Cathrine L. Wimmelmann

Psychological predictors of mental health and health-related quality of life after bariatric surgery: A review of the recent research

BACKGROUND Improvement of mental health and health-related quality of life (HRQOL) is an important success criterion for bariatric surgery. In general, mental health and HRQOL improve after surgery, but some patients experience negative psychological reactions postoperatively and the influence of pre-surgical psychological factors on mental wellbeing after surgery is unclear. The aim of the current article therefore is to review recent research investigating psychological predictors of mental health and HRQOL outcome. METHODS We searched PubMed, PsycInfo and Web of Science for studies investigating psychological predictors of either mental health or HRQOL after bariatric surgery. Original prospective studies published between 2003 and 2012 with a sample size >30 and a minimum of 1 year follow-up were included. RESULTS Only 10 eligible studies were identified. The findings suggest that preoperative psychological factors including psychiatric symptoms, body image and self-esteem may be important for mental health postoperatively. Predictors of postoperative HRQOL seem to include personality, severe psychiatric disorder at baseline and improvement of depressive symptoms. In addition, psychiatric symptoms that persist after surgery and inappropriate eating behaviour postoperatively are likely to contribute to poor health-related quality of life outcome. CONCLUSION Certain psychological factors appear to be important for mental health and HRQOL after bariatric surgery. However, the literature is extremely sparse and further research is highly needed.

Prevalence and correlates of being overweight or obese in college.

Recent statistics indicate that over one-third of college students are currently overweight or obese, however, the impact of weight in this population from academic and psychiatric perspectives is not fully understood. This study sought to examine the prevalence of overweight and obesity in college students and its association with stress, mental health disorders and academic achievement. A total of 1765 students completed the College Student Computer User Survey (CSCUS) online at a large Midwestern United States University. Responders were classified by weight as normal, overweight or obese based on body mass index. Data were stratified by sex, with cross-tabulation and t-tests, one-way analysis of variance, and logistic regression for analysis. A total of 492 (27.9%) students were overweight (20.2%; range 25.01-29.98) or obese (7.7%; range 30.04-71.26). Overweight and obesity were associated with significantly lower overall academic achievement, more depressive symptoms, and using diet pills for weight loss. Obese males had significantly higher rates of lifetime trichotillomania while overweight and obese females reported higher rates of panic disorder. Higher educational institutions should be aware of the significant burden associated with overweight and obesity in students, and of the differing demographic and clinical associations between overweight or obesity in men and women.

Increased post-operative cardiopulmonary fitness in gastric bypass patients is explained by weight loss

Roux‐en‐Y gastric bypass (RYGB) leads to a major weight loss in obese patients. However, given that most patients remain obese after the weight loss, regular exercise should be part of a healthier lifestyle. The primary aim of this study was to investigate the cardiopulmonary fitness in obese patients before and after RYGB. Thirty‐four patients had body composition and cardiopulmonary fitness (VO2max) assessed and completed questionnaires regarding physical activity and function twice before RYGB (time points A and B) and 4 and 18 months after surgery (time points C and D). Weight loss was 37 ± 2 kg during the study period. VO2max increased (A: 21 ± 1 vs D: 29 mL/min/kg, P < 0.001), but absolute VO2max decreased (A: 2713 ± 126 vs 2609 ± 187 mL/min, P = 0.02) and VO2max per kilogram fat free mass did not change. Self‐perceived limitations to perform exercise decreased and self‐perceived physical fitness increased after RYGB. Self‐reported low‐ and high‐intensity physical activity did not change. With weight loss, self‐rated fitness level increased and the limitations to perform exercise decreased in RYGB patients. Nevertheless, as shown by the lower absolute VO2max, RYGB patients do not adopt new exercise habits following surgery.

The Effect of Preoperative Type 2 Diabetes and Physical Fitness on Mental Health and Health-Related Quality of Life after Roux-en-Y Gastric Bypass.

Objective. To investigate the predictive value of type 2 diabetes and lack of physical activity for mental health and health-related quality of life after Roux-en-Y gastric bypass. Method. Forty severely obese patients undergoing Roux-en-Y gastric bypass were included in the GASMITO study. Information about physiological and psychological factors was prospectively assessed at four time points, two times prior to surgery and two times after surgery. Measures included oral and intravenous glucose tolerance tests, VO2max test, Symptoms Checklist (SCL-90), Short Form Health Survey 36 (SF-36), Body Image Questionnaire, and a questionnaire assessing sociodemographic factors and medical status. Results. Mean % excess weight loss was 65% (±12) at 18-month follow-up and 50% of the participants with diabetes experienced total remission. Also, significant improvements were observed with regard to physical fitness, mental distress, health-related quality of life, and weight-related body image (p < 0.05). The interaction between follow-up time and type 2 diabetes at baseline significantly predicted six of the thirteen psychological subscales (p < 0.05) and, across the follow-ups, physical fitness level made modest contributions to variations in mental symptoms and HRQOL but not weight-related body image. Conclusion. The results suggest that baseline difference in mental symptoms and physical HRQOL between diabetic and nondiabetic patients declines across follow-ups and resolves around the time of surgery.

