activity and self-reported physical activity show congruent trends among patients undergoing bariatric surgery. More research is needed to determine optimal long-term monitoring and promotion of physical activity among patients.

Childhood Adversity, Addiction Severity, and Comorbidity Among Patients Receiving Opioid Use Disorder Treatment: The Role of Emotion Regulation.

ABSTRACT: Patients in opioid use disorder (OUD) treatment report high rates of childhood adversity, and women experience greater exposure to certain types of childhood adversity ( e.g. , sexual abuse). Childhood adversity is associated with clinical severity, but the mechanisms explaining this association are not well understood. Participants ( N = 171) in opioid agonist treatment completed measures of childhood adversity, emotion regulation, and clinical severity ( i.e. , addictive behaviors, depression, and anxiety). Women endorsed greater childhood adversity and higher current psychopathology than men. The association between childhood adversity and clinical severity varied as a function of symptom type, although emotion regulation was a strong predictor in all models. Women reported higher levels of anxiety after controlling for covariates, childhood adversity, and emotion dysregulation. Future research should investigate treatment strategies to address emotion dysregulation among patients in OUD treatment, particularly women who may present with greater childhood adversity exposure and anxiety.

The moderating effects of intolerance of uncertainty and social connectedness on college students' addictive behaviors and mental health symptoms during the COVID-19 pandemic.

Objective: This study aimed to understand COVID-19 pandemic impacts on anxiety, depression, and addictive/excessive behaviors, with exploration of intolerance of uncertainty (IU) and social connectedness as potential moderators. Participants: Adult college students participated. Method: Our online survey assessed symptoms and behaviors prior to COVID-19, during the initial outbreak (Wave 1), and during early 2021 (Wave 2). Results: Significant increases were found in anxiety, depression, binge eating, sexual behaviors, video game playing, internet/social media usage, and compulsive exercise in both waves. IU moderated the relationship between both depression/anxiety and certain excessive behaviors; social connectedness moderated the relationship between anxiety and smoking. Conclusions: This study replicated prior work and highlights new impacts on addictive/excessive behaviors, as well as moderating effects from social connectedness and IU. Future research is warranted to evaluate the efficacy of treatments targeting IU and social connectedness as the pandemic continues to unfold.

Foods and Nutritional Characteristics Associated With Addictive-Like Eating.

Emerging literature is exploring the contribution of specific nutritional characteristics and food additives to the development of addictive-like eating, implicating highly processed foods and those high in fat and sugar in its pathophysiology. To our knowledge, no mixed methods study has yet aimed to investigate the relationship between food characteristics and addictive-like eating. Towards this end, we applied an a priori classification scheme to open-ended answers to enable us to use quantitative methods to analyze qualitative data. A sample of individuals who endorsed self-perceived "food addiction" (N = 182; 50% female; Mage = 34.1) reported the foods to which they believed they were "addicted." We classified these foods according to their levels of fat, carbohydrates, sugar, and sodium, and evaluated their predictive power on addictive-like eating. Pizza, chocolate, hamburgers, and pasta respectively, were the most reported food items to which participants felt they were addicted. Addictive-like eating was significantly predicted by endorsement of "addiction" to high-sodium foods. In contrast, "addiction" to high-sugar foods negatively predicted addictive-like eating symptoms. Findings support an association between highly processed and high-sodium foods with addictive-like eating behavior among humans, consistent in large part with prior human and animal literature. Results also suggest that people are readily able to report on their experiences of addiction to foods; specifically, they can freely endorse the experience of addictive-like eating and offer experiences of addictive foods that are largely consistent with theory and the literature.

Psychological Functioning and Health Behaviors Associated with Weight Loss Patterns up to 13.7 Years After Weight Loss Surgery.

