Cognitive-Behavioral Therapy for Postbariatric Surgery Patients With Mental Disorders: A Pilot Study

Background: Binge-eating disorder (BED) and major depressive disorder (MDD) following bariatric surgery are significant predictors for less post-operative weight loss and/or weight regain, however, cognitive-behavioral therapy (CBT) addressing these disorders following surgery has not been investigated so far. Objective: This study examined feasibility of a short-term CBT based on evidence-based manuals for BED and MDD that were adapted to patients following bariatric surgery, and investigated its effectiveness in improving weight loss outcome, psychopathology, and psychosocial functioning. Materials and Methods: In an uncontrolled proof-of-concept study, the CBT manual was piloted in N = 7 patients who had undergone roux-en-Y gastric bypass surgery at least 6 months before. Weight loss, eating disorder psychopathology, depressive symptoms, and self-esteem were assessed using clinical interviews and self-report questionnaires at pre-treatment, post-treatment, and in a 3-month follow-up. Results: A significant reduction of body weight was found as well as medium to large effects in the improvement of eating disorder psychopathology, depressive symptoms, and self-esteem from pre-treatment to post-treatment were found. Most of those changes remained stable during the 3-month follow-up period. Study retention was 71.4%. Conclusions: Feasibility and effectiveness of CBT were documented for patients with BED or MDD following bariatric surgery. Adaptations of the study procedure for proof-of efficacy in randomized-controlled studies are discussed

Implicit cognitive processes in binge-eating disorder and obesity

Objectives: Binge-eating disorder (BED) is characterized by recurrent binge eating episodes, associated eating disorder and general psychopathology, and commonly occurs in obese individuals. Explicit self-esteem and explicit weight bias have been linked to BED, while little is known about implicit cognitive processes such as implicit self-esteem and implicit weight bias. Methods: Obese participants with BED and an individually matched obese only group (OB) and normal weight control group (CG; each N = 26) were recruited from the community to examine group differences and associations in explicit and implicit self-esteem and weight bias, as well as the impact of implicit cognitive processes on global eating disorder psychopathology. Implicit cognitive processes were assessed using the Implicit Association Test. Results: Significantly lower explicit self-esteem, as well as higher exposure to explicit weight bias, compared to CG and OB was found in the BED group. All groups showed positive implicit self-esteem, however, it was significantly lower in BED when compared to CG. BED and CG demonstrated equally high implicit weight bias whereas OB did not. Explicit and implicit measures were not significantly correlated. Global eating disorder psychopathology was predicted by explicit and implicit self-esteem. Conclusions: The results of the present study add to the importance of implicit self-esteem and implicit weight bias beyond explicit measures in BED, while both were previously shown to be associated with onset and maintenance of BED. In conclusion, implicit cognitive processes should be focused on in interventions for BED to investigate their impact on psychological treatments

Longitudinalstudie zur normalen Entwicklung autonomer Rhythmen im II. und III. Schwangerschaftstrimester mittels Herzfrequenzvariabilitätsanalyse

