Background
The Attitudes Toward Persons with Obesity (ATOP) scale is widely used to assess stigmatization toward persons with obesity. The measure has previously been suggested to assess three ...facets—self-esteem, personality, and social difficulties—however, psychometric support for this has been inconsistent and warrants further study if the measure intends to be scored this way.
Objectives
Explore and confirm the factor structure of the ATOP in people assessed prior to bariatric surgery and reassessed 1 year postoperatively
Setting
Midwestern hospital in the USA.
Materials and Methods
Three-hundred sixteen people who were seeking bariatric surgery were assessed preoperatively, and 161 of those people were reassessed 1 year after surgery with a battery of measures including the ATOP. Exploratory factor analysis (EFA) was performed on ATOP data from a random split-half of people before surgery, and confirmatory factor analysis (CFA) was performed on the second randomly selected half. With the postoperative sample, a CFA was performed, testing the best-fitting model from the preoperative CFA findings.
Results
The EFA suggested a two-factor structure interpreted as self-esteem and personality/social difficulties. This structure was supported by CFA performed on the second randomly selected half of people at preoperative assessment and by CFA performed on people 1 year following surgery. Tests of measurement invariance suggested that the two-factor structure was similar at both time points.
Conclusions
Only two factors for the ATOP were empirically supported in the current sample (self-esteem and personality/social difficulties), which is slightly different from the three factors that were originally proposed when the measure was developed. This factor structure is supported both prior to bariatric surgery and 1 year after bariatric surgery.
Graphical abstract
This pilot study tested the efficacy of an Internet-administered smoking cessation treatment for overweight/obese smokers. Participants were 54 community volunteers with overweight/obesity who were ...regular smokers. Treatment consisted of 12 weeks of nicotine replacement therapy and randomization to Internet-administered cognitive behavioral treatment or health education. In-person assessments of key outcomes occurred at baseline, post-treatment, and at 24-week follow-up. Cessation rates did not differ across the two treatments (25.9% vs 18.5%). Participants receiving cognitive behavioral treatment gained less weight when abstinent than those receiving the standard treatment. Larger studies are needed to replicate these findings.
Objective
Externalized weight bias (EWB), directed towards others, and internalized weight bias (IWB), directed towards the self, are thought to exacerbate obesity and disordered eating and may be ...important factors to assess and understand among individuals seeking bariatric surgery. This study examined clinical correlates (pre-surgical BMI, depressive symptoms, weight self-efficacy, and shape/weight overvaluation) of both EWB and IWB among individuals presenting for bariatric surgery with and without regular loss-of-control eating (LOC eating).
Methods
A total of 316 adults presenting for bariatric surgery completed established self-report measures to assess EWB, IWB, depressive symptoms, weight self-efficacy, and core symptoms of disordered eating including LOC eating and overvaluation of shape/weight.
Results
IWB and EWB were not associated with pre-surgical BMI, age, or sex, but were both significantly higher among White than non-White participants. Adjusting for race, IWB and EWB were significantly associated with greater eating disorder psychopathology and depressive symptoms and with less weight-related self-efficacy. Participants who endorsed regular LOC eating (53.5% of the sample) endorsed significantly lower weight self-efficacy and higher IWB, EWB, depressive symptoms, and overvaluation of shape/weight.
Conclusions
Findings suggest that regular LOC eating is common among individuals seeking bariatric surgery and associated with a range of heightened eating disorder and psychosocial concerns including both IWB and EWB. Future research exploring the longitudinal significance of the relationship between these two forms of weight bias and LOC eating is indicated.
Purpose
Post-operative loss-of-control (LOC)-eating is a negative prognostic indicator for long-term outcomes following bariatric surgery. Emerging research suggests that night eating might also be ...associated with poorer post-operative outcomes. This study examined the co-occurrence and clinical features of night eating in patients with LOC-eating following bariatric surgery.