Weight loss surgery produces dramatic health improvements immediately after surgery, including rapid declines in diabetes. However, less is known about its long-term effects. 124 St. Vincent Bariatric Center patients completed questionnaires on weight and psychological functioning a mean of 7.7 and 13.7 years post-surgery (T1 and T2, respectively). Because mean weight data may mask differing weight trajectories, participants were categorized based on weight over time. Most participants underwent Roux-En-Y gastric bypass (90.3%) and were Caucasian (96%), female (81.5%), and married (69.1%). Mean age at T2 was 64; mean %EWL was 64.9%. Most patients fit into one of three weight change patterns, reaching weight nadir, and regaining by T1 and then, by T2, experiencing (1) Weight Loss (n = 36), (2) Weight Maintenance (n = 37), or (3) Continued Weight Gain (n = 39). Groups differed significantly on body satisfaction, weighing frequency, and conscientiousness, with Weight Gainers significantly lower than other groups on conscientiousness and body satisfaction, and Weight Losers reporting higher frequency of weighing than Maintainers. Bariatric patients can maintain substantial weight loss and positive psychological functioning for many years post-surgery, although weight regain is associated with less body satisfaction. Conscientiousness may signify medical adherence, whereas frequent weighing may be a behavior that promotes ongoing weight loss.

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).

Development and Validation of the Recognizing Addictive Disorders Scale: A Transdiagnostic Measure of Substance-Related and Other Addictive Disorders.

OBJECTIVE: Substance use disorders and behavioral addictions commonly co-occur. However, few available self-report measures reliably and validly assess the full range of addictive conditions. The development and initial validation of a new measure-Recognizing Addictive Disorders (RADs) scale addresses a significant gap in the literature. Method: After items were generated and evaluated in Study 1, Study 2 (N = 300), applied exploratory factor analysis to the item pool using an online-based community sample. In Study 3 (N = 427), the factor structure was validated using an independent online-based community sample and confirmatory factor analysis. Results: The scale demonstrated good internal consistency (a = .92) and construct validity, including replication of the factor structure (χ2 (553) = 760.83, p < .001, CFI = .997, TLI = .997, RMSEA = .030) and correlation with a related transdiagnostic measure of addiction (r = .72). Discussion: Overall, results support the preliminary validity of a brief transdiagnostic measure of addiction that considers a diverse range of behaviors. For patients presenting to substance abuse treatment, this tool may be useful in identifying symptoms of other types of non-substance problems, which could ultimately aid in treatment planning.

Measurement Invariance of the Modified Yale Food Addiction Scale 2.0 Across Gender and Racial Groups.

Objective: Food addiction reflects a substance use disorder framework, suggesting certain foods (e.g., high-fat, high-sugar foods) may trigger an addictive-like eating response in vulnerable individuals. This study explored whether the Modified Yale Food Addiction Scale 2.0 (mYFAS 2.0), a newly validated and shortened measure of food addiction, is appropriate for use in heterogeneous samples. Assessment of mYFAS 2.0 invariance is essential, as this measure was developed for use as a brief screener in large epidemiological samples that are likely demographically diverse. Method: Multigroup confirmatory factor analysis examined measurement invariance across racial/ethnic (White, Black, and Hispanic) and gender (male, female) groups. Participants were recruited through Qualtrics qBus, which uses demographic quotas to recruit a sample representative of the U.S. census reference population. Individuals were included in analyses if they identified their race/ethnicity as White, Black, or Hispanic (N = 923). Results: Results supported full and partial measurement invariance across racial and gender groups, respectively. Discussion: Results increase confidence in the generalizability of findings using the mYFAS 2.0 and indicate that observed differences in prevalence rates, such as the higher rates of food addiction observed for women and Hispanic individuals, are likely due to true differences in the population rather than due to measurement bias.

Combined Use of Alcohol and the Internet: Associated Features.

Background: With the potentiality of excessive Internet usage being associated with adverse consequences, the current study assessed adverse outcomes of combined Internet and alcohol misuse. Objective: We hypothesized that participants who simultaneously engage in both alcohol and Internet use would experience adverse outcomes from their actions, compared to those who just misuse the Internet in the absence of alcohol. Methods: The current study deployed an anonymous online survey comprised of scales measuring several domains such as impulsivity, neglect of responsibilities, depression, frequency and quantity of alcohol consumption, as well as Internet usage. From a large (N = 550) sample of college student surveys, we compared the 39 Internet drinkers with a randomly selected sampled of 39 non-drinking counterparts. Results: Relative to their non-drinking counterparts, Internet Drinkers were elevated on measures of alcohol misuse and some features of Internet addiction, but not depression. Conclusion: Of the final sample, 64.7% of those who drank alcohol while using the Internet indicated doing something they later regretted while online. Further exploration is warranted to more fully understand how non-substance compulsive behaviors can be misused and how they interact with substance misuse and co-occurring mental health issues.

