Feasibility and Effectiveness of a Comprehensive Care Program for People Living with Obesity: A Real-World Experience in a Public Hospital in Mexico.

INTRODUCTION: Existing evidence indicates that the best treatment model for obesity leading to successful weight loss consists of a so-called comprehensive lifestyle intervention program, but the offer, implementation, and coverage of these kinds of programs for the diagnosis, management, and follow-up of people living with obesity are limited. So, the aim of this study was an evaluation of the feasibility and effectiveness of a comprehensive care program for obesity in a public tertiary hospital in Mexico. METHODS: An observational, longitudinal, and retrospective study evaluated a six-month long medium-intensity comprehensive care program (seven visits focused on medical, nutritional, psychological, and psychiatric diagnosis and treatment). A total of 1,017 people living with obesity were recruited for the program. Logistic regression models were used to predict the factors associated with attendance and weight loss. RESULTS: Of the 1,017 participants, 661 completed the program (65% retention rate) and attended 4.9 ± 1.9 visits each, with 40.1% losing ≥5% of their starting weight (X = 4.3 ± 4.4%). From visit 1 to visit 7, the participants that completed the program had weight decreases of Δ = -4.8 kg and body mass index (BMI) -2.3 kg/m2; p < 0.01. Each additional visit increased the likelihood of a 5% weight loss [OR 1.90, 95% CI: 1.51-2.38, p < 0.001] and 10% [OR 2.45, 95% CI: 1.49-4.02, p < 0.001], becoming statistically significant after attending more than four visits. Each additional year of age increased the likelihood of losing ≥5% body weight [OR 1.01, 95% CI: 1.00-1.03, p < 0.05] and increased the likelihood of completing the program [OR 1.02, 95% CI: 1.00-1.03, p < 0.01] after controlling for sex, weight, BMI, and psychiatric and weight loss medications. DISCUSSION/CONCLUSION: This study demonstrates the feasibility and effectiveness of a six-month comprehensive program for obesity in a public hospital in Mexico.

Patient motivation to lose weight: Importance of healthcare professional support, goals and self-efficacy.

BACKGROUND: People with obesity (PwO) often struggle to achieve and maintain weight loss. This can perpetuate and/or be influenced by feelings of low motivation. This analysis from ACTION-IO data identified factors associated with PwO motivation to lose weight. METHODS: PwO completed an online survey in 11 countries. Exploratory multinomial logistic regression analyses identified independent variables associated with self-report of feeling motivated versus not motivated to lose weight. RESULTS: Data from 10,854 PwO were included (5,369 motivated; 3,312 neutral; 2,173 not motivated). Variables associated with feeling motivated versus not motivated included (odds ratio [95% confidence interval]): acknowledgement of healthcare professional (HCP) responsibility to contribute to weight loss (2.32 [1.86-2.88]), comfort in talking to their HCP about weight (1.46 [1.24-1.72), agreement that it is easy to lose weight (1.73 [1.30-2.31]), and a goal of reducing risks from excess weight (1.45 [1.22-1.73]). Conversely, if PwO considered obesity less important than other diseases they were less likely to report feeling motivated (0.49 [0.41-0.58]). PwO who reported being motivated to lose weight were more likely to exercise ≥5 times a week versus <1 time a week (2.77 [2.09-3.68]) than those who reported they were not motivated. CONCLUSIONS: Positive interactions with HCPs, self-efficacy, setting goals and knowledge of the importance of weight management, in addition to regular exercising, may increase PwO motivation for weight loss. Appropriate HCP support may help PwO who are ready to engage in weight management. CLINICAL TRIAL REGISTRATION: NCT03584191.

The 3Ds - Discussion, diagnosis and direction: Elements for effective obesity care by healthcare professionals.