Does vital exhaustion increase the risk of type 2 diabetes? A prospective study

BACKGROUND There is evidence that both stress and depression have a causal relationship with type 2 diabetes suggesting that vital exhaustion (VE) too could be a risk factor. The association between VE and type 2 diabetes has, however, not been investigated prospectively. AIM To prospectively investigate whether VE is associated with an increased risk of type 2 diabetes in a Danish population. METHODS A prospective cohort study based on the Copenhagen City Heart Study (1991-1993). The degree of VE was measured among 9075 participants without type 1 or 2 diabetes at baseline. To detect type 2 diabetes in the follow-up period, two different approaches were used: In the first substudy, type 2 diabetes was defined based on blood samples and questionnaires from a follow-up study in 2001-2003 (N=4708). The second substudy was register-based, and the study population was linked to the Danish Hospital Discharge Register to detect registrations with type 2 diabetes until 2014. RESULTS A high degree of VE was associated with an increased risk of developing type 2 diabetes in both substudies. In the first substudy, the OR for developing type 2 diabetes was 2.56 (95% CI, 1.53; 4,29, P<0,001) among the quartile of participants reporting the highest degree of VE. In the second substudy, the OR was 1.31 (95% CI, 0.99; 1.72, P=0.053) for this group. CONCLUSION The results indicate that VE may be a useful measure in clinical practice in order to discover individuals at risk of type 2 diabetes.

Physical activity as intervention for age-related loss of muscle mass and function: protocol for a randomised controlled trial (the LISA study)

Introduction Physical and cognitive function decline with age, accelerating during the 6th decade. Loss of muscle power (force×velocity product) is a dominant physical determinant for loss of functional ability, especially if the lower extremities are affected. Muscle strength training is known to maintain or even improve muscle power as well as physical function in older adults, but the optimal type of training for beneficial long-term training effects over several years is unknown. Moreover, the impact of muscle strength training on cognitive function and brain structure remains speculative. The primary aim of this randomised controlled trial is to compare the efficacy of two different 1 year strength training regimens on immediate and long-lasting improvements in muscle power in retirement-age individuals. Secondary aims are to evaluate the effect on muscle strength, muscle mass, physical and cognitive function, mental well-being, health-related quality of life and brain morphology. Methods and analysis The study includes 450 home-dwelling men and women (62–70 years). Participants are randomly allocated to (1) 1 year of supervised, centre-based heavy resistance training, (2) home-based moderate intensity resistance training or (3) habitual physical activity (control). Changes in primary (leg extensor power) and secondary outcomes are analysed according to the intention to treat principle and per protocol at 1, 2, 4, 7 and 10 years. Ethics and dissemination The study is expected to generate new insights into training-induced promotion of functional ability and independency after retirement and will help to formulate national recommendations regarding physical activity schemes for the growing population of older individuals in western societies. Results will be published in scientific peer-reviewed journals, in PhD theses and at public meetings. The study is approved by the Regional Ethical Committee (Capital Region, Copenhagen, Denmark, number H-3-2014-017). Trial registration number NCT02123641.

Associations between obesity and mental distress in late midlife: results from a large Danish community sample

BackgroundTo examine associations of Body mass Index (BMI) and mental distress in late midlife in a large Danish community sample and to investigate the effect of socio-demographic factors.MethodsThe study sample comprised 3613 Danish men and 1673 women aged 49–63 years from the Copenhagen Ageing and Midlife Biobank (CAMB) with complete information on measured BMI, severity of mental symptoms assessed by the Symptom Check-List’ (SCL-90), and socio-demographic factors including sex, age, occupational social class, and educational duration. Linear and logistic regression were used to evaluate associations between BMI category and SCL-90.ResultsUnadjusted SCL-90 subscale scores differed significantly across BMI categories (p < 0.001) among both men and women with more mental distress in the underweight, obese and severely obese BMI categories except for the anxiety scale which was not associated with BMI category in women. In the adjusted analyses, all symptom scales remained significantly associated with BMI among men after adjusting for socio-demographic factors while only associations with somatization and depression scales remained significant for women.. When SCL-90 case status was applied as an outcome, significant unadjusted associations with BMI category were observed for somatization (p < 0.001), depression (p = 0.026) and the General Severity Index (p = 0.002) among men and somatization (p = 0.002) among women. Furthermore, somatization case-status was significantly predicted by BMI category (p < 0.001) in men after adjusting for socio-demographic factors.ConclusionResults indicate more mental distress among underweight, obese and severely obese men and women after adjusting for socio-demographic factors. Furthermore, obese men have higher risk of reporting clinically relevant symptoms of somatization independently of socio-demographic factors.

Prospective Associations of the Short Form Health Survey Vitality Scale and Changes in Body Mass Index and Obesity Status

Objectives The objectives of the current study were to prospectively investigate the predictive value of the vitality scale of the Short Form Health Survey for changes in body mass index and development of obesity. Methods The study population comprised 2864 (81.5%) men and 648 (18.5%) women from the Metropolit Project and the Danish Longitudinal Study on Work, Unemployment and Health, who participated in a follow-up examination in 2009–2011 corresponding to a follow-up period of 3–7 years. Associations of vitality with body mass index and obesity were investigated separately for men and women in linear and logistic regression models adjusting for age, baseline body mass index, education, physical activity, smoking, and obesity-related diseases. Results Vitality was significantly associated with change in body mass index among men (p < 0.001) and women (p < 0.05) gaining weight after adjusting for age, baseline body mass index, education, physical activity, smoking, and obesity-related diseases. No significant associations of vitality with BMI change were observed among individuals maintaining or losing weight during the follow-up period. Furthermore, vitality significantly predicted development of obesity among women. Conclusion The study indicates that vitality is of predictive value for increases in BMI over time among individuals gaining weight and may further predict the development of obesity among women. This identification of poor vitality as a potential risk indicator for weight gain and development of obesity may be beneficial in clinical practice.