Methods
Participants were 131 adults who sought treatment for eating/weight concerns 6 months following sleeve gastrectomy. The Eating Disorder Examination (EDE) interview (Bariatric-Surgery-Version) assessed LOC-eating, regular night eating (at least weekly), and eating-disorder psychopathology. Participants completed the Night Eating Questionnaire (NEQ), Beck Depression Inventory (BDI-II), and the Pittsburgh Sleep Quality Index (PSQI).
Results
Approximately, 15% met screening criteria for night-eating syndrome based on the NEQ. Greater NEQ scores were associated significantly with race, lower percent total weight loss (%TWL), and greater EDE, BDI-II, and PSQI scores. Similar results were observed when comparing groups with regular night eating (21.4%) versus without (78.6%); adjusting for race and %TWL revealed similar findings.
Discussion
In post-bariatric patients with LOC-eating, 15% likely had night-eating syndrome and 21.4% engaged in regular night-eating behavior. The co-occurrence of LOC-eating and regular night eating following sleeve gastrectomy may represent a more severe subgroup with elevated psychopathology, poorer sleep and %TWL.
Level of evidence
Level III, evidence obtained from well-designed cohort or case–control analytic studies
Purpose
Food addiction (FA) is related to greater body mass index (BMI), eating-disorder psychopathology, food craving, and psychosocial impairment. Less is known regarding the utility of the FA ...severity specifiers, as measured by the number of symptoms endorsed on the Yale Food Addiction Scale (YFAS 2.0).
Methods
Participants (
N
= 1854) were recruited from Amazon Mechanical Turk to complete an online survey on eating behaviors. Participants completed self-report measures assessing FA, eating-disorder psychopathology (Eating Disorder Examination Questionnaire), and food craving (Food Craving Inventory). Based on the YFAS 2.0 specifiers, participants were classified into four FA groups: No FA (
n
= 1643), mild (
n
= 40), moderate (
n
= 55), and severe (
n
= 116).
Results
There were significant differences found in age, sex, BMI, and frequency of objective binge-eating episodes (OBEs) among the FA groups. Using ANCOVA, adjusted for multiple comparisons and covariates (e.g., BMI, sex, OBEs), the No FA group reported significantly lower levels of shape concern (
η
2
= 0.05;
p
< 0.001), weight concern (
η
2
= 0.04;
p
< 0.001), eating concern (
η
2
= 0.15;
p
< 0.001), and global eating-disorder psychopathology (
η
2
= 0.06;
p
< 0.001) than mild, moderate, or severe FA groups. The No FA group reported significantly lower levels of dietary restraint (
η
2
= 0.01;
p
< 0.01) than mild and severe FA groups. The severe FA group reported higher food craving scores (
η
2
= 0.02;
p
< 0.001) compared to the No FA group.
Conclusion
Our findings parallel the severity specifiers literature for eating and substance use disorders by also indicating the limited utility of severity specifiers based on symptom count. Future research should investigate alternative targets for discriminating among levels of FA.
Level of evidence
Level V, cross-sectional descriptive study.
Food addiction (FA) has been linked to clinical features in binge-eating disorder (BED) and obesity. A feature of behavioral weight loss (BWL) treatment involves frequent weighing. However, little is ...known regarding how frequency of self-weighing and related perceptions are associated with BWL outcomes among individuals with BED and obesity stratified by FA status. Participants (
= 186) were assessed with the Eating Disorder Examination before and after BWL treatment. Mixed effects models examined FA (presence/absence) before and after (post-treatment and 6- and 12-month follow-up) treatment and associations with frequency of weighing and related perceptions (reactions to weighing, sensitivity to weight gain and shape/weight acceptance). Participants with FA reported more negative reactions to weighing and less acceptance of shape/weight throughout treatment and follow-ups, and both variables were associated with greater disordered eating at follow-ups among participants with FA. Sensitivity to weight gain decreased over time independent of FA status. Frequency of weighing was associated with a greater likelihood of achieving 5% weight loss only among those without FA. Reactions to weighing and sensitivity to weight gain are associated with FA and poorer treatment outcomes in individuals with BED and obesity. Targeting these features may improve BWL outcomes among individuals with BED, obesity and FA.