BACKGROUND: The care of people with obesity is often suboptimal due to both physician and patient perceptions about obesity itself and clinical barriers. Using data from the ACTION-IO study, we aimed to identify factors that might improve the quality of obesity care through adoption of the 3D approach (Discussion, Diagnosis and Direction [follow-up]) by healthcare professionals (HCPs). METHODS: An online survey was completed by HCPs in 11 countries. Exploratory beta regression analyses identified independent variables associated with each component of the 3D approach. RESULTS: Data from 2,331 HCPs were included in the statistical models. HCPs were significantly more likely to initiate weight discussions and inform patients of obesity diagnoses, respectively, if (odds ratio [95% confidence interval]): they recorded an obesity diagnosis in their patient's medical notes (1.59, [1.43-1.76] and 2.16 [1.94-2.40], respectively); and they were comfortable discussing weight with their patients (1.53 [1.39-1.69] and 1.15 [1.04-1.27]). HCPs who reported feeling motivated to help their patients lose weight were also more likely to initiate discussions (1.36 [1.21-1.53]) and schedule follow-up appointments (1.21 [1.06-1.38]). By contrast, HCPs who lacked advanced formal training in obesity management were less likely to inform patients of obesity diagnoses (0.83 [0.74-0.92]) or schedule follow-up appointments (0.69 [0.62-0.78]). CONCLUSION: Specific actions that could improve obesity care through the 3D approach include: encouraging HCPs to record an obesity diagnosis; providing tools to help HCPs feel more comfortable initiating weight discussions; and provision of training in obesity management. CLINICAL TRIAL REGISTRATION: NCT03584191.

Sensitivity, specificity, and cut-off points in the Brief Questionnaire for Measuring Disordered Eating Behaviors in Mexican Women.

BACKGROUND: Evidence suggests that disordered eating behaviors can result in eating disorders, which is already a reality for the Mexican population, representing an increasingly complex public health problem. Early detection is therefore essential. AIM OF THE STUDY: To obtain the sensitivity, specificity, and cut-off points of the Brief Questionnaire for Measuring Disordered Eating Behaviors to identify eating disorders in Mexican women. METHODS: The Eating Disorders Examination-Questionnaire and the Brief Questionnaire for Disordered Eating Behaviors were applied to patients diagnosed with eating disorders at two public health institutions and university students. ROC analysis was performed to determine sensitivity, specificity, predictive values, and cut-off points. RESULTS: Three cut-off points were obtained: first: eight points (Sensitivity = 60.7%, Specificity = 92.2%), showing low risk; second: 11 points (sensitivity = 24.1%; specificity = 98.9%), detecting moderate risk; and, finally, 15 points and over (sensitivity = 4.46%; specificity = 100%), indicating high risk. CONCLUSIONS: The instrument adequately identifies those individuals who are not at risk for eating disorders, making it possible to channel prevention efforts towards those who do have DEB, thus optimizing resources. LEVEL OF EVIDENCE: Level III: case-control analytic study.

Perceptions, Attitudes, and Barriers to Obesity Care in Mexico: Data From the ACTION-IO Study.

OBJECTIVE: The Awareness, Care, and Treatment in Obesity Management-International Observation (ACTION-IO) study (ClinicalTrials.gov identifier NCT03584191) aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity care in people with obesity (PwO) and health care professionals (HCPs). This study presents the results from Mexico. METHODS: An online survey was conducted. In Mexico, eligible PwO were ≥18 years of age with BMI ≥30 kg/m2 based on self-reported height and weight. Eligible HCPs had direct patient care. RESULTS: The survey was completed by 2,000 PwO and 400 HCPs in Mexico. Many PwO (71%) and HCPs (94%) categorized obesity as a chronic disease. Sixty-three percent of PwO felt motivated to lose weight, but many HCPs perceived that PwO were not interested in losing weight (76%) or motivated to lose weight (69%). Lack of financial means to support weight-loss efforts was a barrier for PwO (34%) to discussing weight with HCPs. Sixty-five percent of PwO had discussed weight with HCPs in the past 5 years. PwO (80%) and HCPs (89%) considered lack of exercise as the main barrier to weight loss. Few PwO (34%) had successfully lost ≥5% of their body mass over the past 3 years. CONCLUSIONS: This ACTION-IO study in Mexico identified discrepancies in the perceptions of PwO and HCPs, highlighting opportunities for further education and patient-centered approaches.

