Associations between binge eating, depressive symptoms and anxiety and weight regain after Roux-en-Y gastric bypass surgery.

BACKGROUND: Weight regain (WR) after bariatric surgery (BS) is frequent. OBJECTIVE: The aim of this study was to evaluate whether the occurrence of psychiatric disorders would be associated with short- and long-term WR after BS. METHODS: Ninety-six patients (77.6% female, age 40.2 ± 10.1 years, BMI of 50 ± 8.2 kg/m2) from the Obesity and Bariatric Surgery Outpatient Clinic of the Universidade Federal São Paulo completed the Questionnaire on Eating and Weight Patterns-Revised, the Beck Depression Inventory and an anxiety inventory to assess the occurrence of binge eating, depressive symptoms (DS) and anxious symptoms (AS) before and after short-term and long-term BS. RESULTS: Twenty-four months after BS, the prevalence of binge eating, depression and anxiety decreased from 100 to 13%, 100 to 15% and 43 to 4%, respectively. The mean WR of 35.2 ± 17.3% of weight loss occurred in nine patients after 24 months and was associated with binge eating (p = 0.002) but not with DS or AS. At long-term follow-up (12 ± 1.5 years), 67% had a mean WR of 50.3 ± 24.9%. The prevalence of binge eating, DS and AS were 48%, 46% and 63%, respectively, in this group, and significant associations were observed between WR and binge eating (p = 0.001), DS (p = 0.029) and AS (p = 0.001). Furthermore, the number of psychiatric disorders was inversely associated with the percentage of weight loss (p < 0.05) and positively associated with WR (p < 0.05). CONCLUSION: Weight regain was associated with the occurrence of binge eating in the short and long term after BS, whereas the occurrence of depressive and anxious symptoms was associated with WR only in the long term. LEVEL III: Evidence obtained from well-designed cohort or case-control analytic studies.

Binge eating disorder is not predictive of alcohol abuse disorders in long-term follow-up period after Roux-en-Y gastric bypass surgery.

INTRODUCTION: Some studies have shown an increase in alcohol use disorders (AUD) after Roux-en-Y gastric bypass surgery (RYGB), but its relationship with binge eating disorder (BED) has not been fully explored. The purpose of this study was to determine the prevalence of AUD and BED after RYGB and also to evaluate if BED is predictive of late postoperative occurrence of AUD or BED. METHODS: Patients (n = 46) submitted to RYGB, in a tertiary outpatient weight management service at a Federal University of Sao Paulo, Brazil, were tested for BED and AUD using the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and AUDIT, respectively. BED was tested before surgery, while both disorders were evaluated with a follow-up period of 12 ± 1.6 years after RYGB. RESULTS: No patients reported AUD before RYBP. After a mean period of 12 years from surgery, ten patients (21.7%) were diagnosed with AUD. Before surgery, BED was present in 24 patients (52.2%) and it was detected in seven out of these 24 patients (29.2%) after RYGB. Thirteen new cases of BED (28.2%) were detected after surgery; total of 20 patients (43.5%) with BED. No association was found between pre- and postsurgery BED (p = 0.148). After RYGB, four out of 24 patients (16.6%) with presurgery BED developed AUD, and no association was found between presurgery BED and postsurgery AUD (p = 0.384). Seven out of ten patients (70%) with AUD after RYGB also developed BED, but no statistical significance was found between these two disorders (p = 0.061). CONCLUSION: The presence of BED before RYGB did not predict AUD and BED after RYGB. Nevertheless, factors involved in a possible association between BED and AUD after surgery remain to be determined. LEVEL OF EVIDENCE: Level III, cohort study.

Do diagnostico a acao: Programa de Atividades para o Paciente obeso (PAPo) - uma abordagem interdisciplinar com adolescentes / From diagnosis to action: Program of Activities for the obese Patient (PAPo) - an interdisciplinary approach with adolescents

O Programa de Atividades para o Paciente Obeso aplica uma abordagem interdisciplinar de intervencao para tratamento do excesso de peso em mocas adolescentes, focado na mudanca de comportamentos e habitos de vida. As atividades, realizadas em 32 semanas de intervencao, sao fundamentalmente educacionais e de suporte as mudancas, buscando utilizar estrategias motivadoras e interessantes para as jovens. Atualmente, o programa oferece as adolescentes atividades nas areas de Educacao Fisica, Modalidades Esportivas, Educacao Nutricional, Psicologia e Percepcao Corporal, todas realizadas em grupo. Mensalmente, ha reunioes de aconselhamento comportamental com os familiares, para que possam interferir positivamente nos habitos das mocas. Alem disso, ocorrem alguns eventos pontuais como caminhada no parque, gincana no mercado municipal e oficina de maquiagem. Tambem fazem parte do programa avaliacoes pre e pos-intervencao. Desta forma, espera-se contribuir para que as mudancas de comportamentos e habitos de vida sejam alcancaveis, assim como sua manutencao.

The Program of Activities for the Obese Patient applies an interdisciplinary intervention approach for treatment of overweight adolescent girls, focusing behaviors and lifestyle changes. The activities, carried out at 32 weeks of intervention, are primarily educational and supportive, seeking to use motivational and interesting strategies for young people. Currently, the program offers activities of Physical Education, Sports, Nutritional Education, Psychology, and Body Perception, all performed in group. Monthly, there are meetings of behavioral counseling with family members, so they can positively affect the habits of hers girls. In addition, there are events such as walking in parks, contests in municipal markets and make-up workshops. It is also part of the program pre and post intervention evaluations. Thus, to contribute to enable attainable behavior and lifestyle changes, as well as its maintenance, are expectations of the program.