Body image and body avoidance nine years after bariatric surgery and conventional weight loss treatment

Recently, there has been an increasing focus on body image dissatisfaction (BID), both as a motivational factor for seeking bariatric surgery and as a factor influencing weight loss outcome after surgery. Although associations have been reported between BID, emotional distress and successful weight loss, conclusions are limited due to methodological issues such as non-weight-specific assessment tools for body image and neglect of behavioral components (e.g. body avoidance, BA). The present study seeks to report on BID and BA 9 years after bariatric surgery using a cross-sectional data set from the 9-year follow-up assessment of the Essen–Bochum Obesity Treatment Study (EBOTS). In total, N = 291 participants of the original EBOTS sample were included in the present analyses (N = 78 bariatric surgery patients, SURG; N = 124 patients of a conventional treatment program, CONV; and N = 83 individuals with obesity not seeking treatment, OC). Current body image facets (BID and BA) were captured at the 9-year follow-up assessment $\it via$ silhouette scales adapted for use in samples with obesity. Moreover, BID was assessed retrospectively to obtain baseline attitudes. Possible influences of eating disorder symptoms and depression/anxiety were controlled for and assessed $\it via$ standardized self-report measures. The results imply an improvement in BID in the SURG group, but not in the CONV and OC groups. The level of BA in relation to clothing was significantly higher in the CONV group compared to both the SURG and OC group. Current BID as well as BA were positively associated with current body weight as well as depression, anxiety, and levels of disinhibited eating. A positive change from baseline to current levels of BID was associated with successful weight loss, independently of treatment. The findings emphasize the role of the different components of body image after surgery for mental health features, and suggest a robust relationship between BID and weight loss (success). Thus, it might be helpful to address BID in treatment. However, further research, particularly in the form of prospective studies, is necessary to determine the direction of influence

What kind of patients receive inpatient and day-hospital treatment in departments of psychosomatic medicine and psychotherapy in Germany?

$\bf Introduction:$ Germany is one of the few countries with a medical specialty of psychosomatic medicine and psychotherapy and many treatment resources of this kind. $\bf Objective:$ This observational study describes the psychosomatic treatment programs as well as a large sample of day-hospital and inpatients in great detail using structured diagnostic interviews. $\bf Methods:$ Mental disorders were diagnosed according to ICD-10 and DSM-IV by means of Mini-DIPS and SCID-II. In addition to the case records, a modified version of the CSSRI was employed to collect demographic data and service use. The PHQ-D was used to assess depression, anxiety, and somatization. $\bf Results:$ 2,094 patients from 19 departments participated in the study after giving informed consent. The sample consisted of a high proportion of "complex patients" with high comorbidity of mental and somatic diseases, severe psychopathology, and considerable social and occupational dysfunction including more than 50 days of sick leave per year in half of the sample. The most frequent diagnoses were depression, somatoform and anxiety disorders, eating disorders, personality disorders, and somato-psychic conditions. $\bf Conclusions:$ Inpatient and day-hospital treatment in German university departments of psychosomatic medicine and psychotherapy is an intensive multimodal treatment for complex patients with high comorbidity and social as well as occupational dysfunction

The multicenter effectiveness study of inpatient and day hospital treatment in departments of psychosomatic medicine and psychotherapy in Germany

$\bf Background:$ Reliable outcome data of psychosomatic inpatient and day hospital treatment with a focus on psychotherapy are important to strengthen ecological validity by assessing the reality of mental health care in the field. This study aims to evaluate the effectiveness of inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy in a prospective, naturalistic, multicenter design including structured assessments. $\bf Methods:$ Structured interviews were used to diagnose mental disorders according to ICD-10 and DSM-IV at baseline. Depression, anxiety, somatization, eating disorder and posttraumatic stress disorder (PTSD) symptoms, as well as personality functioning were assessed by means of questionnaires on admission and at discharge. $\bf Results:$ 2,094 patients recruited by 19 participating university hospitals consented to participation in the study. Effect sizes for each of the outcome criteria were calculated for 4–5 sub-groups per outcome domain with differing severity at baseline. Pre-post effect sizes for patients with moderate and high symptom severity at baseline ranged from $\it d$ = 0.78 to $\it d$ = 3.61 with symptoms of PTSD, depression, and anxiety showing the largest and somatization as well as personality functioning showing somewhat smaller effects. $\bf Conclusions:$ Inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy is effective under field conditions. $\bf Clinical trial registration:$ https://drks.de/search/de/trial/DRKS00016412, identifier: DRKS00016412