Continuous glucose monitoring in the management of patients after gastric bypass

Summary: In patients with gastric bypass (GB), high glucose variability (GV) and hypoglycemia have been demonstrated, which could impact the metabolic status and eating behavior. We describe the glucose patterns determined through continuous glucose monitoring (CGM) in two patients with >5 years follow-up after GB and significant weight recovery, who reported hypoglycemic symptoms that interfered with daily activities, and their response to a nutritional and psycho-educative prescription. Case 1: A 40-year-old woman without pre-surgical type 2 diabetes (T2DM) and normal HbA1c, in whom CGM showed high GV and hypoglycemic episodes that did not correlate with the time of hypoglycemic symptoms. Her GV reduced after prescription of a diet with low glycemic index and modification of meal patterns. Case 2: A 48-year-old male with pre-surgical diagnosis of T2DM and current normal HbA1c, reported skipping meals. The CGM showed high GV, 15% of time in hypoglycemia and hyperglycemic spikes. After prescription of a low glycemic index diet, his GV increased and time in hypoglycemia decreased. Through the detailed self-monitoring needed for CGM, we discovered severe anxiety symptoms, consumption of simple carbohydrates and lack of meal structure. He was referred for more intensive psychological counseling. In conclusion, CGM can detect disorders in glucose homeostasis derived both from the mechanisms of bariatric surgery, as well as the patient's behaviors and mental health, improving decision-making during follow-up. Learning Points: High glycemic variability is frequent in patients operated with gastric bypass. Diverse eating patterns, such as prolonged fasting and simple carbohydrate ingestion, and mental health disorders, including anxiety, can promote and be confused with worsened hypoglycemia. CGM requires a detailed record of food ingested that can be accompanied by associated factors (circumstances, eating patterns, emotional symptoms). This allows the detection of particular behaviors and amount of dietary simple carbohydrates to guide recommendations provided within clinical care of these patients.

Gaps to bridge: Misalignment between perception, reality and actions in obesity.

AIMS: Despite increased recognition as a chronic disease, obesity remains greatly underdiagnosed and undertreated. We aimed to identify international perceptions, attitudes, behaviours and barriers to effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs). MATERIALS AND METHODS: An online survey was conducted in 11 countries. Participants were adults with obesity and HCPs who were primarily concerned with direct patient care. RESULTS: A total of 14 502 PwO and 2785 HCPs completed the survey. Most PwO (68%) and HCPs (88%) agreed that obesity is a disease. However, 81% of PwO assumed complete responsibility for their own weight loss and only 44% of HCPs agreed that genetics were a barrier. There was a median of three (mean, six) years between the time PwO began struggling with excess weight or obesity and when they first discussed their weight with an HCP. Many PwO were concerned about the impact of excess weight on health (46%) and were motivated to lose weight (48%). Most PwO (68%) would like their HCP to initiate a conversation about weight and only 3% were offended by such a conversation. Among HCPs, belief that patients have little interest in or motivation for weight management may constitute a barrier for weight management conversations. When discussed, HCPs typically recommended lifestyle changes; however, more referrals and follow-up appointments are required. CONCLUSIONS: Our international dataset reveals a need to increase understanding of obesity and improve education concerning its physiological basis and clinical management. Realization that PwO are motivated to lose weight offers an opportunity for HCPs to initiate earlier weight management conversations.

Validation of eating disorders examination questionnaire in Mexican women.

BACKGROUND: Efficient assessment of eating disorders (ED) is indispensable for research and clinical practice in Mexico. One of the most commonly used questionnaires, the EDE-Q, has a self-applicable questionnaire format with 28 questions and four subscales drawn from the Eating Disorder Examination (EDE), a semistructured interview developed to evaluate the specific symptomatology of eating disorders. OBJECTIVE: Obtain the factorial structure and construct validity of the EDE-Q questionnaire in Mexican women. METHOD: The language in the EDE-Q was adapted. It was applied to university students (N = 330) and a sample of patients with ED (N = 165) from two ED outpatient treatment services. The anthropometric data of the participants was obtained. Internal consistency was explored using the Cronbach's Alpha coefficient and a confirmatory factor analysis was conducted by group. RESULTS: Cronbach's alpha was 0.9 for the full scale in all groups, while the reliability of each of the subscales fluctuated between 0.8 and 0.9. Confirmatory factor analysis showed that the fit of the seven-item model in three factors was better than that of the original 22-item one and that of the eight-item model for one factor. CONCLUSIONS: This study provides information supporting the seven-item and three-factor version, rather than the original or eight-item versions of the EDE-Q. In the future, the adapted version of the EDE-Q will make it possible to draw comparisons between Mexican samples in other socio-cultural contexts. Future research is required to continue refining the instruments to achieve more representative results from the general ED population.