Die Herzfrequenzvariabilität spiegelt die durch Sympathikus und Parasympathikus vermittelten neurovegetativen Regulationen wieder, die sich während der fetalen Entwicklung herausbilden. Die fetale Magnetkardiographie gilt als die zuverlässigste Methode um bereits ab der 20. Schwangerschaftswoche elektrische Signale des fetalen Herzens zu erfassen. Das Ziel der Arbeit bestand darin zu prüfen, ob Phasen autonomer Reifung mit Hilfe geeigneter Herzfrequenzvariabilitäts-Parameter genauer erfassbar sind, bzw. ob ein longitudinales Studiendesign die präzisere Einschätzung pränataler Reifung ermöglicht. Es wurden 42 Feten mittels fetaler Magnetkardiographie über 30 min/Messung im Rahmen einer Längsschnittstudie untersucht. Es wurden geeignete Parameter berechnet und anschließend die Ergebnisse der Längsschnittstudie mit den Ergebnissen von 72 Probandinnen aus einer bestehenden Querschnittstudiendatenbank verglichen. Die größte vegetative Reifung konnte dabei am Übergang in das dritte Trimester nachgewiesen werden. Der Höhepunkt der parasympathischen Reifung lag zwischen der 24. und 31. Schwangerschaftswoche. Über den autonomen Informationsfluss konnte eine zunehmende Komplexität der neurovegetativen Koordination zwischen der 24. und 31. Schwangerschaftswoche gezeigt werden. Die untersuchten Herzfrequenzvariabilitäts-Parameter sind in der Lage die Reifung vagaler und sympathischer Aktivität und deren komplexe Koordination quantitativ zu erfassen. Dazu konnte in der Arbeit der Entwicklungssprung am Übergang zum dritten Trimester aufgrund des longitudinalen Studiendesigns klar beschrieben werden. Es ist die Berücksichtigung definierter fetaler Verhaltenszustände notwendig, die nicht zwangsläufig in einer 30 min Messung auftreten, weshalb der Fokus auf dem häufiger auftretenden aktiven Verhaltenszustand lag. Die hier erlangten Ergebnisse stellen wesentliche Bausteine für die Entwicklung eines klinischen fetalen Monitoringsystems zur Reifungs- und Risikoeinschätzung dar

Psychosocial status and mental health in adolescents before and after bariatric surgery: a systematic literature review

Objective: As long-term results of conservative treatment for obesity are discouraging, bariatric surgery is becoming a treatment option for extremely obese adolescents. However, mental and behavioral problems need to be respected when treating this vulnerable target group. Methods: A detailed systematic literature review on pre- and post-operative depressive, anxiety and eating disorder symptoms of adolescent patients was performed in PsychINFO, PubMed and Medline electronic databases. Results: Twelve studies met the inclusion criteria. Although strength of evidence was limited, results suggested that pre-operatively a third of adolescents suffered from moderate to severe depressive disorder symptoms and a quarter from anxiety disorder symptoms, while a substantial number showed eating disorder symptoms. Post-operatively, levels of depressive disorder symptoms significantly improved. Original articles on outcomes of eating and anxiety disorder symptoms after weight loss surgery were not found. Conclusions: Further attention is needed on consistent clinical assessment of mental health disturbances and their consecutive treatment in adolescents. Future research should also focus on psychological and psychosocial predictors of weight loss after bariatric surgery

A novel measure to assess self-discrimination in binge eating disorder and obesity

Stigmatized obese individuals tend to internalize the pervasive weight stigma which might lead to self-discrimination and increased psychopathology. While explicit and implicit weight stigma can be measured using self-report questionnaires and Implicit Association Tests (IAT), respectively, the assessment of self-discrimination relied solely on self-report. The present study sought to develop an IAT measuring implicit self-discrimination (SD-IAT) in samples of obese individuals with and without binge-eating disorder (BED). Seventy-eight individuals were recruited from the community and individually matched in three groups. Obese participants with BED, obese participants without BED (OB), and a normal weight control group without eating disorder psychopathology (HC) were assessed with the SD-IAT and other measures relevant for convergent and discriminant validation. Results revealed significantly higher implicit self-discrimination in the BED group when compared to both OB and HC. Furthermore, significant correlations were found between the SD-IAT with body mass index, experiences of weight stigma, depressive symptoms, and implicit self-esteem. Finally, implicit self-discrimination predicted eating disorder psychopathology over and above group membership, and experiences of weight stigma. This study provides first evidence of the validity of the SD-IAT. Assessing implicit self-discrimination might further increase understanding of weight stigma and its significance for psychosocial functioning among vulnerable obese individuals

Regionalzentren in Westungarn: Gewinner der Transformation?; Györ und Pécs in den 1990er Jahren

