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Psychopathological similarities and differences between obese patients seeking surgical and non-surgical overweight treatments

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity volume 19, pages 95–102 (2014)Cite this article

Abstract

Purpose

To compare the psychopathological characteristics of obese patients seeking bariatric surgery with those seeking a medical approach.

Methods

A total of 394 consecutive outpatients seeking bariatric surgery were compared with 683 outpatients seeking a medical treatment. All patients were referred to the same institution.

Results

Obesity surgery patients reported higher body mass index (BMI), objective/subjective binging and more severe general psychopathology, while obesity medical patients showed more eating and body shape concerns. Depression was associated with higher BMI among obesity surgery clinic patients, whereas eating-specific psychopathology was associated with higher BMI and objective binge-eating frequency among obesity medical clinic patients.

Conclusions

Patients seeking bariatric surgery showed different psychopathological features compared with those seeking a non-surgical approach. This suggests the importance for clinicians to consider that patients could seek bariatric surgery on the basis of the severity of the psychological distress associated with their morbid obesity, rather than criteria only based on clinical indication.

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References

  1. WHO (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894:1–253

    Google Scholar 

  2. Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, Gortmaker SL (2011) The global obesity pandemic: shaped by global drivers and local environments. Lancet 378:804–814. doi:10.1016/S0140-6736(11)60813-1

    PubMed  Article  Google Scholar 

  3. NIH conference (1991) Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med 115:956–961

    Google Scholar 

  4. Ogden CL, Yanovski SZ, Carroll MD, Flegal KM (2007) The epidemiology of obesity. Gastroenterology 132:2087–2102

    PubMed  Article  Google Scholar 

  5. Pull CB (2010) Current psychological assessment practices in obesity surgery programs: what to assess and why. Curr Opin Psychiatry 23:30–36. doi:10.1097/YCO.0b013e328334c817

    PubMed  Article  Google Scholar 

  6. Casazza K, Fontaine KR, Astrup A et al (2013) Myths, presumptions, and facts about obesity. N Engl J Med 368:446–454. doi:10.1056/NEJMsa1208051

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  7. Douketis JD, Macie C, Thabane L, Williamson DF (2005) Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes (Lond) 29:1153–1167

    Google Scholar 

  8. Gilbert EW, Wolfe BM (2012) Bariatric surgery for the management of obesity: state of the field. Plast Reconstr Surg 130:948–954

    CAS  PubMed  Article  Google Scholar 

  9. Picot J, Jones J, Colquitt JL, Loveman E, Clegg AJ (2012) Weight loss surgery for mild to moderate obesity: a systematic review and economic evaluation. Obes Surg 22:1496–1506. doi:10.1007/s11695-012-0679-z

    PubMed  Article  Google Scholar 

  10. Jackson TD, Hutter MM (2012) Morbidity and effectiveness of laparoscopic sleeve gastrectomy, adjustable gastric band, and gastric bypass for morbid obesity. Adv Surg 46:255–268

    PubMed  Article  Google Scholar 

  11. Baumeister H, Härter M (2007) Mental disorders in patients with obesity in comparison with healthy probands. Int J Obes (Lond) 31:1155–1164

    Google Scholar 

  12. Guerdjikova AI, McElroy SL, Kotwal R, Keck PEJ (2007) Comparison of obese men and women with binge eating disorder seeking weight management. Eat Weight Disord 12:19–23

    Article  Google Scholar 

  13. Wadden TA, Butryn ML, Sarwer DB et al (2006) Comparison of psychosocial status in treatment-seeking women with class III vs class I-II obesity. Surg Obes Relat Dis 2:138–145

    PubMed  Article  Google Scholar 

  14. De Zwaan M, Hilbert A, Swan-Kremeier L, Simonich H, Lancaster K, Howell LM, Monson T, Crosby RD, Mitchell JE (2010) Comprehensive interview assessment of eating behavior 18–35 months after gastric bypass surgery for morbid obesity. Surg Obes Relat Dis 6:79–85. doi:10.1016/j.soard.2009.08.011

    PubMed  Article  Google Scholar 

  15. Stunkard AJ, Faith MS, Allison KC (2003) Depression and obesity. Biol Psychiatry 54:330–337

    PubMed  Article  Google Scholar 

  16. Castellini G, Lapi F, Ravaldi C, Vannacci A, Rotella CM, Faravelli C, Ricca V (2008) Eating disorder psychopathology does not predict the overweight severity in subjects seeking weight loss treatment. Compr Psychiatry 49:359–363. doi:10.1016/j.comppsych.2008.01.005

    PubMed  Article  Google Scholar 

  17. Faulconbridge LF, Wadden TA, Thomas JG, Jones-Corneille LR, Sarwer DB, Fabricatore AN (2012) Changes in depression and quality of life in obese individuals with binge eating disorder: bariatric surgery versus lifestyle modification. Surg Obes Relat Dis. doi: 10.1016/j.soard.2012.10.010

