Development of a Multicomponent Intervention to Initiate Health Behavior Change in Primary Care: The Kickstart Health Program.

There is a growing movement to integrate behavioral health specialists into primary care settings in order to better manage patients' health behaviors. Group interventions in healthcare settings can provide services to multiple individuals simultaneously; however, the participants' experiences taking part in these activities and the logistics of integrating them into clinical settings are largely under-studied. This article describes the development and implementation of a novel group intervention for health behavior change, The Kickstart Health Program, which integrates components of cognitive, behavioral, acceptance, and experiential therapies. Participant feasibility, acceptability, experiences, and treatment course were assessed. Acceptability among a small sample of attendees was high, and initial data on behavior change suggest there were benefits to patients who attended the program. Increases in mindfulness practice and decreases in exercise barriers from baseline to 10-week follow-up were detected as were improvements in overall perceived health and well-being. Participants expressed that the program was acceptable and successful at helping them reach their individual health goals; however, enrollment barriers negatively impacted the feasibility of the program in regard to attendance. Modification to the enrollment process such as embedding referrals into the electronic medical record, encouraging spouse or family co-enrollment, and peer coaching may address these barriers. The Kickstart Health Program has the potential to improve health behaviors and paves the way for unique studies of dissemination and implementation of efficacious behavioral health interventions into real-world healthcare settings.

Racial Differences in Psychological Symptoms and Eating Behaviors Among Bariatric Surgery Candidates.

BACKGROUND: Black patients typically lose less weight than White patients following bariatric surgery; however, the reasons for this racial disparity are unclear. The purpose of the current study was to evaluate whether there are differences in psychiatric symptoms and problematic eating behaviors between White and Black patients pursuing bariatric surgery as this may aid in understanding postsurgical weight loss disparities and inform psychosocial assessment of bariatric candidates. METHODS: A retrospective chart review was conducted of participants (N = 284) who completed a psychological evaluation prior to surgery. Information collected included history of binge eating and purging as well as data from measures administered (i.e., the Hospital Anxiety and Depression Scale, the Emotional Eating Scale, and the Yale Food Addiction Scale 2.0). RESULTS: White patients reported higher levels of eating in response to anger/frustration (p = .03) and eating in response to depression (p = .01) than Black patients. White patients also reported more symptoms of food addiction, a difference that was trending toward significance (p = .05). No significant differences were found on measures of anxiety or depression. CONCLUSION: White patients appear to have higher levels of presurgical problematic eating as compared with Black patients pursuing bariatric surgery; thus, these measurements of problematic eating may not explain the racial disparity in outcomes. However, future research should determine whether measures are valid among diverse populations and identify additional factors that may contribute to racial disparities in bariatric outcomes.

Predictors of Alcohol Use after Bariatric Surgery.

Patients undergoing bariatric surgery are at risk for devloping an alcohol use disorder (AUD). The purpose of this study was to investigate pre-surgical psychosocial risk factors for post-surgical alcohol consumption and hazardous drinking. Participants (N = 567) who underwent bariatric surgery between 2014 and 2017 reported their post-surgical alcohol use. Information was collected from the pre-surgical evaluation including history of alcohol use, psychiatric symptoms, and maladaptive eating behaviors (i.e., binge eating, purging, and emotional eating). Younger age and pre-surgical alcohol use predicted post-surgical alcohol use and hazardous drinking. In addition, higher levels of depressive symptoms and maladaptive eating patterns predicted post-surgical binge drinking. Clinicians conducting pre-surgical psychosocial evaluations should be aware of the multiple risk factors related to post-surgical problematic alcohol use. Future research should evaluate whether preventive interventions for high-risk patients decrease risk for post-surgical alcohol misuse.

An Investigation of Racial Disparities in Weight Loss Outcomes: Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy.

OBJECTIVE: The current study aimed to test if racial disparities in weight loss outcomes between African American and Caucasian patients who underwent bariatric surgery were due to pre-surgical BMI differences. METHODS: Primary data was collected from pre-surgical evaluations conducted at a midwestern hospital. A retrospective chart review was conducted of 136 patients. Patient age and race, type of procedure, and pre- and 1-year post-surgical BMI were collected. RESULTS: African American patients were less likely to undergo bariatric surgery compared with Caucasian patients. Caucasian patients undergoing Roux-en-Y Gastric Bypass (RYGB) had a greater change in BMI compared with African American patients who underwent RYGB. Significant differences in weight loss outcomes were not found among patients who underwent the sleeve gastrectomy. Race was not related to pre-surgical BMI or procedure type. CONCLUSION: Despite pre-surgical BMI typically being higher among African American patients, this was not found in the current study. Pre-surgical BMI may not explain the racial disparities in weight loss post-bariatric surgery that are found between African American and Caucasian patients. Future studies should consider psychosocial, environmental, and cultural influences on racial disparities.

Health Literacy, Health Numeracy, and Cognitive Functioning Among Bariatric Surgery Candidates.

Inadequate health literacy or numeracy and probable cognitive impairment influence patients' medical outcomes. The study purpose was to examine the prevalence of inadequate health literacy, inadequate health numeracy, and probable cognitive impairment among bariatric surgery candidates and examine associations with undergoing bariatric surgery. Patients (N = 314) completed measures assessing these constructs during a required pre-surgical psychological evaluation. Approximately 9.6%, 24.2%, and 29.5% of the sample had inadequate health literacy, inadequate health numeracy, and probable cognitive impairment, respectively. In univariate analyses, those with inadequate levels of health literacy, inadequate health numeracy, and probable cognitive impairment were less likely to undergo surgery. In a multivariate model, inadequate health literacy independently predicted a lower likelihood of undergoing bariatric surgery. Findings underscore the importance of assessing these factors.