Food cravings after bariatric surgery: comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass.

BACKGROUND: Research suggests that food choices, preferences, and tastes change after bariatric surgery, but evidence regarding changes in food cravings is mixed. OBJECTIVES: The primary aim of this cohort study was to compare food cravings during the first year following bariatric surgery in patients who had undergone sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). SETTING: Integrated multispecialty health system, United States. METHODS: Patients aged ≥ 18 years seen between May 2017 and July 2019, provided informed consent, completed the Food Craving Inventory (FCI), and had ≥ 1 year of follow-up after undergoing primary SG or RYGB were included in the study. Secondary data captured included psychological and behavioral measures. Preoperative and postoperative (3, 6, 9, and 12 months) FCI scores of patients who underwent SG and RYGB were compared. RESULTS: Some attrition occurred postoperatively (N = 187 at baseline, 141 at 3 months, 108 at 6 months, 89 at 9 months, and 84 at 12 months). No significant relationship between pre- or postoperative food cravings and surgery type was found except on the carbohydrate subscale. Patients with higher preoperative food addiction symptoms were not more likely to experience an earlier reoccurrence of food cravings during the first 12 months after surgery. Likewise, patients with higher levels of preoperative depression and anxiety were not more likely to have early reoccurrence of food cravings during the first 12 months after surgery; however, those with higher PHQ9 scores at baseline had uniformly higher food craving scores at all timepoints (pre-surgery, 3 m, 6 m, 9 m, and 12 m). CONCLUSIONS: Results suggest that food cravings in the year after bariatric surgery are equivalent by surgery type and do not appear to be related to preoperative psychological factors or eating behaviors. LEVEL OF EVIDENCE: Level III: Evidence obtained from well-designed cohort.

Preoperative high respiratory quotient correlates with lower weight loss after bariatric surgery.

BACKGROUND: The respiratory coefficient (RQ), as determined by indirect calorimetry (IC), classifies diet as being carbohydrate rich (RQ = 0.7-0.8), fat rich (RQ = 0.9-1.0), or overfeeding (RQ > 1). We hypothesized that preoperative RQ may be associated with weight-loss outcomes after bariatric surgery. METHODS: From 2016 to 2018, 137 obese patients were enrolled in a Bariatric Registry and underwent dietary and behavioral counseling, followed by preoperative IC. Resting energy expenditure (REE) and RQ of all patients was measured. Patients were classified as over-feeders (OF; 42, 31%) with RQ > 1 or non-over-feeders (NOF; 95, 69%) with RQ < 1. At baseline, there was no difference between groups in gender [female: 105 (76.6%), male: 32 (23.4%)], body mass index (BMI; OF: 46.8 ± 7.8 vs. NOF: 44.8 ± 7.4 kg/m2, p = 0.40), or baseline REE (OF: 1897 ± 622 vs. NOF: 1874 ± 579, p = 0.74), although OF were younger [mean age (OF: 47.1 ± 13.0 years vs. NOF: 43.1 ± 13.4; p = 0.009). At 6-month follow-up 94 patients [53.28%; OF: 35 (83%) vs. NOF: 59 (62%), p = 0.016] were seen and 48 [35.03%; OF: 23 (55%) vs. NOF: 25 (59%), p = 0.001] at 12-month follow-up. On preoperative psychological assessment, OF had a significantly higher rate of childhood neglect (OF: 28 (47.46%) vs. NOF: 40 (28.99%); p = 0.01). RESULTS: At 1 year postoperatively, the OF had a significantly higher BMI (OF: 34.3 ± 6.5 vs. NOF: 29.3 ± 5.1 kg/m2, p = 0.009). Differences in weight were not significant at 6-month (OF: 36.0 ± 6.5 vs. NOF: 33.5 ± 5.9 kg/m2, p = 0.07). There was no difference between type of operation and RQ group (RYGB; OF: 55 (75%) vs. NOF: 18 (25%) and SG; OF: 40 (62%) vs. NOF: 24 (38%), p = 0.14), nor in BMI loss after operation. CONCLUSION: Evidence of overfeeding in the preoperative period prior to bariatric surgery is associated with higher resultant BMI at 1 year. Calculation of the RQ with IC has prognostic significance in bariatric surgery, and calculation of REE based on assumed normal RQ potentiates error. It is unclear if overfeeding is purely behavioral or secondary to potentially reversible metabolic etiology.