Eine Folge der neuen regionalen Differenzierungsprozesse der 1990er Jahre ist die divergierende ökonomische und soziale Entwicklung der jeweiligen westlichen und östlichen Regionen innerhalb der ostmitteleuropäischen Transformationsländer. Die Grenzgebiete zum Westen gelten neben den hauptstädtischen Metropolregionen als prosperierende Regionen, die in besonderer Weise am ökonomischen Aufschwung partizipieren. So erfuhren etwa die nordwestlichen Gebiete Ungarns während der 1990er Jahre ein vergleichsweise stabiles Wirtschaftswachstum. Auch innerhalb der erfolgreichen Regionen sind es vor allem die Städte, die die Träger der ökonomischen Prosperität darstellen. Im vorliegenden Beitrag werden die wesentlichen raumstrukturellen Veränderungen zweier ungarischer Regionalstädte, Györ und Pécs, untersucht, wobei insbesondere deren spezifische regionale Bedingungen Berücksichtigung finden. Der strukturelle Wandel beider Städte wird vor allem aus der Perspektive möglicher konvergenter Entwicklungswege zu westeuropäischen Stadtentwicklungen betrachtet. Der strukturelle Wandel und die damit verbundenen Kernstadt-Umland-Prozesse verlaufen sowohl in Györ als auch in Pécs sehr dynamisch. Sie sind mit neuen sozial- und funktionalräumlichen Differenzierungen innerhalb der jeweiligen Stadtregion verbunden. Die räumlichen Differenzierungen beruhen auf einer unterschiedlichen Investitions- und Deinvestitionsdynamik in den verschiedenen Teilräumen der Stadtregion. Die Sanierung der historischen Stadtzentren beider Städte ist mit einer Inwertsetzung des Stadtraumes für den sich schnell entwickelnden tertiären Sektor verbunden. Das derzeitige Siedlungswachstum findet in beiden Städten vor allem in den kleinen Dörfern und Wochenendhausgebieten des Umlandes statt. Neu ist jedoch die Dimension der gegenwärtigen Wohnsuburbanisierung, die zu einem starken Wandel der traditionellen Dorfstrukturen führt. Neuartige räumliche Strukturen finden sich an der Peripherie beider Stadtregionen vor allem durch die Entwicklung des großflächigen Einzelhandels mit regionalen Reichweiten. Nur noch partiell an der lokalen Nachfrage orientiert, stellen die "big boxes" neuen Formen des Einzelhandels dar, die zu einem veränderten Einkaufsverhalten führen. Diese Standorte sind die wichtigsten Elemente der Internationalisierung räumlicher Strukturen in beiden Stadtregionen. Bezüglich der Entwicklung des produzierenden Gewerbes ließen sich bedeutende Unterschiede zwischen beiden Stadtregionen feststellen. Györ kann auf eine überaus erfolgreiche Investitionsentwicklung verweisen. Zwar gibt es auch in Pécs Ansiedlungserfolge auf neuen Industrieflächen, doch ließ sich hier kein derartig dynamisches Wachstum des produzierenden Gewerbes feststellen. Die Bedingungen für die erfolgreichere gewerbliche Entwicklung von Györ im Vergleich zu derjenigen von Pécs ist vor allem auf der regionalen Ebene angesiedelt. Doch sind die geographische Nähe Györs zu Österreich und die weiter entwickelte verkehrstechnische Infrastruktur nicht die einzigen Faktoren der erfolgreichen Entwicklung. Der strukturelle Vorsprung beruht vor allem auch auf der industriellen Tradition und der Konzentration von Betrieben des Maschinen- und Fahrzeugbaus in den nordwestlichen Regionen Ungarn und auf dem bereits vor der ökonomischen Öffnung existierenden Netzwerk von Zulieferfirmen. Die bereits in den 1980er Jahren einsetzende Entwicklung privater Kleinbetriebe hat wesentlich dazu beigetragen, dass sich die in der Region vorhandenen spezialisierten Wissensvorteile in strukturelle Entwicklungsvorteile umsetzen ließen. Pécs dagegen weist bisher aufgrund der ungünstigen verkehrsinfrastrukturellen Situation und Lage innerhalb eines strukturschwachen Umfeldes schlechtere Voraussetzungen für eine beschleunigte Gewerbeentwicklung auf. Der Einbindung der jeweiligen Stadt in die Weltwirtschaft ist von entscheidender Bedeutung für eine konvergente Entwicklung räumlicher Strukturmuster einer Stadtregion. Dies wurde vor allem an den jeweiligen Peripherien beider Städte deutlich, deren Strukturen (Gewerbeparks, großflächiger Einzelhandel, Produktionsstandorte