Differences in Body Composition in Patients with Obesity 1 Year After Roux-En-Y Gastric Bypass: Successful Vs. Unsuccessful Weight Loss.

AIM: The aim of this study is to compare the differences in body composition in patients with obesity with successful weight loss (SWL) and unsuccessful (USWL) 1 year after Roux-en-Y gastric bypass (RYGB). METHODS: We included 36 women and 22 men. After stratifying patients according with SWL (defined as ≥ 50% of excess weight loss), fat-free mass (FFM) and fat mass (FM) trajectories were analyzed in each group. RESULTS: The %FM in SWL women (78%) was lower than USWL (36 vs. 44, p < 0.001). The %FM in SWL men (77%) was lower than USWL (27 vs. 38, p < 0.05). A lower %FM before surgery increased the probability of success (p < 0.05). CONCLUSIONS: SWL patients have a lower %FM, and those with lower pre-surgical %FM are more likely to have SWL 1 year after RYGB.

Eating behavior and psychological profile: associations between daughters with distinct eating disorders and their mothers.

BACKGROUND: Associations of eating behaviors and psychological profile between mothers and daughters with eating disorders exist, but it is important to dissect the influence of the mother in each specific disorder since all eating disorders must be seen or treated not as one entity. The aim of the present study was to evaluate the association of eating behavior and psychological profile between mothers and daughters with different eating disorders and a control group. METHODS: The study group included young girls with anorexia nervosa (AN, n = 30), bulimia nervosa (BN, n = 30), binge eating disorder (BED, n = 19), and a control group of women (Non-ED, n = 54) together with their mothers. BMI was calculated for dyads and Eating Disorder Inventory, Beck Depression Inventory, Beck Anxiety Inventory, Toronto Alexithymia Scale and Three-Factor Eating Questionnaire were applied. The differences between dyads were tested by Student's t test and Pearson's correlation was used to study the association between BMI, variables of eating behavior and psychological profile in each dyad. RESULTS: The study found significant inverse correlations between the AN dyad; some correlations between the BN dyad, and the highest positive correlations exist in BED dyad, especially in eating behavior. Finally, between the control dyads, low but significant correlations were found in the majority of cases. CONCLUSIONS: The study concluded that the associations between mothers and daughters with distinct eating disorders varied depending on the specific diagnosis of the daughter, indicating it is necessary to analyze them individually, given that there may be different implications for treatment.

Experience of an eating disorders out-patient program in an internal medicine hospital.

PURPOSE: The aim of this study was to develop a successful low budget out-patient program, in an internal medicine hospital, for patients presenting eating disorders in an emerging nation. METHODS: A total of 144 patients were included in a 6 month intervention centered in medical support, with fortnightly medical consultations, monthly counseling by a nutritionist and by a psychiatrist and three psycho-educational courses. The Three Factor Eating Questionnaire and the Eating Disorders Inventory-2 were performed at the beginning and at the end of the study. RESULTS: After 6 months, more than half of the patients who completed the intervention were on remission. Substantial improvement was observed regarding the scores of both instruments after completion of the program. CONCLUSIONS: The outcome of this study compares favorably to previous published data of more intensive programs. These results were obtained having little infrastructure, a low budget and limited human resources, making this a suitable eating disorders program for emerging nations.

[Obesity and metabolic syndrome. A challenge for the Mexican Institutes of Health]. / La obesidad y el síndrome metabólico. Un reto para los Institutos Nacionales de Saluda.