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.

Measurement invariance of the Yale Food Addiction Scale 2.0 across gender and racial groups.

Food addiction describes a psychological and behavioral eating pattern that is similar to the experience of those compulsively taking drugs of abuse. Recent developments related to food addiction, including the development and validation of an updated measure (Yale Food Addiction Scale 2.0; Gearhardt, Corbin, & Brownell, 2016), have increased knowledge as to the prevalence and associated correlates of food addiction. However, less is known about the phenomenological experience of food addiction in diverse samples or how the existing measure of food addiction performs in heterogeneous samples. In a cross-sectional survey design, using a diverse sample of undergraduate students (N = 642) tests of measurement invariance were performed. Confirmatory factor analysis supported the hypothesized factor structure, indicating a single latent construct of food addiction modeled by 11 dichotomous indicators, in samples of White and Black participants as well as samples of men and women. Measurement invariance testing across the various demographic groups broadly provided good psychometric support for use of the measure. However, a single indicator related to attempts to cut down on highly palatable food varied across men and women. Thus, when using the measure in mixed gender samples researchers may consider obtaining additional information regarding gender and its relative impact on the experience of food addiction, particularly with respect to efforts to quit or cut down intake of highly palatable foods. (PsycINFO Database Record

Internalized weight bias mediates the relationship between depressive symptoms and disordered eating behavior among women who think they are overweight.

OBJECTIVE: This study tested the potential mediating role of Internalized Weight Bias (IWB) in the relationship between depressive symptoms (DEP-SX) and disordered eating behavior. In particular, we hypothesized that IWB may be an intervening variable in the well documented association between depression and disordered eating. METHOD: College women (N=172) who were taking undergraduate psychology courses and who endorsed thinking they were overweight completed the Patient Health Questionnaire depression screener (PHQ-9), the Weight Bias Internalization Scale (WBIS), and the Eating Disorder Examination Questionnaire (EDE-Q). Bootstrapping mediation analyses were conducted to explore the relationships between these variables. RESULTS: IWB was significantly correlated with eating disorder symptoms and DEP-SX, but not Body Mass Index. Mediation analyses supported a model in which IWB mediated the relationship between DEP-SX and disordered eating behavior. DISCUSSION: Results indicate that individuals with elevated DEP-SX may be likely to internalize weight bias, which may in turn lead to maladaptive approaches to eating and weight control, regardless of one's actual weight status.

Exploratory Factor Analysis of Diagnostic and Statistical Manual, 5th Edition, Criteria for Posttraumatic Stress Disorder.

One change to the posttraumatic stress disorder (PTSD) nomenclature highlighted in the Diagnostic and Statistical Manual, 5th Edition (DSM-5; American Psychiatric Association, 2013) is the conceptualization of PTSD as a diagnostic category with four distinct symptom clusters. This article presents exploratory factor analysis to test the structural validity of the DSM-5 conceptualization of PTSD via an online survey that included the PTSD Checklist-5. The study utilized a sample of 113 college students from a large Midwestern university and 177 Amazon Mechanical Turk users. Participants were primarily female, Caucasian, single, and heterosexual with an average age of 32 years. Approximately 30% to 35% of participants met diagnostic criteria for PTSD based on two different scoring criteria. Results of the exploratory factor analysis revealed five distinct symptom clusters. The implications for the classification of PTSD are discussed.

Predictors of Lowest Weight and Long-Term Weight Regain Among Roux-en-Y Gastric Bypass Patients.