Role of Adverse Childhood Experiences in the Onset of Overweight/Obesity.

PURPOSE OF REVIEW: The goal of this chapter was to summarize the literature on childhood adversity and obesity, discuss treatment implications with a case example, and provide recommendations for trauma-informed care for clinicians who work with individuals living with obesity. RECENT FINDINGS: Adversity in childhood is related directly and indirectly to obesity development. Upstream contributors like adverse childhood experiences (ACEs) and other factors can lead to experiences of toxic stress and increased allostatic load, resulting in downstream effects of obesity and other chronic health conditions. A well-established literature has linked ACEs and obesity suggesting complex interactions between genetic, biological, behavioral, mental health, social, and environmental factors and obesity. Trauma-informed care strategies can be used to optimize care for individuals living with obesity. Care pathways should include individual (clinician) and systemic (organizational) evidence-based interventions.

A prospective study of the relationship between illness perception, depression, anxiety, and quality of life in hematopoietic stem cell transplant patients.

AIM: The aim of study was to investigate whether depression and anxiety symptoms and illness perception prior to hematopoietic stem cell transplantation (HSCT) predict health related quality of life (HRQOL) at Day 100 and 1 year following HSCT. METHODS: A total of 205 patients who underwent HSCT (N = 127 autologous transplants, N = 78 allogeneic transplants) were included in this prospective study. Baseline assessment was assessed prior to transplantation and post HSCT data were collected at Day 100 and 1 year. At baseline we assessed depressive symptoms (Patient Health Questionnaire-9), anxiety symptoms (Generalized Anxiety Disorder-7), illness perception (Brief Illness Perception Questionnaire), and HRQOL (Functional Assessment of Cancer Therapy-BMT). RESULTS: Patients who expressed a greater level of concern about the severity, course, and ability to exert control over one's illness (i.e., illness perception) and who reported a greater level of depression and anxiety symptoms prior to HSCT reported lower HRQOL at both Day 100 and 1 year posttransplant, with a similar degree of association observed at the two follow-up time points. CONCLUSIONS: Our findings suggest that pretransplant perceptions about their illness and negative mood are significant predictors of HRQOL following HSCT. Illness perception, depression, and anxiety are potentially modifiable risk factors for less than optimal outcome after HCSCT and intervention strategies should be explored.

Loneliness, immunological recovery patterns, and health-related quality of life (HRQOL) outcomes in patients receiving hematopoietic stem cell transplantation.

PURPOSE: Loneliness may compromise health-related quality of life (HRQOL) outcomes and the immunological impacts of loneliness via neuroendocrinological mechanisms likely have consequences for patients who have undergone a hematopoietic stem cell transplantation (HSCT). RESEARCH APPROACH AND MEASURES: Loneliness (pre-transplant), immunological recovery (Day 30, Day 100, 1-year post-transplant), and HRQOL (Day 100, 1 year) were measured in a sample of 205 patients completing a HSCT (127 autologous, 78 allogenic). RESULTS: Greater levels of pre-transplant loneliness predicted poorer HRQOL at Day 100 and 1-year follow-up. Loneliness also was associated with higher absolute neutrophil to absolute lymphocyte (ANC/ALC) ratios in the entire sample at Day 30, which in turn was associated with Day 100 HRQOL. CONCLUSIONS: Findings demonstrate that pretransplant loneliness predicts HRQOL outcomes and associates with inflammatory immunological recovery patterns in HSCT patients. The balance of innate neutrophils to adaptive lymphocytes at Day 30 present a distinct profile in lonely individuals, with this immunity recovery profile predicting reduced HRQOL 100 days after the transplant. Addressing perceptions of loneliness before HSCT may be an important factor in improving immunological recovery and HRQOL outcomes.

Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery.

Weight regain after bariatric surgery is associated with problematic eating behaviors that have either recurred after a period of improvement or are new-onset behaviors. Problematic eating behaviors after bariatric surgery have been conceptualized in different ways in the literature, such as having a food addiction and experiencing a loss of control of eating. The intersection of these constructs appears to be driven overeating defined as patients' experiences of reduced control of their eating which results in overeating behavior. The purpose of this review is to define patient experiences of driven overeating through the behavioral expression of emotion-based eating, reward-based eating, and executive functioning deficits-namely impulsivity-which is associated with weight regain after having bariatric surgery. Delineating concepts in this way and determining treatment strategies accordingly may reduce distress related to the inevitable return of increased hunger, cravings, portion sizes, and tolerance for highly palatable foods after surgery. Along with standard behavioral weight maintenance strategies, topics including acceptance, motivation, emotion-based eating, reward-based/impulsive eating, physical activity, and self-compassion are discussed. These concepts have been adapted for patients experiencing weight regain after having bariatric surgery and may be particularly helpful in attenuating driven overeating and weight regain.

A pilot investigation of a multidisciplinary quality of life intervention for men with biochemical recurrence of prostate cancer.

OBJECTIVE: This pilot project evaluated the acceptability and estimated the effect size of a tailored multidisciplinary quality of life (MQOL) intervention for men who have biochemical recurrence of prostate cancer. METHODS: Participants included 57 men with localized prostate cancer with biochemical recurrence (Median=76 years; 89% White). Participants were randomized to wait list control which offered the intervention upon conclusion of the study (n=27) or to an eight-session group-based, MQOL (n=30) intervention. Assessments were completed at baseline, end of treatment, and 6 months post-treatment. RESULTS: MQOL was acceptable as indicated by favorable participant retention (100% retained), treatment compliance (97% attended > 6 treatment sessions), and high ratings of helpfulness (80% rated helpfulness > 4 on 5-point scale). MQOL had a favorable impact on the mental health composite score of the Short Form-36 at the end of treatment but not at 6 months (effect size=0.52 and -0.04); health-related QOL as measured by the Functional Assessment of Cancer Therapy-Prostate at the end of treatment and 6 months (effect size=0.14 and 0.10); and prostate cancer specific anxiety as measured by the Memorial Anxiety Scale for Prostate Cancer at the end of treatment and 6 months (effect size=0.45 and 0.23). CONCLUSIONS: This pilot project provides preliminary data supporting the premise that a tailored behaviorally based MQOL intervention for men with biochemical recurrence of prostate cancer is acceptable to men and might reduce prostate cancer specific anxiety and enhance QOL. Further research examining the efficacy of this intervention in a larger randomized trial is warranted.

Quality of life of patients undergoing surgical treatment for newly-diagnosed, clinically localized renal cell carcinoma.

This investigation sought to evaluate the psychological needs of individuals (N = 28) undergoing nephrectomy for newly diagnosed, localized renal cell carcinoma (RCC) using a mixed qualitative-quantitative approach. The qualitative component consisted of individual semi-structured interviews ≥4 weeks postnephrectomy. The quantitative component involved standardized measures assessing anxiety, depressive symptoms, psychological distress, and general and disease specific quality of life (QOL) prior to nephrectomy and at 4, 12, and 24 weeks postnephrectomy. This investigation provides a unique view of the experiences and needs of persons undergoing surgery for newly diagnosed, localized RCC and reveals that these individuals experience fatigue, anxiety, and depressive symptoms.

Addiction Transfer and Other Behavioral Changes Following Bariatric Surgery.

Despite its important treatment implications for obesity and related comorbidities, bariatric surgery requires several behavioral changes that warrant comprehensive evaluation and support before and after surgery. This article outlines emerging scientific and anecdotal evidence for addiction transfer after bariatric surgery. Other common behavioral changes that impact adherence, weight loss, and psychiatric risk after surgery are also reviewed. Last, recommendations for presurgical psychological evaluation and postoperative support are provided.

