Does changing weight change pain? Retrospective data analysis from a national multidisciplinary weight management service.

BACKGROUND: Musculoskeletal (MSK) pain is common in obese populations. Multidisciplinary Tier 3 weight management services (WMS) are effective in reducing weight; however, MSK pain as an outcome is not routinely reported post-WMS interventions. METHODS: Following ethical approval this retrospective design study using anonymized data from a national WMS established changes in anthropometric and pain prevalence and intensity scores as well as establishing variables predictive of achieving clinically significant changes (CSC) in pain scores. RESULTS: Of the 806 patients registered to the WMS (January 2011-February 2015), 59% (n = 476; CI = 56-62) attended their reassessments at 6 months. The overall mean age was 45.1 ± 12 years and 62% (n = 294) were female. At baseline 70% (n = 281; CI = 65-75) reported low back pain (LBP) and 59% (n = 234; CI = 54-64) had knee pain. At reassessment 37.3% (n = 177) of patients lost ≥5% body weight, 58.7% (n = 279) were weight stable (5% weight loss or gain) and 4.0% (n = 19) gained ≥5% body weight. Low back and knee pain prevalence reduced significantly for those who lost ≥5% body weight. Variables predictive of a CSC in LBP numerical rating scale (NRS) score included a higher baseline NRS score, weighing more, and rating losing weight as being important (p < 0.05). Higher baseline NRS and being younger resulted in higher odds of a CSC in knee pain NRS (p < 0.05). CONCLUSIONS: Overall this WMS was effective for clinical weight loss. For those who lost most weight prevalence of knee and LBP reduced. Imbedding pain management strategies within WMS's may provide a more holistic approach to obesity management. SIGNIFICANCE: Weight loss can reduce musculoskeletal pain, particularly for those who lose more weight. Imbedding pain management strategies within these services may provide a more holistic approach to obesity management.

How Do Individuals Develop Alcohol Use Disorder After Bariatric Surgery? A Grounded Theory Exploration.

BACKGROUND: Bariatric surgery is the most effective treatment for severe obesity. However, following Roux-en-Y gastric bypass (RYGB) surgery, a small minority of patients develop new-onset alcohol use disorder (AUD), the aetiology of which is poorly understood. AIM: The aim is to construct a theory to explain the development of AUD among a sample of individuals who reported problematic drinking following RYGB. METHOD: Semi-structured interviews were conducted with eight RYGB patients diagnosed with AUD attending a multi-disciplinary outpatient weight management service at a public hospital in the Republic of Ireland. A constructivist grounded theory methodology was used to analyse interview transcripts. RESULTS: Participants' main concern was identified as 'unresolved psychological issues' which were managed by 'external coping mechanisms', namely, 'eating to cope'. After RYGB, comfort eating was no longer possible to the same extent. Following a 'honeymoon period', participants' need for an external coping mechanism resurfaced. 'Filling the void' provides a framework to explain how participants managed the symptoms of their unresolved psychological issues through 'behavioural substitution', that is, drinking alcohol instead of eating. CONCLUSION: The theoretical framework of 'filling the void' adds to contemporary research that conceptualises AUD behavioural substitution as 'addiction transfer' by describing the process by which the phenomenon occurs as well as the characteristics of participants. The clinical implication of this research is to advocate for a reshaping of treatment of RYGB patients, with increased psychological input following surgery.

Musculoskeletal pain profile of obese individuals attending a multidisciplinary weight management service.

Obesity is associated with numerous chronic diseases, including musculoskeletal (MSK) pain, which affects on quality of life (QoL). There is, however, limited research providing a comprehensive MSK pain profile of an obese cohort. This retrospective study used a patient database at a national weight management service. After ethical approval, anonymized patient data were statistically analyzed to develop a pain profile, investigate relationships between pain, sleep, and function, and explore variables associated with having low back pain (LBP) and knee pain. Overall, 915 individuals attended the weight management service from January 2011 to September 2015 [male, 35% (n = 318; confidence interval [CI] = 32-38); female, 65% (n = 597; CI = 62-68); mean age 44.6]. Mean body mass index was 50.7 kg/m [class III obese (body mass index ≥40 kg/m), 92% (n = 835; CI = 91-94)]. Approximately 91% reported MSK pain: LBP, 69% (n = 539; CI = 65-72) [mean Numeric Rating Scale 7.4]; knee pain, 58% (n = 447; CI = 55-61) [mean Numeric Rating Scale 6.8]. Class III obese and multisite pain patients had lower QoL and physical activity levels, reduced sleep, and poorer physical function than less obese patients and those without pain (P < 0.05). Relationships were found between demographic, pain, self-report, psychological, and functional measures (P < 0.05). Patients who slept fewer hours and had poorer functional outcomes were more likely to have LBP; patients who were divorced, had lower QoL, and more frequent nocturia were more likely to have knee pain (P < 0.05). Multisite MSK pain is prevalent and severe in obese patients and is negatively associated with most self-report and functional outcomes. This high prevalence suggests that pain management strategies must be considered when treating obesity.

Obesity, food restriction, and implicit attitudes to healthy and unhealthy foods: Lessons learned from the implicit relational assessment procedure.

It has been argued that obese individuals evaluate high caloric, palatable foods more positively than their normal weight peers, and that this positivity bias causes them to consume such foods, even when healthy alternatives are available. Yet when self-reported and automatic food preferences are assessed no such evaluative biases tend to emerge. We argue that situational (food deprivation) and methodological factors may explain why implicit measures often fail to discriminate between the food-evaluations of these two groups. Across three studies we manipulated the food deprivation state of clinically obese and normal-weight participants and then exposed them to an indirect procedure (IRAP) and self-report questionnaires. We found that automatic food-related cognition was moderated by a person's weight status and food deprivation state. Our findings suggest that the diagnostic and predictive value of implicit measures may be increased when (a) situational moderators are taken into consideration and (b) we pay greater attention to the different ways in which people automatically relate rather than simply categorize food stimuli.

Impaired decision making among morbidly obese adults.

OBJECTIVE: The Iowa Gambling Task (IGT) measures affective decision making and has revealed decision making impairments across a wide range of eating disorders. This study aimed to investigate affective decision making in severely obese individuals. METHODS: Forty-two (12 male, 30 female) morbidly obese participants (mean BMI = 41.45) and 50 comparison participants (17 male, 33 female) matched for age, gender and education, completed the IGT. RESULTS: Obese participants performed significantly worse on the IGT compared to the comparison group, with 69% of the obese group demonstrating clinically impaired decision making. There was no evidence of learning across the five trial blocks in obese participants, with significant differences between the groups emerging in blocks 3, 4, and 5. IGT impairment was unrelated to BMI or eating pathology. CONCLUSION: Obese participants were significantly impaired on the IGT. The pattern of performance suggested a potential inability to maximise an immediate reward or program a delayed reward. The findings support the view that common decision making impairments exist across disordered eating populations. Future research is required to specify the source and mechanisms of these decision making deficits. The logical progression of this research is the development of interventions which improve decision making capacity and measure subsequent impact on psychological and physical outcomes.