internationaler Unternehmen) darüber Auskunft geben, inwieweit der Raum tatsächlich in globale Zusammenhänge einbezogen ist.One consequence of the new regional differentiation processes of the nineteen nineties is the diversifying economic and social development of the respective western and eastern regions within the transformation countries of eastern central Europe. In addition to the catchment areas around the capital cities, the areas bordering on the West are regarded as being prosperous regions, participating to a large extent in the economic upswing. The north- western regions of Hungary, for example, enjoyed comparably stable economic growth during the nineties. Indeed, the cities within these successful regions carried the economic prosperity to a particular extent. This article analyses the main changes in terms of regional structure in two regional cities in Hungary, Györ and Pécs, whereby it focuses in particular on their specific regional ties. The structural transformation of both cities is considered from the perspective of possible convergent development paths compared to western European city development. The structural development and the consequent core city - suburbia processes are extremely dynamic in Györ and in Pécs. This process is linked to differentiation in social and functional regions within each city area. The regional differences are based on differences in the dynamics of investment and de-investment in the different areas of the city region. The redevelopment of t he historical city centres of both cities is linked to a gentrification of the city region for the fast-developing tertiary sector. The current settlement growth is taking in place in both cities above all in the small villages and weekend home areas around the cities. However, the current dimension of residential suburbanisation is new, which is leading to a marked transformation of the traditional village structures. There are new regional structures on the periphery of both city regions, above all due to the development of expansive retail trade attracting custom on a regional level. The "big boxes" are new forms of retail trade and are only partia lly designed for local demand; they lead to changes in consumer behaviour. These locations are the most important elements in the internationalisation of regional structures in both city regions. There were considerable differences between the two city regions in terms of the development of the manufacturing industry. Györ can draw on an extremely successful investment development. Although Pécs has enjoyed some success in attracting new industry, there has been no comparably dynamic growth in manufacturing industry. The circumstances for the successful industrial development of Györ compared to Pécs are mainly found on a regional level. However, Györ's geographic proximity to Austria and a more developed transport infrastructure are not the only factors for successful development. The structural head start is mainly due to the industrial tradition and the concentration of machine engineering and automobile industries in the north-western regions of Hungary, as well as the existing network of supply firms, which existed even before economic liberalisation. Th e development of small private firms, which set in at the start of the nineteen eighties, made a considerable contribution to the implementation of the regional, specialised know-how to achieve structural advantages in terms of development. Conversely, due to its unfavourable transport infrastructure situation and location within a structurally weak area, Pécs has less promising conditions for fast-track industrial growth. The integration of both cities in the global economy is of decisive importance for the convergent development of regional structure patterns within a city region. This was particularly apparent on the peripheries of both cities, as their structures (industrial parks, expansive retail trade, production plants of international companies) provide information on the extent to which a region is truly part of a global context