Validation of the Yale Food Addiction Scale 2.0 in Patients Seeking Bariatric Surgery.

BACKGROUND: The Yale Food Addiction Scale (YFAS) was developed in 2009 to assess food addiction (FA); a revised version was released in 2016 (YFAS 2.0). The objective of this study was to determine the statistical and clinical validity of the YFAS 2.0 in adults seeking bariatric surgery. METHODS: Patients who underwent a preoperative psychological evaluation in preparation for bariatric surgery from 2015 to 2018 were included. The YFAS 2.0 was administered as part of routine clinical care and validated against an assessment battery of standardized clinical measures. Statistical analyses included chi-square and Wilcoxon rank sum tests and calculation of Spearman's rank correlation coefficients. RESULTS: Overall, 1061 patients were included. Mean age and BMI were 47.5 ± 12.9 years and 46.9 ± 13.4 kg/m2, respectively. There were 196 (18%) patients who screened positive on the YFAS 2.0 (21% mild, 23% moderate, and 56% severe FA). The YFAS 2.0 demonstrated strong convergent validity where patients who met criteria for FA had significantly increased levels of binge eating (p < 0.001), emotional eating (p < 0.001), and lower self-efficacy (p < 0.001). Discriminant validity was demonstrated by lack of association with alcohol use (p = 0.319). The YFAS 2.0 was significantly correlated with total scores for depression (p < 0.001), anxiety (p < 0.001), bipolar disorder symptoms (p < 0.001), and trauma history (p < 0.001). CONCLUSIONS: The prevalence of FA in a large sample of patients seeking bariatric surgery was consistent with previous literature. These data suggest that the YFAS 2.0 is psychometrically valid, demonstrating strong construct validity, and is a clinically useful measure of FA severity in patients pursuing bariatric surgery.

Endoscopic sleeve gastroplasty and postprocedural nutritional deficiencies: results from a single center exploratory study.

Nutritional deficiencies following endoscopic sleeve gastroplasty (ESG) are unknown. We retrospectively studied nutritional deficiencies in 20 patients who underwent ESG at our institution. No subjects had preprocedural anemia, whereas 22.2% (N = 2/9) developed anemia at 12 months. Vitamin D deficiency developed in one subject post-ESG. Vitamin A, E, C and magnesium deficiencies developed in 8.3% (N = 1/12), 18.2% (N = 2/11), 14.3% (N = 1/7) and 10% (N = 1/10) of subjects, respectively, at 12 months. Vitamin B12 and B6 deficiencies were detected in 12.5 and 14.3% of the subjects at baseline, however, resolved at 12 months. There were no pre- or postprocedural deficiencies in zinc, selenium, copper, folate, thiamine, phosphorus or calcium. In this study, nutritional deficiencies were observed in a very small subset of patients at various time points after ESG.

Integrated smoking cessation and binge drinking intervention for young adults: a pilot investigation.

BACKGROUND: Alcohol consumption is strongly associated with cigarette smoking in young adults. PURPOSE: The aim of this study was to evaluate the acceptability and estimate the magnitude of the effect of a novel-integrated smoking cessation and binge-drinking intervention for young adults compared with standard treatment control. METHODS: Participants were 41 young adult smokers (≥ 10 cigarettes per day) who regularly (≥ 2 times per month) binge drank who were randomly assigned to standard treatment (n = 19) involving eight individual treatment visits plus 8 weeks of nicotine patch therapy or the identical smoking cessation treatment integrated with a binge-drinking intervention (integrated intervention; n = 22). RESULTS: Participants rated integrated intervention as highly acceptable as indicated by 100% of participants rating helpfulness as 5 on 5-point scale. Using an intent-to-treat analysis for tobacco abstinence, at both week 12 end of treatment and week 24 follow-up, more participants who received integrated intervention were biochemically confirmed abstinent from tobacco than those who received standard treatment (36% vs. 21% at week 12; 23% vs. 11% at week 24). At week 24, change from baseline in binge-drinking episodes, drinks consumed, and drinking days between treatment groups were similar (intent-to-treat analysis was not used for alcohol data). CONCLUSIONS: Preliminary data support the intriguing possibility that integrated intervention may enhance smoking cessation and reduce binge drinking.

