Emotion processing and regulation in women with morbid obesity who apply for bariatric surgery.

Emotional eating, the tendency to eat when experiencing negative affect, is prevalent in morbid obesity and may indicate that ways to deal with emotions are disturbed. Our aim was to compare emotion processing and regulation between 102 women with morbid obesity who apply for bariatric surgery and 102 women from the general population (control group) and to examine in the group with morbid obesity the association of emotion processing and regulation with emotional eating. The group with morbid obesity reported higher scores on difficulty identifying feelings (alexithymia, p = 0.002) and suppression of emotions (p = 0.003) than the control group. In the women with morbid obesity, more negative affect and a higher difficulty identifying feelings were correlated with more emotional eating (r = 0.36 and r = 0.35, p < 0.001). Our study suggests that negative emotions and unhealthy emotion processing may play a role in emotional eating, and it indicates the possible relevance of emotion processing and emotional regulation as initiating or perpetuating mechanisms in morbid obesity.

Physical activity after surgery for severe obesity: the role of exercise cognitions.

BACKGROUND: Physical activity after bariatric surgery is associated with sustained weight loss and improved quality of life. Some bariatric patients engage insufficiently in physical activity. This may be due to exercise cognitions, i.e., specific beliefs about benefits of and barriers to physical exercise. The aim of this study was to examine whether and to what extent both physical activity and exercise cognitions changed at 1 and 2 years post-surgery and whether exercise cognitions predict physical activity. METHODS: Forty-two bariatric patients (38 women, 4 men; mean age 38 ± 8 years, mean body mass index prior to surgery 47 ± 6 kg/m(2)) filled out self-report instruments to examine physical activity and exercise cognitions pre- and post-surgery. RESULTS: A large increase in physical activity and favorable changes in exercise cognitions were observed after surgery, viz. a decrease of fear of injury and embarrassment and an increase of the perception of exercise benefits and confidence in exercising. Perceiving less exercise benefits and having less confidence in exercising before surgery predicted less physical activity 2 years after surgery. High fear of injury 1 year after surgery predicted less physical activity 2 years after surgery. CONCLUSIONS: After bariatric surgery, favorable changes in physical activity and beliefs about the benefits and barriers of exercising are observed. Our results suggest that targeting exercise cognitions before and after surgery might be relevant to improve physical activity.

Conversion to gastric bypass in patients with unsuccessful weight loss after gastric banding may depend on mental quality of life.

BACKGROUND: A low quality of life has been regarded a cue to action. Some patients with unsuccessful weight loss after laparoscopic adjustable gastric banding (LAGB) undergo a conversion of gastric banding to gastric by-pass. This study examines whether patients who did or did not undergo conversion to gastric bypass differed in quality of life before and after gastric banding. METHODS: Of 34 patients with unsuccessful weight loss after gastric banding (excess body mass index loss < 25%), 14 had a conversion to gastric bypass 2 years or more after gastric banding. All patients completed the RAND-36 quality of life questionnaire before gastric banding. After gastric banding, 24 patients (70.6%) filled out the RAND-36 at 6, 12, and 24 months. RESULTS: Pre-banding and postbanding mental quality of life was lower in the conversion compared to the non-conversion group. CONCLUSION: Our results suggest that a relatively stable lower mental quality of life is a signal for further intervention. The bariatric team and patients should be aware that mental health may play a role in the decision for conversion to gastric bypass. The possible mechanisms underlying this finding, and limitations of the study are discussed.

Initiation and maintenance of weight loss after laparoscopic adjustable gastric banding. The role of outcome expectation and satisfaction with the psychosocial outcome.

BACKGROUND: A premise of this study was that different psychological processes would predict the initiation and maintenance of weight loss after surgery for morbid obesity. Our aim was to examine whether more favorable preoperative expectations of psychosocial outcomes predict weight loss in the first year after laparoscopic adjustable gastric banding (LAGB) and whether postoperative satisfaction with these outcomes predicts weight maintenance in the second year after the operation. METHODS: Six months before and 1 year after surgery, the "Obesity Psychosocial State Questionnaire" was filled out by 91 patients (77 female, 14 male, mean age 45+/-9 years, mean preoperative body mass index 47+/-6 kg/m2). We evaluated the preoperative outcome expectations and the postoperative satisfaction for the seven domains of psychosocial and physical functioning of this questionnaire, as well as the correlations between these scores and both weight loss and weight maintenance. RESULTS: Patients showed high satisfaction with psychosocial outcomes after LAGB in all seven domains (p<0.001), even though the improvement was less than expected in five of the domains (p

Patients' explanations for unsuccessful weight loss after laparoscopic adjustable gastric banding (LAGB).

OBJECTIVE: Not all morbidly obese patients attain sufficient weight loss after laparoscopic adjustable gastric banding (LAGB). We examined patients' explanations for unsuccessful weight loss and self-awareness regarding food intake. METHODS: Interviews with 11 patients (10 female/1 male; mean age 46 years) with unsuccessful weight loss were transcribed and analyzed with the MAXqda2 program. RESULTS: Interviewees were disappointed with the postoperative outcome. Some showed no awareness of their own role, while others were inefficacious to continue the actions needed to maintain weight loss, especially during times of stress. Typical statements that distinguished interviewees were: 'It didn't work out', 'I don't care anymore', 'I know I have to do it', 'I know I can do it'. CONCLUSION: Some patients with unsuccessful weight loss after LAGB are insufficiently aware that their own effort is needed to maintain weight loss. Others have self-awareness, but find it difficult to turn awareness into action. PRACTICE IMPLICATIONS: This group could perhaps be helped by tailoring postoperative guidance to the stage of change of an individual patient. Counseling could include increasing awareness of the need to self-control eating and offering assistance to turn intentions into action and to deal with stress, emotions and physical problems.

The association between weight loss and self-regulation cognitions before and after laparoscopic adjustable gastric banding for obesity: a longitudinal study.

BACKGROUND: The outcome of restrictive types of bariatric operation might be affected by cognitions (beliefs) about one's capability to regulate eating behavior. Our aim was to examine the association between weight loss and self-regulation cognitions before and after laparoscopic adjustable gastric banding for morbid obesity or severe obesity with serious comorbidity. METHODS: Six months before and 1 year after the operation, the Obesity Cognition Questionnaire and an eating behavior self-efficacy scale were completed by 77 patients: 68 women, 9 men, mean age 43 years (range, 27-62 y), mean preoperative body mass index 47 kg/m(2) (range, 36-63 kg/m(2)). Pearson correlations were calculated and t tests and effect size calculations were used to examine preoperative to postoperative changes of self-regulation cognitions. RESULTS: The mean body mass index 1 year after the operation was 38 kg/m(2) (range, 25-55 kg/m(2)). Self-regulation cognitions did not predict weight outcome, but the self-regulation cognitions time-line (ie, the attitude about the prognosis of one's overweight, P < .001), psychologic consequences (P = .002), and self-efficacy (P < .001) changed in a positive way 1 year after the operation. CONCLUSIONS: Intake screening of self-regulation cognitions is of little use for prediction of short-term weight outcome after bariatric operation. It is suggested that beliefs about one's capability to control eating behavior change after the operation.