Purpose
Motivational interviewing (MI) weight-loss interventions have garnered much attention, particularly in primary care. Few studies, however, have examined long-term outcomes of MI for weight ...loss in primary care. This study sought to examine the longer-term outcomes of a combination approach comprising MI and nutrition psychoeducation (MINP) with a publically available web-support component (i.e., livestrong.com).
Methods
Thirty-one adults with overweight/obesity were enrolled in a 3-month MINP treatment delivered in primary care by medical assistants. Weight, blood pressure, and depression (beck depression inventory) were assessed at baseline and 1-year following treatment cessation (i.e., 15 months total).
Results
Participants’ average BMI was significantly lower 12-months following treatment. Approximately one-third of participants (34.8%) maintained 5% or more weight loss. Participants also experienced significant decreases in diastolic blood pressure, resting heart rate, and depression symptoms, but not systolic blood pressure or waist circumference.
Conclusion
The scalable (2.5 h total) MINP intervention delivered in primary care by medical assistants resulted in significant weight (medium effect size) and psychological improvements 12 months later. These findings complement previous RCT findings that MI or nutrition psychoeducation interventions, delivered separately, resulted in small weight loss effects after 12 months, with 5% and 17% of participants, respectively, maintaining 5% weight loss. It remains unclear, however, if implementing MI in primary care for weight loss is cost effective beyond providing nutrition psychoeducation alone.
Clinical trial registration
The clinical trial registration number is NCT02578199.
Level of evidence
IV, uncontrolled trial.
Postoperative loss-of-control (LOC) eating is related to poorer weight loss outcomes after bariatric surgery, but little is known about LOC eating after sleeve gastrectomy surgery.
To examine LOC ...eating severity and weight loss after sleeve gastrectomy SETTING: University School of Medicine, United States METHODS: Participants were 71 individuals (84.5% female; n = 60) who underwent sleeve gastrectomy surgery within the previous 4 to 9 months and reported LOC eating at least once weekly during the previous 28 days. LOC eating was assessed using the Eating Disorder Examination (EDE) Bariatric Surgery Version. Current mean age and body mass index were 47.3 (SD = 10.1) years and 37.9 (SD = 8.2) kg/m
. Two groups, bariatric binge-eating disorder (Bar-BED) and loss-of-control eating only (LOC-only), were created based on modified binge-eating disorder (BED) criteria, which excluded the "unusually large quantity of food" criterion due to limited gastric capacity postsurgery. Bar-BED criteria mirrored BED criteria and consisted of the following: at least 12 LOC eating episodes over the prior 3 months (once weekly), 3 of 5 associated symptoms, marked distress over LOC eating, and lack of regular compensatory behaviors.
Based on these revised criteria, 49.3% (n = 35) were classified as the Bar-BED group and 50.7% (n = 36) as the LOC-only group. Compared with the LOC-only group, the Bar-BED group had significantly greater EDE global and subscale scores and lower percent weight loss by 6 months postsurgery.
Findings suggest LOC eating that parallels BED postsurgery is associated with poorer outcomes after sleeve gastrectomy including poorer weight loss and greater severity of eating-disorder psychopathology.
Abstract Objective The objective was to compare weight-bias attitudes among treatment-seeking obese patients with and without binge eating disorder (BED vs. NBO) and to explore racial and sex ...differences and correlates of weight-bias attitudes. Method Participants included 221 obese patients (169 female, 52 male) seeking treatment for weight and eating, recruited through primary care settings; of these, 168 patients met BED criteria. Patients completed semi-structured interviews and psychometrically established self-report measures of attitudes about obesity, eating pathology and depression. Results Main effects for group (BED vs. NBO) and race (White vs. African American) were significant. Patients with BED had significantly higher levels of negative attitudes towards obesity than NBO patients, while African American patients had significantly lower levels of weight bias than did White patients. Greater negative attitudes towards obesity were significantly correlated with higher levels of depression and eating pathology for all patients. Conclusions Endorsement of negative weight bias was related to binge eating status, race, disordered eating, and depression. Primary care providers should be aware of weight biases among their patients.
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