Rethinking Patient and Medical Professional Perspectives on Bariatric Surgery as a Medically Necessary Treatment.

The prevalence of class 3 obesity (body mass index ≥40 kg/m2) is 7.7% of the United States adult population; thus, more than 25 million people may be medically appropriate for consideration of bariatric surgery as therapy for severe obesity. Although bariatric surgery is the most effective therapy for patients with severe obesity, the surgery is performed in less than 1% of patients annually for whom it may be appropriate. Patients' and medical professionals' misperceptions about obesity and bariatric surgery create barriers to accessing bariatric surgery that are not given adequate attention and clinical consideration. Commonly cited patient barriers are lack of knowledge about the severity of obesity, the perception that obesity is a lifestyle problem rather than a chronic disease, and fear that bariatric surgery is dangerous. Medical professional barriers include failing to recognize causes of obesity and weight gain, providing recommendations that are inconsistent with current obesity treatment guidelines, and being uncomfortable counseling patients about treatment options for severe obesity. Previous research has revealed that medical professional counseling and accurate perception of the health risks associated with severe obesity are strong predictors of patients' willingness to consider bariatric surgery. This article reviews patient and medical professional barriers to acceptance of bariatric surgery as a treatment of medical necessity and offers practical advice for medical professionals to rethink perspectives about bariatric surgery when it is medically and psychologically appropriate.

Effect of expressive writing as a treatment adjunct for reducing smoking cessation related weight gain in young adult smokers.

This investigation evaluated the effect of expressive writing on weight gain in young adults being treated for smoking cessation. This study was conducted between July 2001 and June 2005. Participants (N = 196) ages 18-24 years (M = 20.8, SD = 2.0 years), who were recruited from a large city in the southeastern United States were randomized to brief office intervention or expressive writing plus brief office intervention. The sample was 56% female, 93% Caucasian, smoked a mean of 18.1 cigarettes per day (SD = 6.1), and had a mean body mass index of 24.9 (SD = 5.6). Participants who received the expressive writing plus brief office intervention gained significantly less weight than those receiving the brief office interventions from week 3 to 24, but did not significantly differ at week 52. A limitation of this investigation relates to the fact that the impact of expressive writing on weight was an unanticipated treatment effect that was evaluated in post-hoc analyses. Although the findings suggest that expressive writing holds promise as a treatment adjunct to decrease weight gain associated with smoking cessation, further research is warranted.

Association of Adverse Childhood Experiences and Food Addiction to Bariatric Surgery Completion and Weight Loss Outcome.

INTRODUCTION/PURPOSE: Adverse childhood experiences (ACEs) are known risk factors for obesity and poor outcomes following weight loss interventions. ACEs are also associated with addictive behaviors and, potentially, food addiction (FA). This study examined the relationship between ACEs and FA, and their association to undergoing bariatric surgery and post-surgical weight loss outcomes. MATERIALS AND METHODS: Between June 2013 and January 2016, 1586 bariatric-surgery-seeking patients completed a psychological evaluation. During their evaluation, the patients were administered measures including the ACE questionnaire and the Yale Food Addiction Scale. RESULTS: 19.2% of those seeking bariatric surgery reported being the victim of childhood sexual abuse, and 22.1% reported being the victim of childhood physical abuse. An elevated ACE score corresponded to increased likelihood of screening positive for FA and more severe FA. When the type of ACE was analyzed separately, ACE was not associated with bariatric surgery completion or percent total weight loss (%TWL). Screening positive for FA corresponded to less %TWL 1 year post-surgery as the total number of ACEs increased, yet there was no association with %TWL 2 years post-surgery. The participants were classified into two groups, those positive for an ACE or FA versus those negative for both. Those who screened positive were significantly less likely to undergo bariatric surgery. CONCLUSION: Screening positive for experiencing ACEs was related to severity of FA, and screening positive for being the victim of either childhood abuse or FA reduced the likelihood of completing bariatric surgery. More research is needed to determine how these psychosocial factors might influence bariatric surgery outcomes.

