An examination of psychological risk factors for the development of substance abuse among post-bariatric surgery patients

Bariatric surgery is a clinically effective tool that commonly results in sustained weight loss changes for the majority of patients. While bariatric surgery is generally associated with a number of positive health outcomes post-operatively, some popular media outlets and clinical anecdotes have presented concerns about the notion of “addiction transfer” and substance abuse post-bariatric surgery. There is a lack of research, however, in this area. The present study examined the rate of substance abuse in a broad sample of postbariatric surgery patients and examined potential risk factors for the development of substance abuse post-surgery. It was hypothesized that documented risk factors for substance abuse, more generally, would also predict substance abuse among this population. In addition, it was hypothesized that a number of theoretically-driven variables would predict substance abuse among this sample more specifically. For instance, it was hypothesized that those who had high food addiction scores pre-surgery would be more likely to meet criteria for substance abuse post-surgery, thereby supporting the addiction transfer theory. Participants completed a web-based survey assessing retrospective accounts of pre-surgical substance use, eating pathology, family history, and traumatic history, post-surgical substance use, life stressors, and body image, and global trait-like measures such as emotion dysregulation, impulsivity, sensation-seeking, and coping skills. Findings revealed that a subgroup of individuals met criteria for substance abuse post-bariatric surgery; however, the majority of those who met substance abuse criteria post-surgery did not have a history of substance abuse. Family history of substance abuse, poor coping skills, and major life stressors were related to substance abuse post-bariatric surgery, particularly for the new-onset substance abuse group. Contrary to expectations, however, the theory of addiction transfer was not supported. Findings highlight future directions for pre-bariatric assessments and the need for improved follow-up care among post-bariatric surgery patients. Future longitudinal studies with larger sample sizes are needed to better understand both psychological and physiological risk factors for substance abuse development post-bariatric surgery

Food for thought: An examination of the relationship between binge eating and psychological variables in a diverse college-student population

Binge eating is associated with a host of adverse outcomes, but little is known about sex and racial differences among those who binge eat. The present study examined sex and racial group differences in binge eating within a college-student population. It was hypothesized that White women would endorse higher rates of binge eating than the other groups, and that predictors of binge eating would differ across groups. Participants completed a web-based survey assessing depression, anxiety, body image, weight history, physical activity, smoking, and body mass index. Findings highlight sex and racial differences in the predictors of binge eating, with depression a common predictor across groups. Results suggest that approaches to preventing BE among college students should focus on depression and overweight preoccupation among White students and Black women. These findings may help in the development of tailored treatment approaches, which could be evaluated in future research

Examining Self-Weighing Behaviors and Associated Features and Treatment Outcomes in Patients with Binge-Eating Disorder and Obesity with and without Food Addiction

Food addiction (FA) has been linked to clinical features in binge-eating disorder (BED) and obesity. A feature of behavioral weight loss (BWL) treatment involves frequent weighing. However, little is known regarding how frequency of self-weighing and related perceptions are associated with BWL outcomes among individuals with BED and obesity stratified by FA status. Participants (n = 186) were assessed with the Eating Disorder Examination before and after BWL treatment. Mixed effects models examined FA (presence/absence) before and after (post-treatment and 6- and 12-month follow-up) treatment and associations with frequency of weighing and related perceptions (reactions to weighing, sensitivity to weight gain and shape/weight acceptance). Participants with FA reported more negative reactions to weighing and less acceptance of shape/weight throughout treatment and follow-ups, and both variables were associated with greater disordered eating at follow-ups among participants with FA. Sensitivity to weight gain decreased over time independent of FA status. Frequency of weighing was associated with a greater likelihood of achieving 5% weight loss only among those without FA. Reactions to weighing and sensitivity to weight gain are associated with FA and poorer treatment outcomes in individuals with BED and obesity. Targeting these features may improve BWL outcomes among individuals with BED, obesity and FA

Interrater reliability and internal consistency of the eating disorder examination in the longitudinal assessment of bariatric surgery study

Background: Psychometric studies of eating disorder measures within bariatric surgery populations are limited. Objectives: To examine the interrater reliability and internal consistency of the Eating Disorder Examination (EDE) among patients before and after bariatric surgery. Setting: Three clinical centers of the Longitudinal Assessment of Bariatric Surgery Research Consortium. Methods: The EDE-Bariatric Surgery Version was administered and audio-recorded by trained interviewers before and at annual assessments after bariatric surgery. Approximately 20% of interviews were randomly selected for rating by a second interviewer. Reliability of the original and brief EDE subscales was examined. Results: Interrater reliability of the EDE subscales ranged from.86–.97 for the original subscales and.83–.95 for brief subscales before surgery, and.90–.98 for the original subscales and.92–.97 for brief subscales after bariatric surgery. Interrater agreement (based on kappa) was almost perfect for overeating and binge-eating behaviors and substantial for loss-of-control eating before surgery. Similar interrater agreements (based on kappa) were observed after surgery for subjective overeating and binge-eating episodes. Internal consistency of the subscale and global scores was variable, ranging from.41–.97. Conclusion: Findings provide support of the interrater reliability of the EDE, albeit with variable internal consistency, before and after bariatric surgery. Despite support for trained raters to reliably assess EDE constructs, variability in internal consistency suggests that further psychometric testing and rigorous scale development of disordered eating may be needed for the bariatric surgery population

Disordered eating following bariatric surgery: a review of measurement and conceptual considerations

Eating disorders are associated with significant medical morbidity and mortality and serious psychological impairment. Individuals seeking bariatric surgery represent a high-risk group for evidencing disordered eating and eating disorders, with some patients experiencing the persistence or onset of disordered eating postsurgery. This review synthesizes the available literature on problematic or disordered eating in the bariatric field, followed by a review of measurement and conceptual considerations related to the use of eating disorder assessment tools within the bariatric population