Comportamentos auto-flagelatórios e tentativas de suicídio na obesidade

A obesidade foi definida pela Organização Mundial de Saúde, como a epidemia do século XXI, devido à sua elevada prevalência e pelas várias implicações médicas, psicológicas e sociais que afetam os sujeitos (OMS, 2010). Na população obesa há um aumento de predomínio de sintomas psicológicos, tais como sintomas depressivos, ansiosos e alimentares (Segal,1999). OBJETIVO: O presente estudo tem 2 objetivos: (1) avaliar a frequência de comportamentos auto-flagelatórios e tentativas de suicídio, em pacientes obesos candidatos à cirurgia bariátrica e pacientes que já foram submetidos a essa mesma cirurgia; (2) caracterizar os indicadores de psicopatologia associados à obesidade. MÉTODO: Participaram nesta investigação 100 sujeitos, 68 candidatos à cirurgia bariátrica e 32 sujeitos que já tinham sido submetidos a essa mesma cirurgia. Para a realização do presente estudo foi administrado um Questionário Sócio Demográfico; o Exame das Perturbações do Comportamento Alimentar - Questionário (EDE-Q) (Fairburn & Beglin, 1994, traduzido e adaptado por Machado et al., 2002) e o Inventário dos Sintomas Psicopatológicos (BSI) (Derogátis, 1993; adaptação Portuguesa por Canavarro, 1999). RESULTADOS: Obtiveram-se resultados estatisticamente significativos entre os 2 grupos, relativamente aos itens: (1) peso; (2) índice de massa corporal; (3) Ingestão alimentar excessiva e compulsiva; (4) preocupação com a forma; (5) preocupação com a comida; (6) preocupação com o peso e (7) restrição. No grupo de sujeitos candidatos à cirurgia bariátrica registaram-se diferenças significativas, entre os que tinham parecer favorável para a cirurgia e os que tinham parecer desfavorável/adiado, relativamente aos itens (1) ocupação e (2) tempo livre. DISCUSSÃO: Não foram encontrados comportamentos auto-flagelatórios em nenhum dos grupos dos sujeitos obesos. Conclui-se ainda que existem alguns indicadores de psicopatologia, principalmente no grupo candidato à cirurgia, em contrapartida o grupo que já tinha realizado a cirurgia apresentou taxas mais elevadas de tentativas de suicídio.Obesity was classified by World Health Organization as the 21st century epidemic, due to its high prevalence and its implications for the various medical, psychological and social factors which affect subjects (WHO, 2010). Among the obese, psychological symptoms such as depression, anxiety and eating disorders prevail (Segal, 1999). OBJECTIVE: This study has two objectives: (1) assess the frequency of self-injury behaviors and suicide attempts, in obese bariatric surgery candidates and patients who have already undergone the same surgery; (2) characterize psychopathology indicators associated with obesity. METHOD: The investigation involved 100 subjects, 68 of whom had applied for bariatric surgery and 32 who had undergone the same surgery. A Socio Demographic Questionnaire - Eating Disorders Examination – Questionnaire (EDE-Q) (Fairburn & Beglin, 1994, translated and adapted by Machado et al., 2002) and Brief Symptom Inventory (BSI) (Derogátis, 1993; Portuguese adaptation by Canavarro, 1999) - was administered to the subjects. RESULTS: Statistically significant results were observed between the two groups, for the items: (1) weight; (2) body mass index; (3) compulsive overeating; (4) body shape concerns; (5) preoccupation with food; (6) preoccupation with weight and (7) restriction. Among the candidates for bariatric surgery there were significant differences between those who had a favorable opinion for surgery and those who had an unfavorable opinion/postponed, with regard to items (1) occupation and (2) free time. DISCUSSION: Self–injury behavior was not found in any group of obese subjects. We also conclude that there are some psychopathology indicators, especially in the group candidate for surgery, however the group that had undergone the surgery had higher rates of suicide attempts

APOLO-Bari, an internet-based program for longitudinal support of bariatric surgery patients: study protocol for a randomized controlled trial

Background: Despite evidence of successful weight loss for bariatric surgery patients, some patients experience considerable weight regain over the long term. Given the strong association between post-surgery health behaviors and outcomes, aftercare intervention to address key behaviors appears to be a reasonable relapse-prevention strategy. As the burden of obesity rates increases in healthcare centers, an internet-based program appears to be a reasonable strategy for supporting bariatric surgery patients in the long term. The primary purpose of the current project is to develop and test the efficacy and perceived utility of APOLO-Bari.Methods/design: This study is a randomized control trial, which will be conducted in two hospital centers in the North of Portugal; it includes a control group receiving treatment as usual and an intervention group receiving the APOLO-Bari program for one year in addition to treatment as usual. A total of 180 male and female participants who underwent bariatric surgery (gastric sleeve or gastric bypass surgery) for 12 to 20 months will be recruited. Both groups will complete a similar set of questionnaires at baseline, every 4 months until the end of the intervention, and at 6 and 12 months follow-up. Assessment includes anthropometric variables and psychological self-report measures. The primary outcome measure will be weight regain measured at the end of treatment, and at 6 and 12 months follow-up. The secondary aims are to test the cost-effectiveness of the intervention and to investigate psychological predictors and trajectories of weight regain. APOLO-Bari was developed to address the weight regain problem in the bariatric population by offering additional guidance to bariatric patients during the postoperative period. The program includes: (a) a psychoeducational cognitive-behavioral-based self-help manual, (b) a weekly feedback messaging system that sends a feedback statement related to information reported by the participant, and (c) interactive chat sessions scheduled witThis research was partially supported by the Fundacao para a Ciencia e a Tecnologia through a European Union COMPETE program grant to Eva Conceicao (IF/01219/2014 and PTDC/MHC-PCL/4974/2012), a doctoral scholarship to Ana Pinto-Bastos (SFRH/BD/104159/2014), a doctoral scholarship to Sofia Ramalho (SFRH/BD/104182/2014), and a postdoctoral scholarship to Ana Rita Vaz (SFRH/BPD/94490/2013), co-financed by FEDER under the PT2020 Partnership Agreement (UID/PSI/01662/2013).info:eu-repo/semantics/publishedVersio