Guiding Patients Toward the Appropriate Surgical Treatment for Obesity: Should Presurgery Psychological Correlates Influence Choice Between Roux-en-Y Gastric Bypass and Vertical Sleeve Gastrectomy?

BACKGROUND: Helping patients determine which type of bariatric surgery, Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG), may be the best treatment can be challenging. This study investigated psychological correlates and their influence on weight loss for patients who underwent RYGB or VSG. METHODS: Four hundred twenty-two patients (RYGB = 305; VSG = 117) completed screening questionnaires presurgery and underwent surgery between August 2012 and April 2015. Associations between demographics and questionnaires with percentage weight change were evaluated using multivariable linear regression models. RESULTS: Median age was 48 years and median BMI 45.3 kg/m2 presurgery. Median percentage changes in weight from baseline to years 1 and 2 follow-up were - 31.5% (range - 52.2 to - 9.2%) and - 31.2% (range - 50.0 to - 1.2%) for RYGB and 25.3% (range - 49.8 to - 4.7%) and - 23.3% (range - 58.9 to - 1.6%) for VSG, respectively. Linear regression models revealed that younger patients lost more weight than older patients at years 1 (RYGB p < 0.0001; VSG p = 0.0001) and 2 (RYGB p = 0.005; VSG p = 0.002). No psychological correlates were significantly associated with weight loss outcomes. Post hoc analyses comparing patients who had surgery to those in the same cohort who did not have surgery revealed significantly higher rates of depression (p < 0.001), anxiety (p < 0.001), binge eating (p = 0.003), night eating (p < 0.001), food addiction (p = 0.042), and lower self-efficacy (p < 0.001) among patients who did not have surgery. DISCUSSION: Patients who are psychologically higher functioning are more likely to complete the evaluation process and undergo bariatric surgery. For patients who had surgery, psychological correlates were not associated with weight loss outcome for either RYGB or VSG. Implications for surgical choice are discussed.

The relationship among food addiction, negative mood, and eating-disordered behaviors in patients seeking to have bariatric surgery.

BACKGROUND: Food addiction (FA) may be related to poor weight loss outcomes; however, the literature on food addiction in bariatric surgery-seeking populations is limited. OBJECTIVES: The aim of the present study was to identify the prevalence of FA in a bariatric surgery-seeking population and its association with mood, problematic eating behaviors, and substance use. The relationship between prebariatric surgery food addiction screening and postsurgical outcomes was assessed. SETTING: Academic medical center. METHODS: Adult outpatients (n = 923) seeking bariatric surgery underwent psychological evaluation between January 2012 and May 2014. Patients were administered the Yale Food Addiction Scale (YFAS) to assess FA. Of the original sample, 195 patients underwent Roux-en-Y gastric bypass surgery. Patients returned for medical follow-up at 6 (n = 169) and 12 (n = 113) months postsurgery; 26 (13%) patients at 6 months and 82 (42%) patients at 12 months were lost to follow-up or had not reached 1 year postsurgery. RESULTS: Fourteen percent of patients met FA criteria. Patients positive for FA were more likely to endorse greater levels of depression, anxiety, binge eating episodes, nighttime eating syndrome, and low eating self-efficacy. No relationship was observed between FA and current substance use. FA did not predict postoperative outcomes including weight loss, rehospitalization, or attendance at follow-up medical appointments. CONCLUSIONS: FA is related to psychological distress and eating disordered behaviors among bariatric patients. However, FA was not predictive of short-term (6-12 mo) bariatric surgery outcomes. Future research should determine how FA affects long-term postoperative outcomes and mood stability.

Changing weight-loss expectations: a randomized pilot study.

