Athena Robinson

What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year

BACKGROUND Prior evidence indicates that predictors of weight loss outcomes after gastric bypass surgery fall within 5 domains: 1) presurgical factors, 2) postsurgical psychosocial variables (e.g., support group attendance), 3) postsurgical eating patterns, 4) postsurgical physical activity, and 5) follow-up at postsurgical clinic. However, little data exist on which specific behavioral predictors are most associated with successful outcomes (e.g.,≥ 50% excess weight loss) when considering the 5 domains simultaneously. The objective of this study was to specify the behavioral variables, and their respective cutoff points, most associated with successful weight loss outcomes. METHODS Signal detection analysis evaluated associations between 84 pre- and postsurgical behavioral variables (within the 5 domains) and successful weight loss at ≥ 1 year in 274 postgastric bypass surgery patients. RESULTS Successful weight loss was highest (92.6%) among those reporting dietary adherence of>3 on a 9-point scale (median = 5) who grazed no more than once-per-day. Among participants reporting dietary adherence<3 and grazing daily or less, success rates more than doubled when highest lifetime body mass index was<53.7 kg/m(2). Success rates also doubled for participants with dietary adherence = 3 if attending support groups. No variables from the physical activity or postsurgical follow-up domains were significant, nor were years since surgery. The overall models sensitivity = .62, specificity = .92. CONCLUSIONS To our knowledge, this is the first study to simultaneously consider the relative contribution of behavioral variables within 5 domains and offer clinicians an assessment algorithm identifying cut-off points for behaviors most associated with successful postsurgical weight loss. Such data may inform prospective study designs and postsurgical interventions.

Validating stage of change measures for physical activity and dietary behaviors for overweight women

Objective:To investigate the construct, concurrent and predictive validity of stage of change measures for physical activity (PA), and intakes of fruit and vegetables (FVs), dietary fiber (FB) and dietary fat (DF) among a sample of overweight women.Design:Subjects were 401 women (mean age=41, s.d.=8.7 years; mean body mass index=32.35, s.d.=4.6) recruited to participate in a 12-month weight loss intervention trial. Concurrent validity tests included (1) self-report of current behavior, (2) decisional balance (for example, pros and cons of behavior change), (3) self-efficacy, (4) the MTI Actigraph accelerometer (for the PA staging measure), and (5) a food-frequency questionnaire (for all dietary staging measures). Predictive validity was assessed through tests of the relationship between the baseline stage of change measures and their corresponding behavior 1-year later.Results:Coefficient α-tests of internal consistency exceeded 0.70 on the majority of scales. Concurrent validity tests indicated strong validity evidence for three staging measures and little validity for the DF staging measure (η2 range, 0.02–0.18). All staging algorithms demonstrated predictive validity (η2 range, 0.04–0.126).Conclusion:Staging measures can determine motivational readiness for overweight women, contribute to the standardization of stage of change assessment and facilitate cross-study comparisons.

Forty years of progress in the treatment of the eating disorders

This paper reviews progress in the treatment of the eating disorders between 1968 and 2008. In 1968, no evidence-based treatments were available for any of the eating disorders, and binge eating disorder had not yet been described. In 2008, there are still no evidence-based treatments for anorexia nervosa, although a specific form of family therapy (based on the Maudsley model) appears promising. Both psychotherapeutic and psychopharmacological evidence-based treatments are now available for bulimia nervosa and binge eating disorder. Therapist-assisted self-help is a promising approach to treatment because it may reduce the costs of treatment, allow for more adequate dissemination to areas lacking specialty resources and also provide a basis for algorithm-driven approaches to treatment.

Moderators of Dialectical Behavior Therapy for Binge Eating Disorder: Results from a Randomized Controlled Trial

OBJECTIVE Investigate moderators of a randomized clinical trial of group Dialectical Behavior Therapy for Binge Eating Disorder (DBT-BED) compared to an active comparison group control (ACGT) on the post-treatment outcome of binge frequency after twenty 2-h weekly sessions. METHOD Moderation analyses. RESULTS Participants were 101 adults with BED [mean (SD) age, 52.2 (10.6) years and BMI, 36.4 (8.6)]. Analyses identified two moderators of post-treatment outcome. Participants with (1) Avoidant Personality Disorder or (2) an earlier onset of overweight and dieting (<15 years old) evidenced significantly worsened outcome when treated with ACGT versus DBT-BED. DISCUSSION Participants with certain indicators of higher baseline pathology respond better to DBT-BED than ACGT at post-treatment.

Does implicit emotion regulation in binge eating disorder matter

OBJECTIVE To examine if implicit emotion regulation (occurring outside of awareness) is related to binge eating disorder (BED) symptomatology and explicit emotion regulation (occurring within awareness), and can be altered via intervention. METHODS Implicit emotion regulation was assessed via the Emotion Conflict Task (ECT) among a group of adults with BED. Study 1 correlated BED symptomatology and explicit emotion regulation with ECT performance at baseline (BL) and after receiving BED treatment (PT). Study 2 generated effect sizes comparing ECT performance at BL and PT with healthy (non-eating disordered) controls (HC). RESULTS Study 1 yielded significant correlations (p<.05) between both BED symptomatology and explicit emotion regulation with ECT performance. Study 2 found that compared to BL ECT performance, PT shifted (d=-.27), closer to HC. Preliminary results suggest a) BED symptomatology and explicit emotion regulation are associated with ECT performance, and b) PT ECT performance normalized after BED treatment. CONCLUSIONS Implicit emotion regulation may be a BED treatment mechanism because psychotherapy, directly or indirectly, decreased sensitivity to implicit emotional conflict. Further understanding implicit emotion regulation may refine conceptualizations and effective BED treatments.

Subgrouping the users of a specialized app for eating disorders

ABSTRACT Although mobile technologies for eating disorders (EDs) are burgeoning, there is limited data about the clinical characteristics of individuals using specialized smartphone applications (apps) without accompanying traditional forms of treatment. This study evaluated whether the users of an ED app cluster in clinically meaningful groups. Participants were 1,280 app users (91.3% female; mean age 27) who reported not being in a weekly treatment for their ED. A hierarchical cluster analysis distinguished five groups of participants, all approximating DSM-5 ED categories. One cluster comprised of non-female, ethnically diverse users with Bulimia Nervosa features. Findings suggest that app users resemble known patient classifications.

Ethnicity in Bulimia Nervosa and Other Eating Disorders

This chapter reviews the literature to date on the prevalence of disordered eating behaviors among ethnic minorities. Empirical studies from the past decade indicate that disordered eating behaviors among adults and adolescents from various minority groups are more prevalent than previously thought. Preliminary conclusions are that Anorexia Nervosa is rare among blacks, data are mixed on whether rates of Bulimia Nervosa among ethnic minority and white females differ, and rates of binge eating among ethnic minorities are higher than other forms of disordered eating. Primary care physicians are often the first viable line of eating disorder assessment and referral. It is therefore imperative that primary care physicians are aware of disordered eating presentations in minority groups in order to provide needed evaluation and intervention. Areas for future research of disordered eating among minority groups include assessment of variation in risk factors, the relationship between overweight/obesity and binge eating disorder, level of acculturation impacting eating disorder severity, access to and engagement in treatment, and response to treatment.