Weight bias internalization, emotion dysregulation, and non-normative eating behaviors in prebariatric patients

Objective: Weight bias internalization (WBI) is associated with eating disorder psychopathology and non-normative eating behaviors among individuals with overweight and obesity, but has rarely been investigated in prebariatric patients. Based on findings demonstrating a relationship between emotion dysregulation and eating behavior, this study sought to investigate the association between WBI and eating disorder psychopathology as well as non-normative eating behaviors (i.e., food addiction, emotional eating, and eating in the absence of hunger), mediated by emotion dysregulation. Method: Within a consecutive multicenter study, 240 prebariatric patients were assessed using self-report questionnaires. The mediating role of emotion dysregulation was examined using structural equation modeling. Results: The analyses yielded no mediational effect of emotion dysregulation on the association between WBI and eating disorder psychopathology. However, emotion dysregulation fully mediated the associations between WBI and emotional eating as well as eating in the absence of hunger. Further, emotion dysregulation partially mediated the relationship between WBI and food addiction symptoms. Discussion: Prebariatric patients with high levels of WBI are at risk for non-normative eating behaviors, especially if they experience emotion regulation difficulties. These findings highlight the importance of interventions targeting WBI and improving emotion regulation skills for the normalization of eating behavior in prebariatric patients

Two sides of weight bias in adolescent binge-eating disorder: adolescents’ perceptions and maternal attitudes

Objective: Adolescents with binge-eating disorder (BED) are suffering from weight teasing and, as found in adults with BED, are likely to internalize weight bias. Weight teasing by mothers accounts for psychopathology in overweight, but sources of stigmatization are largely unknown in BED. This study sought to address familial weight bias in adolescents with overweight and BED by examining adolescents’ perceived parental weight teasing and weight bias internalization in relation to their eating disorder psychopathology and maternal stigmatizing attitudes and beliefs. Method: Adolescents with overweight and BED (BED; n = 40) were compared to a socio-demographically matched group with overweight only (OW) and a normal-weight control group (NW; each n = 25). They filled out the Perception of Teasing Scale, with parents as the source of teasing, the Weight Bias Internalization Scale and the Eating Disorder Examination-Questionnaire. Their mothers filled out the Attitudes Toward and Beliefs about Obese Persons Scales. Results: Significantly higher perceived parental weight teasing and weight bias internalization were found in BED compared to OW and NW. Maternal stigmatizing attitudes and beliefs did not differ between groups and were not correlated with adolescents’ perceptions of being stigmatized. Perceived parental weight teasing predicted adolescents’ eating disorder psychopathology, however, this association was fully mediated by weight bias internalization. Discussion: These results indicate that adolescents with overweight and BED perceive weight teasing in their own families. As we found no significant association between adolescents’ perceptions of being stigmatized and maternal stigmatizing attitudes, future research should examine weight-related parent-child interaction or implicit measures of stigmatizing attitudes

Noninvasive Detection of Fibrosis Applying Contrast-Enhanced Cardiac Magnetic Resonance in Different Forms of Left Ventricular Hypertrophy Relation to Remodeling

ObjectivesWe aimed to evaluate the incidence and patterns of late gadolinium enhancement (LGE) in different forms of left ventricular hypertrophy (LVH) and to determine their relation to severity of left ventricular (LV) remodeling.BackgroundLeft ventricular hypertrophy is an independent predictor of cardiac mortality. The relationship between LVH and myocardial fibrosis as defined by LGE cardiovascular magnetic resonance (CMR) is not well understood.MethodsA total of 440 patients with aortic stenosis (AS), arterial hypertension (AH), or hypertrophic cardiomyopathy (HCM) fulfilling echo criteria of LVH underwent CMR with assessment of LV size, weight, function, and LGE. Patients with increased left ventricular mass index (LVMI) resulting in global LVH in CMR were included in the study.ResultsCriteria were fulfilled by 83 patients (56 men, age 57 ± 14 years; AS, n = 21; AH, n = 26; HCM, n = 36). Late gadolinium enhancement was present in all forms of LVH (AS: 62%, AH: 50%; HCM: 72%, p = NS) and was correlated with LVMI (r = 0.237, p = 0.045). There was no significant relationship between morphological obstruction and LGE. The AS subjects with LGE showed higher LV end-diastolic volumes than those without (1.0 ± 0.2 ml/cm vs. 0.8 ± 0.2 ml/cm, p < 0.015). Typical patterns of LGE were observed in HCM but not in AS and AH.ConclusionsFibrosis as detected by CMR is a frequent feature of LVH, regardless of its cause, and depends on the severity of LV remodeling. As LGE emerges as a useful tool for risk stratification also in nonischemic heart diseases, our findings have the potential to individualize treatment strategies