Participants in weight-loss programs expect unreasonably large weight losses and believe that such reductions will produce dramatic improvements in their lives. The failure to achieve such benefits may contribute to poor maintenance of lost weight. This randomized pilot study investigated a new cognitive-behavioral intervention designed to modify unrealistic expectations regarding weight loss and its likely impact on appearance, attractiveness, and self-esteem. Twenty-eight overweight and obese young women who completed 10 sessions of standard behavioral weight-loss treatment were randomly assigned to 10 additional sessions of either standard behavioral (SB) treatment or a reformulated cognitive-behavioral (RCB) treatment. At posttreatment, the RCB intervention produced more realistic weight-loss expectations, decreased participants' motivation to lose weight as a means of improving self-confidence, and increased their overall self-esteem, compared with the SB condition (all p's<.05). The mean posttreatment weight changes achieved in the SB (-6.2+/-4.5 kg) and RCB (-5.5+/-3.6 kg) conditions were equivalent, as were the amounts of weight regained during a 6-month follow-up (SB=2.3+/-2.7 kg; RCB=1.5+/-1.7 kg). Collectively, these findings indicate that the RCB intervention was effective in changing unrealistic weight-loss expectations, but it did not produce significantly better maintenance of lost weight than did the SB intervention.

Further statistical and clinical validity for the Weight Efficacy Lifestyle Questionnaire-Short Form.

Identifying barriers to long-term adherence to reduced energy intake and increased physical activity level is critically important for obese patients seeking weight loss treatment. Previous research has identified that one such barrier is low eating self-efficacy or poor confidence in one's ability to control eating behavior in the presence of challenging situations. Accordingly, a valid, brief measure of eating self-efficacy for longitudinal assessment of weight loss and regain is needed. The purpose of this study was to test the internal consistency and clinical validity of the Weight Efficacy Lifestyle Questionnaire-Short Form (WEL-SF). Participants were 1740 consecutive obese patients who presented for a psychological evaluation in consideration for bariatric surgery. Median BMI was 44.9 (range: 35.0-111.9), age 48.7years (range: 18.9-77.3years), and patients were predominantly female (71.1%) and Caucasian (90.8%). The median WEL-SF total score was 56 (range: 0-80) and Cronbach's alpha measuring internal consistency was 0.92 with a one-factor structure. In terms of clinical validation, lower WEL-SF total scores were significantly associated with higher rates of binge eating episodes (P<0.0001), food addiction severity and dependence (P<0.0001), night eating syndrome (P<0.0001), depression (P<0.0001), and anxiety (P<0.0001). In contrast, higher WEL-SF total scores were associated with higher weight management self-efficacy (P<0.0001) and motivation to make positive lifestyle changes (P<0.0001). Taken together, these findings suggest that the WEL-SF is a psychometrically valid clinically meaningful measure of eating self-efficacy.

Psychosocial factors and 2-year outcome following bariatric surgery for weight loss.

BACKGROUND: How psychosocial factors may impact on weight loss after bariatric surgery is not well understood. This lack of knowledge is problematic, because there is a high prevalence of psychosocial distress in patients seeking treatment for obesity in hospital-based programs. The purpose of this study was to examine the relationship between preoperative psychosocial factors and eventual weight loss. METHOD: Between 1987 and 1998, all individuals undergoing Roux-en-Y gastric bypass for weight loss in our institution had psychologic preoperative evaluations. Patients who were followed prospectively were studied. The relation of having received mental health treatment to percentage of excess weight loss at 2 years is examined using t-tests. RESULTS: 62 women and 18 men completed a 2-year follow-up. Patients who had received treatment for either substance abuse (n=10) or psychiatric co-morbidity (n=39) lost more weight compared with those without such histories (P<0.05, P <0.001 respectively). CONCLUSION: Given these results, it is plausible that a history of having received either psychiatric treatment for a disorder or counseling for substance abuse should not be a contraindication to bariatric surgery, and, in fact, may be prognostic of favorable outcome. Further research examining psychosocial factors and outcome from bariatric surgery is clearly warranted.