  18. Devlin MJ, Goldfein JA, Dobrow I (2003) What is this thing called BED? Current status of binge eating disorder nosology. Int J Eat Disord 34(suppl):S2–S18

    PubMed  Article  Google Scholar 

  19. Faith MS, Matz PE, Jorge MA (2002) Obesity-depression associations in the population. J Psychosom Res 53:935–942

    PubMed  Article  Google Scholar 

  20. Mühlhans B, Horbach T, de Zwaan M (2009) Psychiatric disorders in bariatric surgery candidates: a review of the literature and results of a German prebariatric surgery sample. Gen Hosp Psychiatry 31:414–421. doi:10.1016/j.genhosppsych.2009.05.004

    PubMed  Article  Google Scholar 

  21. Buddeberg-Fischer B, Klaghofer R, Krug L, Buddeberg C, Müller MK, Schoeb O, Weber M (2006) Physical and psychosocial outcome in morbidly obese patients with and without bariatric surgery: a 4 1/2-year follow-up. Obes Surg 16:321–330

    PubMed  Article  Google Scholar 

  22. Legenbauer T, Petrak F, de Zwaan M, Herpertz S (2011) Influence of depressive and eating disorders on short- and long-term course of weight after surgical and nonsurgical weight loss treatment. Compr Psychiatry 52:301–311. doi:10.1016/j.comppsych.2010.06.012

    PubMed  Article  Google Scholar 

  23. Rutledge T, Adlerm S, Friedman R (2011) A prospective assessment of psychosocial factors among bariatric versus non-bariatric surgery candidates. Obes Surg 21:1570–1579. doi:10.1007/s11695-010-0287-8

    PubMed Central  PubMed  Article  Google Scholar 

  24. Stunkard AJ, Wadden TA (1992) Psychological aspects of severe obesity. Am J Clin Nutr 55(2Supp):524S–532S

    Google Scholar 

  25. Kolotkin RL, Meter K, Williams GR (2001) Quality of life and obesity. Obes Rev 2:219–229

    CAS  PubMed  Article  Google Scholar 

  26. Abilés V, Rodríguez-Ruiz S, Abilés J, Mellado C, García A, Pérez de la Cruz A, Fernández-Santaella MC (2010) Psychological characteristics of morbidly obese candidates for bariatric surgery. Obes Surg 20:161–167. doi:10.1007/s11695-008-9726-1

    PubMed  Article  Google Scholar 

  27. Lin HY, Huang CK, Tai CM et al (2013) Psychiatric disorders of patients seeking obesity treatment. BMC Psychiatry 13:1. doi:10.1186/1471-244X-13-1

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  28. Teixeira PJ, Going SB, Sardinha LB, Lohman TG (2005) A review of psychosocial pre-treatment predictors of weight control. Obes Rev 6:3–65

    Article  Google Scholar 

  29. Legenbauer T, De Zwaan M, Benecke A, Muhlhans B, Petrak F, Herpertz S (2009) Depression and anxiety: their predictive function for weight loss in obese individuals. Obes Facts 2:227–234. doi:10.1159/000226278

    PubMed  Article  Google Scholar 

  30. Herpertz S, Burgmer R, Stang A, de Zwaan M, Wolf AM, Chen-Stute A, Hulisz T, Jöckel KH, Senf W (2006) Prevalence of mental disorders in normal-weight and obese individuals with and without weight loss treatment in a German urban population. J Psychosom Res 61:95–103

    PubMed  Article  Google Scholar 

  31. Wadden TA, Sarwer DB, Fabricatore AN, LaShanda J, Stack R, Williams NS (2007) Psychosocial and behavioral status of patients undergoing bariatric surgery: what to expect before and after surgery. Med Clin North Am 91:451–469

    PubMed  Article  Google Scholar 

  32. Legenbauer TM, de Zwaan M, Mühlhans B, Petrak F, Herpertz S (2010) Do mental disorders and eating patterns affect long-term weight loss maintenance? Gen Hosp Psychiatry 32:132–140. doi:10.1016/j.genhosppsych.2009.09.001

    PubMed  Article  Google Scholar 

  33. Thonney B, Pataky Z, Badel S, Bobbioni-Harsch E, Golay A (2010) The relationship between weight loss and psychosocial functioning among bariatric surgery patients. Am J Surg 199:183–188. doi:10.1016/j.amjsurg.2008.12.028

    PubMed  Article  Google Scholar 

  34. Pataky Z, Carrard I, Golay A (2011) Psychological factors and weight loss in bariatric surgery. Curr Opin Gastroenterol 27:167–173. doi:10.1097/MOG.0b013e3283422482