Numerous efforts for the development of basic and clinical research in obesity are being made by the National Institutes of Health and Federal Reference Hospitals in Mexico. However, greater interaction among researchers and stronger efforts towards the dissemination of the results are needed. The document outlines the general ideas and proposals of the Academic Group for the Study, Prevention and Treatment of Obesity and Metabolic Syndrome of the Coordinating Committee of the National Institutes of Health and High Specialty Hospitals (CCINSHAE). This is the first step in developing common objectives, with the aim of understanding the effect of these entities in public health and to establish guidelines to limit and eventually overcome them. We discuss the appropriateness of analyzing obesity and the metabolic syndrome together, and the current management of these entities at the National Institutes of Health in Mexico. The problems that arise in clinical practice lead to the need to generate a new model of medical care, including a new health worker and a new patient. It is imperative to establish permanent lines of communication and education with health personnel and with patients. The group proposes an integrated approach for research in these areas. Finally, a master plan that links the National Institutes of Health, particularly in the areas of research and programs within the institutions, is required as a first step in seeking answers useful in solving the problem. The second step would be linking the first and second levels of care through concrete actions needed to limit and reduce obesity and metabolic syndrome in the population.

Los trastornos de la conducta alimentaria / Eating disorders

Los trastornos de la conducta alimentaria constituyen alteraciones severas en la ingesta de los alimentos, en personas que presentan patrones distorsionados en el acto de comer en respuesta a un impulso psíquico. Este grupo de enfermedades engloba a varias entidades que varían grandemente, clasificándose en: anorexia nerviosa, "trastornos de la conducta alimentaria no especificados" y trastorno por atracón. Todas son más frecuentes en las mujeres e iniciándose generalmente durante la adolescencia siendo enfermedades crónicas. El origen preciso no ha podido ser dilucidado, proponiéndose diferentes teorías al respecto. La gran dificultad es que no existen tratamientos farmacológicos o nutricionales de eficacia demostrada, por lo que éstos se dan mediante grupos interdisciplinarios, basándose en psicoterapia, estrategias de apoyo durante el proceso psicoterapéutico y un programa psico-educativo, proceso que lleva meses o años. Estos grupos incluyen: psicólogos, psiquiatras, médicos internistas o endocrinólogos y nutriólogos. Observaciones clínicas han llevado a considerar que existe una serie de sobreposiciones entre la anorexia nerviosa y la obesidad. En algunos casos, el peso y las conductas alimentarias pueden cambiar en sus expresiones en el mismo individuo. Algunas adolescentes que presentaron obesidad importante, desarrollan conductas alimentarias purgativas severas, con lo que logran perder peso, desarrollando un cuadro clínico en todo compatible con bulimia nerviosa. Estas observaciones no pretenden ignorar las enormes diferencias fisiopatogénicas y clínicas que existen entre los distintos trastornos de la conducta alimentaria; su descripción trata de promover una percepción más dinámica de estos fenómenos. Una visión más flexible y dinámica resulta de gran utilidad para comprender y tratar estos padecimientos.

Eating disorders are characterized by severe distortions of food intake in people who have altered eating patterns, secondary to psychological derangement. This group of diseases involve several entities which vary greatly and are classified as: anorexia nervosa, bulimia nervosa, "eating disorder not otherwise specified" and binge eating disorder. All of them are more common in women and generally begin during adolescence, becoming chronic diseases. The precise etiology has not been elucidated but different theories have been proposed to explain it. The main problem regarding eating disorders, thus, these patients are managed in interdisciplinary groups offering: psychotherapy, support strategies during the psychotherapeutic process and a psycho-educational program. The whole process takes from months to several years. Professional staff includes psychologists, psychiatrists, internists, endocrinologists and nutritionists. Clinical observations have led to believe that there is an overlap between anorexia nervosa and obesity. In some individuals, weight and eating behaviors may change. Some teenagers who had obesity develop severe purgative patterns in order to lose weight, presenting a clinical picture resembling bulimia. These observations are not intended to ignore the enormous physiopathogenic and clinical differences that existing in different eating disorders. This description seeks to promote a more dynamic perception of these phenomena. A more flexible and dynamic view is useful to understand and treat these disorders.