BACKGROUND: Weight loss surgery (WLS) outcomes are poorly understood. This study aimed to evaluate the relationship of well-documented (e.g., health, diet, physical activity) and theoretically relevant variables (e.g., substance use and "food addiction") with both weight nadir and weight regain (WR) following WLS. METHODS: A sample of 97 Roux-en-Y gastric bypass patients (M time since surgery = 8.86 years) were surveyed about pre- and post-WLS weight, health, self-management behaviors, alcohol problems, and clinical symptoms. RESULTS: Patients lost a mean of 42 % (SD = 10.71 %) of total weight at weight nadir, but 26 % (SD = 19.66 %) of the lost weight was regained by the time of the survey. Correlates of lower weight nadir and WR differed considerably, with minor overlap. Weight nadir was associated with pre-WLS drug use and post-WLS medical comorbidities. WR, on the other hand, was associated with post-WLS adherence to dietary and physical activity modification. Post-WLS nocturnal eating, depression, and problematic alcohol use were also associated with WR. With all associated variables in regression models, number of post-WLS medical comorbidities (ß = -.313, p < 0.01) and post-WLS depression (ß = 0.325, p < 0.01) accounted for the most variance and remained as significant predictors of weight nadir and WR, respectively. CONCLUSIONS: While weight nadir was associated with relatively few and largely nonmodifiable variables, WR was significantly associated with adherence-related behaviors, mood symptoms, and pathological patterns of food and alcohol use, all of which are potentially modifiable. These findings underscore the importance of long-term behavioral and psychosocial monitoring after surgery.

Associations between relationship stability, relationship quality, and weight loss outcomes among bariatric surgery patients.

After weight loss surgery (WLS), psychosocial functioning, including the quality of social relationships, generally improves, but for a minority, relationships worsen. We examined how changes in relationship stability and quality from pre- to post-WLS relate to long-term weight loss outcomes. Postoperative patients (N=361) completed surveys which queried relationship changes and weight loss. The sample was 95.9% Caucasian, 80.1% female, averaged 7.7years post-WLS, with a mean age at surgery of 47.7years (range 21-72); 87.3% had a Roux-en-Y gastric bypass. Four relationship status groups were created: Not in a relationship at surgery or follow-up (No-Rel, n=66; 18.2%); Post-WLS relationship only (New-Rel, n=23; 6%); Pre-WLS relationship only (Lost-Rel, n=17; 5%); and Pre-Post Relationship (Maintainer, n=255; 70.6%). Current BMI was 34.5 for No-Rel; 40.5 for New-Rel; 37.4 for Lost-Rel; 33.3 for Maintainers (p<.05 for Maintainers and No-Rel vs. New-Rel). These same group differences were significant for weight loss, which was not associated with gender, time since surgery, or age at time of surgery, but was associated with pre-WLS BMI (lower pre-WLS BMI was associated with greater %EWL). Analyses were repeated with pre-WLS BMI as a covariate; group differences remained significant [F (3, 355)=3.09, p=.03], as did pre-WLS BMI, [F (1, 355)=9.12, p=.003]. Among Maintainers, relationship quality was associated with weight loss outcomes: those with improved relationships post-WLS had significantly greater %EWL [F (2, 234)=15.82, p<0.000; p<.05 for Improved>(Stayed Same=Got Worse)]. Findings support the importance of assessing relationship stability and quality in pre-WLS candidates, as healthy and stable relationships may support improved long-term outcomes. Interventions to improve relationships pre-and post-WLS may increase both quality of life and weight loss outcomes.

Problematic intake of high-sugar/low-fat and high glycemic index foods by bariatric patients is associated with development of post-surgical new onset substance use disorders.

Bariatric or weight loss surgery (WLS) patients are overrepresented in substance abuse treatment, constituting about 3% of admissions; about 2/3 of such patients deny problematic substance use prior to WLS. It is important to advance our understanding of the emergence of substance use disorders (SUDs) - particularly the New Onset variant - after WLS. Burgeoning research with both animal models and humans suggests that "food addiction" may play a role in certain forms of obesity, with particular risk conferred by foods high in sugar but low in fat. Therefore, we hypothesized that WLS patients who reported pre-WLS problems with High-Sugar/Low-Fat foods and those high on the glycemic index (GI) would be those most likely to evidence New Onset SUDs after surgery. Secondary data analyses were conducted using a de-identified database from 154 bariatric surgery patients (88% female, Mage=48.7 yrs, SD=10.8, Mtime since surgery=2.7 yrs, SD=2.2 yrs). Participants who endorsed pre-surgical problems with High-Sugar/Low-Fat foods and High GI foods were at greater risk for New Onset SUD in the post-surgical period. These findings remained significant after controlling for other predictors of post-surgical SUD. Our findings provide evidence for the possibility of addiction transfer among certain bariatric patients.

