Fear of hypoglycemia in patients with type 2 diabetes: The role of interoceptive accuracy and prior episodes of hypoglycemia.

OBJECTIVE: Fear of hypoglycemia (FoH) is a limiting factor for diabetes self-management and can have detrimental effects on quality of life. However, relatively little is known about its underlying mechanisms. In line with findings on patients with anxiety disorders, we hypothesized that interoceptive accuracy (IA) might be positively linked to FoH in patients with type 2 diabetes (T2DM). METHODS: 133 patients with T2DM were screened according to the extreme quartiles of the Hypoglycemia Fear Survey worry subscale (HFS-W). Overall, 66 participants (HFS-W<4; HFS-W>17) were included in the present study. Participants completed questionnaires on sociodemographic and diabetes-related measures. Accuracy of heartbeat perception was assessed using the mental tracking task. RESULTS: Contrary to expectations, IA did not differ significantly between patients with low and high FoH. A linear regression analysis demonstrated that the experience of mild hypoglycemia (ß=0.32, p≤0.01) and its interaction with IA (ß=-0.26, p=0.040) were significant predictors of FoH, indicating that low IA and a history of experiencing mild hypoglycemia are positively associated with FoH. CONCLUSION: Our findings suggest a positive association of low IA in combination with prior episodes of hypoglycemia and FoH in patients with T2DM. The results are in line with recent findings on IA in patients with chronic somatic symptom distress more generally and contribute to our understanding of the relations between interoception, body related fears, and physical symptom perception.

Differences in the nature of body image disturbances between female obese individuals with versus without a comorbid binge eating disorder: an exploratory study including static and dynamic aspects of body image.

Various components of body image were measured to assess body image disturbances in patients with obesity. To overcome limitations of previous studies, a photo distortion technique and a biological motion distortion device were included to assess static and dynamic aspects of body image. Questionnaires assessed cognitive-affective aspects, bodily attitudes, and eating behavior. Patients with obesity and a binge eating disorder (OBE, n = 15) were compared with patients with obesity only (ONB; n = 15), to determine the nature of any differences in body image disturbances. Both groups had high levels of body image disturbances with cognitive-affective deficits. Binge eating disorder (BED) participants also had perceptual difficulties (static only). Both groups reported high importance of weight and shape for self-esteem. There were some significant differences between the groups suggesting that a comorbid BED causes further aggravation. Body image interventions in obesity treatment may be warranted.

Obesity and quality of life: a controlled study of normal-weight and obese individuals.

BACKGROUND: Obesity is a major public health problem that is associated with substantial morbidity and mortality. OBJECTIVE: The authors investigated the associations between health-related quality of life (HRQL) and Body Mass Index (BMI), gender, age, mental and somatic disorders, as well as therapy-seeking status. METHOD: A cross-sectional controlled study assessed 640 male and female individuals, clustered into four weight categories. RESULTS: Linear-regression analyses revealed that higher BMI, higher age, and higher numbers of current somatic and mental disorders negatively predicted the physical dimension of HRQL. Higher numbers of both mental and somatic disorders as well as female gender and younger age seemed to be independent negative predictors of mental HRQL, whereas BMI was not associated with mental HRQL. Therapy status was not related to mental or physical HRQL. CONCLUSION: Physical and mental disorders are important detrimental factors for both physical and mental dimensions of HRQL.

Depression and anxiety: their predictive function for weight loss in obese individuals.

OBJECTIVE: To investigate the impact of current mental disorders on weight loss with special consideration of depressive and/or anxiety disorders as well as binge eating behavior in obese individuals undergoing different weight loss treatments. METHODS: Three different samples of obese individuals were investigated in a prospective, longitudinal study: participants in a conventional weight loss treatment program (CONV TREAT; n = 250), obesity surgery patients (OBES SURG; n = 153), and obese control individuals (OC; n = 128). Current mental disorders and BMI were assessed at baseline and at 4-year follow-up. RESULTS: OBES SURG patients with a depressive and/or anxiety disorder lost significantly less weight compared with those without a comorbid mental diagnosis. This result was not detected for CONV TREAT participants. A trend to gain weight was seen in OC participants with a depressive and/or anxiety disorder, whereas OC participants without current mental disorders at baseline lost some weight. Binge eating behavior at baseline did not predict weight loss at 4-year followup. CONCLUSIONS: These results underline the importance of addressing current depressive and anxiety disorders in obese patients, especially when such patients are undergoing obesity surgery.

Changes in depression following gastric banding: a 5- to 7-year prospective study.

BACKGROUND: Long-term outcomes of gastric banding regarding depression and predictors of change in depression are still unclear. This prospective, controlled study investigated depression and self-acceptance in morbidly obese patients before and after gastric banding. METHODS: A total of 248 morbidly obese patients (mean body mass index [BMI] = 46.4, SD = 6.9) seeking gastric banding completed questionnaires for symptoms of depression (Beck Depression Inventory) and self-acceptance. One hundred twenty-eight patients were treated with gastric banding and 120 patients were not. After 5 to 7 years, patients who either had (n = 40) or had not (n = 42) received gastric banding were reassessed. RESULTS: In the preoperative assessment, 35% of all obese patients suffered from clinically relevant depressive symptoms (BDI score > or =18). The mean depression score was higher and the mean self-acceptance score was lower than those of the normal population. Higher preoperative depression scores were observed among patients living alone and who had obtained low levels of education. After 5 to 7 years, patients with gastric banding had lost significantly more weight than patients without gastric banding (mean BMI loss 10.0 vs. 3.3). Gastric banding patients improved significantly in depression and self-acceptance, whereas no change was found in patients without gastric banding. Symptoms of depression were more reduced in patients who lost more weight, lived together with a partner, and had a high preoperative depression score. CONCLUSION: Morbid obesity is associated with depressive symptoms and low self-acceptance. Gastric banding results in both long-term weight loss and improvement in depression and self-acceptance.