    PubMed  Article  Google Scholar 

  35. De Zwaan M, Enderle J, Wagner S, Mühlhans B, Ditzen B, Gefeller O, Mitchell JE, Müller A (2011) Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. J Affect Disord 133:61–68. doi:10.1016/j.jad.2011.03.025

    PubMed  Article  Google Scholar 

  36. Beechy L, Galpern J, Petrone A, Das SK (2012) Assessment tools in obesity—psychological measures, diet, activity, and body composition. Physiol Behav 107:154–171. doi:10.1016/j.physbeh

    CAS  PubMed  Article  Google Scholar 

  37. Mitchell JE, Selzer F, Kalarchian MA, Devlin MJ, Strain GW, Elder KA, Marcus MD, Wonderlich S, Christian NJ, Yanovski SZ (2012) Psychopathology before surgery in the longitudinal assessment of bariatric surgery-3 (LABS-3) psychosocial study. Surg Obes Relat Dis 8:533–541. doi:10.1016/j.soard.2012.07.001

    PubMed Central  PubMed  Article  Google Scholar 

  38. Sockalingam S, Cassin S, Crawford SA, Pitzul K, Khan A, Hawa R, Jackson T, Okrainec A (2012) Psychiatric predictors of surgery non-completion following suitability assessment for bariatric surgery. Obes Surg 23:205–211. doi:10.1007/s11695-012-0762-5

    Article  Google Scholar 

  39. First MB, Spitzer RL, Gibbon M, Williams JBW (1995) Structured clinical interview for DSM-IV axis I disorders. Patient edition (SCID-P, version 2). Biometrics Research, New York State Psychiatric Institute, New York

  40. American Psychiatric Association (2010) DSM-5 development: eating disorders. Available at http://www.dsm5.org/ProposedRevisions/Pages/EatingDisorders.aspx. Accessed 20 July 2010

  41. Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 16:363–370

    CAS  PubMed  Google Scholar 

  42. Kalarchian MA, Wilson GT, Brolin RE, Bradley L (2000) Assessment of eating disorders in bariatric surgery candidates: self-report questionnaire versus interview. Int J Eat Disord 28:465–469

    CAS  PubMed  Article  Google Scholar 

  43. Luce KH, Crowther JH (1999) The reliability of the Eating Disorder Examination-Self-Report Questionnaire Version (EDE-Q). Int J Eat Disord 25:349–351

    CAS  PubMed  Article  Google Scholar 

  44. Mond JM, Hay PJ, Rodgers B, Owen C, Beumont PJ (2004) Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behav Res Ther 42:551–567

    CAS  PubMed  Article  Google Scholar 

  45. Castellini G, Mannucci E, Lo Sauro C, Benni L, Lazzeretti L, Ravaldi C, Rotella CM, Faravelli C, Ricca V (2012) Different moderators of cognitive-behavioral therapy on subjective and objective binge eating in bulimia nervosa and binge eating disorder: a three-year follow-up study. Psychother Psychosom 81:11–20. doi:10.1159/000329358

    PubMed  Article  Google Scholar 

  46. Arnow B, Kenardy J, Agras WS (1995) The Emotional Eating Scale: the development of a measure to assess coping with negative affect by eating. Int J Eat Disord 18:79–90

    CAS  PubMed  Article  Google Scholar 

  47. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psych 5:561–571

    Article  Google Scholar 

  48. Spielberg CD, Gorsuch RL, Lushene RE (1970) Manual for the State-Trait Anxiety Inventory (self-evaluation questionnaire). Consulting Psychologists Press, Palo Alto

    Google Scholar 

  49. Derogatis LR, Lipman RS, Covi L (1973) SCL-90. An outpatient psychiatric rating scale-preliminary report. Psychopharmacol Bull 9:13–28

    CAS  PubMed  Google Scholar 

  50. van Hout GC, van Oudheusden I, van Heck GL (2004) Psychological profile of the morbidly obese. Obes Surg 14:579–588

    PubMed  Article  Google Scholar 

  51. Vallis TM, Butler GS, Perey B (2001) The role of psychological functioning in morbid obesity and its treatment with gastroplasty. Obes Surg 11:716–725

    CAS  PubMed  Article  Google Scholar 

  52. Lang T, Hauser R, Buddeberg C (2002) Impact of gastric banding on eating behavior and weight. Obes Surg 12:100–107

    PubMed  Article  Google Scholar 

  53. Glinski J, Wetzler S, Goodman E (2001) The psychology of gastric bypass surgery. Obes Surg 11:581–588

    CAS  PubMed  Article  Google Scholar 

  54. Hsu LKG, Sullivan SP, Benotti PN (1997) Eating disturbances and outcome of gastric bypass surgery: a pilot study. Int J Eat Disord 21:385–390