Influencia de los padres sobre las preferencias alimentarias en niños de dos escuelas primarias con diferente estrato económico: estudio ESFUERSO / Parental influence in children's food preferences: the ESFUERSO study in two primary schools with different socioeconomic gradients

Objetivo: La mayoría de programas de prevención de obesidad en escuelas primarias fracasan. En este estudio investigamos la influencia de las preferencias alimentarias de los padres en las de sus hijos, de acuerdo con el sexo de los padres y el estrato económico de la familia. Consideramos que esta información será una herramienta útil para elaborar programas de prevención. Material y métodos: Participaron 300 niños de una escuela primaria del Estado (EPE) y 368 de una escuela privada (EPP). Cada pareja de padre y madre contestó dos cuestionarios: uno acerca de ellos mismos y otro sobre sus hijos. El cuestionario incluyó preguntas sobre el consumo de alimentos específicos, analizados por correlación canónica (CC). Resultados: Las escuelas estudiadas no mostraron diferencias en el índice de masa corporal de los padres y sus hijos, sólo en las madres (EPP 24 ± 4 vs. EPE 26 ± 4, p < 0.001). La CC indicó que las madres influyen 30% en las preferencias de sus hijos; esta asociación fue mayor en EPE. La preferencia por alimentos ricos en hidratos de carbono simples se observó sólo en los niños, sin mayor influencia de los padres. Los refrescos regulares mostraron alta preferencia en ambas escuelas; el refresco de dieta es preferido por EPP, pero ambas escuelas prefieren no dar refresco de dieta a los niños. Conclusiones: Existen diferencias de estrato económico y sexo de los padres, que influyen en las preferencias alimentarias de los niños. Los programas de prevención de obesidad deberán considerar las preferencias alimentarias de los padres para aumentar el impacto en los niños.

OBJECTIVE: Programs aimed at obesity prevention among elementary school age children have failed. In the present study, we analyzed the association between parental and child food preferences and determined whether this is influenced by the parents' gender and socio-economic status. MATERIAL AND METHODS: We invited 300 children from a state elementary school (SES) and368 from a private middle class school (PMCS) to participate. A questionnaire was given to each parent to complete together with another questionnaire asking questions about their child. The questionnaire included items on consumption of specific foods. Canonical correlation coefficients (CC) were calculated to assess the association between children's food preferences and their parents' food preferences. RESULTS: Mothers from the PMCS group had lower Body Mass Index (BMIs) than mothers from the SES (24 +/- 4 vs. 26 +/- 4, p < 0.001). Fathers and children from the PMCS group were taller and weighed more than those from the SES but their BMI's were similar. CC indicate that mothers influence their children's food preferences by 30%, and this association is stronger in the SES group. Preference for simple carbohydrates was observed among children without parental supervision. Regular soft drinks were preferred by children in both schools, but diet sodas were more common among PMCS. All families avoided giving their children diet soft drinks. CONCLUSIONS: Socio-economic status and gender diferentially influence children's meal preferences. Obsesity prevention programs should take into account parental food preferences as an important factor that determines obesity during childhood. We expect that our results will contribute to the design of more appropriate prevention programs.

[Parental influence in children's food preferences. The ESFUERSO study in two primary schools with different socioeconomic gradients]. / Influencia de los padres sobre las preferencias alimentarias en niños de dos escuelas primarias con diferente estrato económico. Estudio ESFUERSO.

OBJECTIVE: Programs aimed at obesity prevention among elementary school age children have failed. In the present study, we analyzed the association between parental and child food preferences and determined whether this is influenced by the parents' gender and socio-economic status. MATERIAL AND METHODS: We invited 300 children from a state elementary school (SES) and368 from a private middle class school (PMCS) to participate. A questionnaire was given to each parent to complete together with another questionnaire asking questions about their child. The questionnaire included items on consumption of specific foods. Canonical correlation coefficients (CC) were calculated to assess the association between children's food preferences and their parents' food preferences. RESULTS: Mothers from the PMCS group had lower Body Mass Index (BMIs) than mothers from the SES (24 +/- 4 vs. 26 +/- 4, p < 0.001). Fathers and children from the PMCS group were taller and weighed more than those from the SES but their BMI's were similar. CC indicate that mothers influence their children's food preferences by 30%, and this association is stronger in the SES group. Preference for simple carbohydrates was observed among children without parental supervision. Regular soft drinks were preferred by children in both schools, but diet sodas were more common among PMCS. All families avoided giving their children diet soft drinks. CONCLUSIONS: Socio-economic status and gender diferentially influence children's meal preferences. Obsesity prevention programs should take into account parental food preferences as an important factor that determines obesity during childhood. We expect that our results will contribute to the design of more appropriate prevention programs.