Stability of problem eating behaviors and weight loss trajectories following bariatric surgery: a longitudinal observational study

Background: The literature is rather mixed regarding the stability and the role of pre- and postoperative problematic eating behaviors (PEBs) on weight outcomes after bariatric surgery.Objectives: To investigate the stability of loss of control (LOC) eating and picking and/or nibbling from pre- to postoperative assessments, and to investigate whether pre- and postoperative PEBs are predictors of different weight loss trajectories.Setting: Central Hospital, University, Portugal.Methods: This longitudinal study assessed LOC eating and picking and/or nibbling before and approximately 2 years after laparoscopic adjustable gastric banding or Roux-en-Y gastric bypass through face-to-face interviews and 2 self-report measures. Weight across follow-up time was retrieved from hospital charts. Of the 130 patients invited to participate in the study, 100 were assessed preoperatively, and of these, 61 were also assessed postoperatively.Results: Frequency of PEBs is similar pre- and postoperatively (37.7% and 45.9%, respectively) (McNemar chi(2) P = .832). Yet, about 40% ceased preoperative PEBs. Those with LOC preoperatively were more likely to develop picking and/or nibbling postoperatively (McNemar chi(2) P < .05). About 39.5% developed PEBs de novo after surgery. The presence of PEBs postoperatively was a significant predictor of different weight loss trajectories after both laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass. Worse weight loss outcomes were found particularly at 17-20 months postsurgery. Preoperative PEBs were not a significant predictor.Conclusions: Our data do not support the stability of all PEBs across time, highlighting that the absence of preoperative PEBs does not preclude an unfavorable weight loss outcome after surgery. Postoperative but not preoperative PEBs are predictors of poorer weight loss trajectories after surgery. (C) 2017 American Society for Bariatric Surgery.- This research was partially supported by Fundacao para a Ciencia e a Tecnologia/Foundation for Science and Technology through a European Union COMPETE program grant to Eva Conceicao (IF/01219/2014), and doctoral scholarship (SFRH/BD/104159/2014) to Ana Pinto-Bastos, co-financed by FEDER under the PT2020 Partnership Agreement (UID/PSI/01662/2013) and the project PTDC/MHC-PCL/4974/2012.info:eu-repo/semantics/publishedVersio

Psychological and behavioral aspects of primary and reoperative surgery: a 6-month longitudinal study

Background: Problematic eating behaviors and general psychopathology have been associated with poor weight loss after bariatric surgery. However, little is known about how these aspects impact weight loss outcomes for the increasing number of patients undergoing reoperative surgeries. This study compares disordered eating and weight-related outcomes before and 6months after surgery in patients undergoing primary (P-Group) and reoperative bariatric surgery (R-Group).MethodsThis longitudinal study assessed 122 P-Group and 116 R-Group patients before and 6months after surgery. The assessment included the eating disorder examination diagnostic items, and a set of self-report measures assessing eating disorder symptomatology, grazing, depression, anxiety, and negative urgency.ResultsPreoperatively, no differences were found between the R- and P-Groups in terms of disordered eating-related variables (except for shape concern, which was higher for the R-Group). At 6months after surgery, the R-Group revealed significantly higher values for restraint (F(1,219)=5.84, p=0.016), shape (F(1,219)=5.59, p=0.019), weight concerns (F(1,219)=13.36, p=0.000), depression (F(1,219)=7.17, p=0.008), anxiety (F(1,219)=6.94, p=-0.009), and compulsive grazing (F(1,219)=6.13, p=0.014). No significant pre- or post-surgery predictors of weight loss were found for the P-Group (2=0.70, p=0.872). In the R-Group, post-surgery anxiety (Wald(2)(1)=6.19, p=0.01) and the post-surgery number of days with grazing in the previous month (Wald(2)(1)=3.90, p=0.04) were significant predictors of weight loss.ConclusionAt 6months after surgery, the R-Group presented more problematic eating and general psychological distress, which may put these patients at greater risk of poorer long-term weight outcomes.This study was partially conducted at Psychology Research Centre (PSI/01662), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds, and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653), by the following grants to Eva Conceicao (IF/01219/2014 and POCI-01-0145-FEDER-028209), and doctoral scholarship to Ana Pinto-Bastos (SFRH/BD/104159/2014). The funding body had no role in the design, collection, analysis, and interpretation of data; the writing of the manuscript; or the decision to submit the manuscript for publication