    CAS  PubMed  Article  Google Scholar 

  55. De Zwaan M, Lancaster KL, Mitchell JE (2002) Health related quality of life in morbidly obese patients: effect of gastric bypass surgery. Obes Surg 12:773–780

    PubMed  Article  Google Scholar 

  56. De Zwaan M (2001) Binge eating disorder and obesity. Int J Obes Relat Metab Disord 25(Suppl 1):S51–S55

    PubMed  Article  Google Scholar 

  57. Masheb RM, Grilo CM (2006) Emotional overeating and its associations with eating disorder psychopathology among overweight patients with binge eating disorder. Int J Eat Dis 39:141–146

    Article  Google Scholar 

  58. Ricca V, Castellini G, Lo Sauro C, Ravaldi C, Lapi F, Mannucci E, Rotella CM, Faravelli C (2009) Correlations between binge eating and emotional eating in a sample of overweight subjects. Appetite 53:418–421. doi:10.1016/j.appet.2009.07.008

    PubMed  Article  Google Scholar 

  59. Fairburn CG, Marcus MD, Wilson GT (1993) Cognitive-behavior therapy for binge eating and bulimia nervosa: a comprehensive treatment manual. In: Fairburn CG, Wilson GT (eds) Binge eating: nature assessment and treatment. Guilford Press, New York, pp 361–396

    Google Scholar 

  60. Saunders R (2001) Compulsive eating and gastric bypass surgery: what does hunger have to do with it? Obes Surg 11:757–761

    CAS  PubMed  Article  Google Scholar 

  61. Stein RI, Kenardy J, Wiseman CV, Dounchis JZ, Arnow BA, Wilfley DE (2007) What’s driving the binge in binge eating disorder? A prospective examination of precursors and consequences. Int J Eat Dis 40:195–203

    Article  Google Scholar 

  62. Brody MJ, Walsh BT, Devlin MJ (1994) Binge eating disorder: reliability and validity of a new diagnostic category. J Consult Clin Psychol 62:381–386

    CAS  PubMed  Article  Google Scholar 

  63. Hagan MM, Shuman ES, Oswald KD, Corcoran KJ, Profitt JH, Blackburn K, Schwiebert MW, Chandler PC, Birbaum MC (2002) Incidence of chaotic eating behaviors in binge-eating disorder: contributing factors. Behav Med 28:99–105

    PubMed  Article  Google Scholar 

  64. Neff KJ, le Roux CW (2012) Bariatric surgery: a best practice article. J Clin Pathol 66:90–98. doi:10.1136/jclinpath-2012-200798

    PubMed  Article  Google Scholar 

  65. Padwal R, Klarenbach S, Wiebe N, Birch D, Karmali S, Manns B, Hazel M, Sharma AM, Tonelli M (2011) Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Obes Rev 12:602–621. doi:10.1111/j.1467-789X.2011.00866.x

    CAS  PubMed  Article  Google Scholar 

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Affiliations

  1. Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, Largo Brambilla 3, 50134, Florence, Italy

    Giovanni Castellini, Lucia Godini, Silvia Gorini Amedei & Valdo Ricca

  2. Bariatric Surgery Unit, Careggi Hospital, Viale Morgagni 85, 50134, Florence, Italy

    Lucia Godini, Silvia Gorini Amedei, Giovanna Alpigiano, Elena Mugnaini, Marco Veltri & Marcello Lucchese

  3. Obesity Agency, Department of Clinical Pathophysiology, Florence University, Viale Morgagni 85, 50134, Florence, Italy

    Carlo Maria Rotella

  4. Department of Psychology, Florence University, Via San Niccolò, 93, 50125, Florence, Italy

    Valentina Galli & Carlo Faravelli

  5. Department of Psychology, University of Vermont, Burlington, VT, USA

    Alessandra H. Rellini

Authors
  1. Giovanni Castellini
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  2. Lucia Godini
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  3. Silvia Gorini Amedei
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  4. Valentina Galli
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  5. Giovanna Alpigiano
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  6. Elena Mugnaini
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  7. Marco Veltri
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  8. Alessandra H. Rellini
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  9. Carlo Maria Rotella
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  10. Carlo Faravelli
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  11. Marcello Lucchese
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  12. Valdo Ricca
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Corresponding author

Correspondence to Valdo Ricca.

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Castellini, G., Godini, L., Amedei, S.G. et al. Psychopathological similarities and differences between obese patients seeking surgical and non-surgical overweight treatments. Eat Weight Disord 19, 95–102 (2014). https://doi.org/10.1007/s40519-013-0058-3

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  • DOI: https://doi.org/10.1007/s40519-013-0058-3

Keywords

  • Bariatric surgery
  • Binge eating disorder
  • Medical treatment
  • Obesity
  • Psychopathology