Psychosocial variables, eating behavior, depression, and binge eating in morbidly obese subjects.

OBJECTIVES: Binge eating disorder (BED) is a frequent and significant psychiatric comorbidity among patients seeking treatment for obesity. The purpose of this study was to determine whether morbidly obese subjects with BED differ from those without BED (NBED) in terms of eating behavior, social/environmental variables, and depression. RESEARCH METHODS AND PROCEDURES: Out of 110 morbidly obese (BMI > or = 40 kg/m2) subjects, 88 could be reliably classified as BED (19) or NBED (69). These subjects (age 42.0+/-13.4 years, BMI 47.0+/-5.7 kg/m2) were examined by a semi-structured interview and by validated questionnaires to assess depression and eating behavior. RESULTS: Subjects with BED showed higher scores of disinhibited eating (12.3+/-2.7 vs. 9.1+/-3.6, p<0.05), were more likely to attribute obesity to their eating habits (chi2=8.4, p<0.05), and rated their social environment regarding relationships as less supportive and cohesive (chi2=10.6, p=0.001). In addition, patients with BED experienced an earlier onset of obesity (chi2=6.3, p<0.05). No relationship, however, was found between binge eating disorder and depression. DISCUSSION: Morbidly obese patients with BED exhibit typical psychological features when compared to those without BED. Their recognition by a structured psychological evaluation in conjunction with questionnaires might be necessary to develop appropriate therapeutic strategies to facilitate weight loss.

One-year experience with Tantalus: a new surgical approach to treat morbid obesity.

BACKGROUND: Increased caloric density in modern processed foods may be an important factor underlying the prevalence of obesity, because low-volume, high-caloric food intake may delay activation of volume-dependent gastric mechanical activity known to induce the feeling of fullness. We therefore hypothesized that enhancement of gastric contractions by electrical stimulation at an early stage of the meal will reduce food intake and body weight in morbidly obese subjects. METHODS: The study was a prospective, non-randomized, open-label, single-center trial. 12 subjects (age 36.1 +/- 2.8 years, BMI 43.2 +/- 2.7 kg/m(2), weight 128.8 +/- 5.2 kg, means+/-SEM) underwent laparoscopic implantation with the Tantalus system. A pulse generator with 3 bipolar leads was implanted: 2 pairs in the antrum and a 3rd pair in the fundus. The system was activated at week 6. All subjects were followed for 20 weeks and 9 of them for 52 weeks. RESULTS: All subjects finished the initial 20-week observation period. Following activation of the Tantalus System, a reduction (P<0.05) in hunger and an increase in cognitive control (P<0.05) as assessed by the Three-Factor Eating Questionnaire (TFEQ) could be observed. Body weight decreased (P<0.05) from 128.8+/-5.2 to 119.9+5.9 (17.6+4.3% EWL, N=12) after 20 weeks (14 weeks of treatment). In the 9 subjects continuing for 52 weeks (46 weeks of treatment), body weight further decreased to 112.4 +/- 3.8 kg (26.6 +/- 8.5 %EWL, N=9). Blood pressure decreased (P<0.05) from 142 +/- 6.1/91 +/- 3.2 to 125.5 +/- 4.0/83 +/- 2.6 mmHg by week 20 and 128.8 +/- 3.8 / 86.3 +/- 3.6 mmHg after 1 year. The frequency and severity of device and/or procedure-related adverse events indicate that the method is safe and well-tolerated. CONCLUSION: This data suggests that gastric stimulation by the minimally invasive Tantalus System is safe and leads to favorable changes in eating behavior, clinically significant weight loss and reduction in blood pressure. Treatment with the Tantalus System is therefore a promising minimally invasive treatment for obesity.