[Prevalence of psychiatric disorders in patients with severe obesity waiting for bariatric surgery]. / Prevalencia de trastornos psiquiátricos en pacientes con obesidad extrema candidatos a cirugía bariátrica.

INTRODUCTION: Obesity is a chronic condition, in which different systems of the body are affected. There are some previous studies in which the prevalence of psychiatric disorders in extreme obese patients has been reported, but there are some methodological problems. As far as we know this is the first report of the prevalence of psychiatric disorders in obese patients that need to have a surgical treatment for this disorder in Mexico. The main goal of this study was to determine the prevalence and risk factors of psychiatric disorders in extreme obese patients candidates to bariatric surgery. MATERIAL AND METHODS: The Structured Clinical Interview for DSM-IV (SCID) axis I disorders, were performed in 70 obese patients that will undergo for bariatric surgery. Also the medical files were reviewed in order to obtain the main medical conditions related to obesity. RESULTS: There were 25 men and 35 women in this study (average age +/- s.d = 39.0 +/- 10.4). The Body Mass Index (BMI) was 53.8 +/- 11.9. Sixty percent of the patients had some psychiatric disorder in the axis I of DSM-IV. The most frequent psychiatric problem that was observed was anxiety disorders. The main medical problems observed were: arterial hypertension (59%), diabetes mellitus type 2 (29%) and obstructive sleep apnea syndrome (29%). The BMI and diabetes mellitus were associated with a lower risk for presenting a psychiatric disorder (for a BMI of 65.5 +/- 10.3 kg/m2: OR 0.26, CI 0.05-1.15, p = 0.04; for diabetes mellitus: OR 0.20, CI 0.03-1.05, p = 0.02). CONCLUSIONS: More than half of the patients had at least one psychiatric disorder in axis 1 of DSM-IV, related mostly to anxiety and mood disorders. Our findings point out the importance of psychiatric and psychological intervention in this group of patients, in which a follow up and adherence of medical, nutritional and psychological problems could be the difference, between a good or bad prognosis. Follow-up studies with obese patients after bariatric surgery, will be important to support our findings.

[Internal validity and diagnostic utility of the Eating Disorder Inventory in Mexican women]. / Validez interna y utilidad diagnóstica del Eating Disorder Inventory, en mujeres mexicanas.

OBJECTIVE: To assess the diagnostic utility and internal validity of the Eating Disorder Inventory (EDI-2) in Mexican women. MATERIAL AND METHODS: An observational, cross-sectional study was conducted between October 2000 and January 2001. The sample population consisted of two groups of women: patients diagnosed with anorexia nervosa or bulimia, but no other psychiatric pathology, seen by psychiatrists at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (National Institute of Medical Sciences and Nutrition Salvador Zubirán), and a randomly selected sample of women from a school in Mexico City. A structured interview was conducted using SCID/DSM-IV as the gold standard. Finally the EDI-2 was administered. Statistical analysis was performed using Student's t test for independent samples, Cronbach's alpha test, and calculation of sensitivity, specificity, and positive and negative predictive values. RESULTS: No significant differences were found for weight, height, and body mass index. Women with no eating disorders were younger than those with eating disorders (16.7 +/- 2.8 vs. 19.9 +/- 4.3, p = 0.004). The EDI-2 total score was clearly different between the groups (53.8 +/- 32.4 vs. 146.3 +/- 45.6 respectively, p < 0.001). All Cronbach's alpha coefficients for all subscales were over 0.85. For the total score, a sensitive cutoff point of 80 (sensitivity 90.9, 95% confidence interval [CI] 69.4 to 98.4; specificity 80, 95% CI 58.7 to 92.4) and a specific cutoff point of 105 (sensitivity 81.8, 95% CI 59 to 94; specificity 89.3, 95% CI 70.6 to 97.2) are recommended. CONCLUSIONS: The EDI-2 has a high internal validity and should be a useful tool to assess eating disorders.