New-onset substance use disorder after gastric bypass surgery: rates and associated characteristics.

BACKGROUND: Substance use disorder (SUD) may develop de novo for a subgroup of weight loss surgery patients, particularly those who have had the Roux-en-Y gastric bypass (RYGB) procedure. The present study examined the rate of SUD in a broad sample of RYGB patients and identified associated behavioral and psychological factors. METHODS: Participants included 143 RYGB patients; the majority were women (n = 120; 83.9 %) and white (n = 135; 94.4 %). Participants completed a web-based survey assessing retrospective accounts of presurgical substance use, eating pathology, family history, and traumatic history, postsurgical substance use, life stressors, and global trait-like measures (emotion dysregulation, impulsivity, sensation-seeking, and coping skills). RESULTS: A subgroup (n = 28, 19.6 %) of post-RYGB patients met criteria for probable SUD; however, the majority of those who met SUD criteria postsurgery (n = 19, 68 %) did not report a pre-RYGB SUD history. Family history of substance abuse, poor coping skills, and potential life stressors were related to post-RYGB SUD, particularly for the new-onset group. Additionally, the majority of those who met criteria for pre-RYGB SUD (n = 21, 70 %) did not continue to meet SUD criteria following RYGB. CONCLUSIONS: Findings highlight a subgroup of post-RYGB patients reporting new-onset SUD, which is unexpected among middle-aged women. Importantly, findings also indicate that many patients with presurgical SUD did not relapse postsurgery. Assessing for family history of SUD and coping skills at the presurgical evaluation is recommended. Future research should identify psychological and physiological risk factors for SUD postsurgery and examine protective factors of those who discontinue substance use postsurgery.

Substance misuse following Roux-en-Y gastric bypass surgery.

Post-bariatric surgery patients are overrepresented in substance abuse treatment, particularly those who have had the Roux-en-Y gastric bypass (RYGB) procedure. The severity of the substance use disorder (SUD; i.e., warranting inpatient treatment) and related consequences necessitate a better understanding of the variables associated with post-RYGB SUDs. This investigation assessed factors associated with post-RYGB substance misuse. Post-RYGB patients (N = 141; at least 24 months postsurgery) completed an online survey assessing variables hypothesized to contribute to post-RYGB SUDs. Fourteen percent of participants met criteria for postoperative substance misuse. Those with a lower percent total weight loss (%TWL) were more likely to endorse substance misuse. Family history of substance misuse was strongly associated with postoperative substance misuse. Eating-related variables including presurgical food addiction and postsurgical nocturnal eating, subjective hunger, and environmental responsiveness to food cues were also associated with a probable postoperative SUD. These findings have clinical utility in that family history of substance misuse can be easily assessed, and at-risk patients can be advised accordingly. In addition, those who endorse post-RYGB substance misuse appear to have stronger cognitive and behavioral responses to food, providing some support for the theory of behavioral substitution (or "addiction transfer").

The relationship between emotional eating and weight problem perception is not a function of body mass index or depression.

Weight problem perception (WPP) refers to the belief that one is overweight. Previous research suggests that WPP, even in the absence of actual overweight status, is associated with disordered eating, binge eating, and body image dissatisfaction. However, the relationship between emotional eating, BMI, and WPP has not yet been explored. This investigation recruited a total of 409 college students who completed a web-based survey. An additional 76 participants were recruited to complete an identical survey with the addition of a depression measure to evaluate the contribution of this potentially important covariate. As hypothesized, WPP was associated with emotional eating, while actual BMI was not. In the second sample, WPP remained significantly associated with emotional eating, even after depression was included as a covariate. Results suggest that non-overweight young adults who express the belief that they are overweight may be at risk for emotional eating, which, over the long term, could indeed adversely impact BMI. Cognitive approaches to address disordered eating may benefit from addressing WPP.