Colleen S. W. Rand

The night eating syndrome in the general population and among postoperative obesity surgery patients

OBJECTIVE To determine the prevalence of night-eating syndrome in the general population and among a new sample of obesity surgery patients. METHODS Night-eating syndrome was defined by presence of morning anorexia, excessive evening eating, evening tension and/or feeling upset, and insomnia. A randomly selected sample of 2,097 adults (survey sample) answered structured interview questions on night-eating syndrome. A self-report form was completed by 111 patients who had received gastric restriction surgery for obesity at a patient reunion (patient sample). RESULTS Prevalence of night-eating syndrome in the survey sample was 1.5% (31 of 2,097). Prevalence in the patient sample was 27% (30 of 111). Weights for subjects in each sample, with and without the syndrome, were comparable. DISCUSSION Prevalence of night-eating syndrome was higher in the patient sample than in the survey sample. Within each sample, presence of the syndrome was not related to weight. Prevalence in the survey sample was within the range reported for binge-eating disorder. Night-eating syndrome may warrant consideration as a distinct eating disorder.

Continuity and change in the evaluation of ideal and acceptable body sizes across a wide age span.

OBJECTIVE Continuity and change in the evaluation of ideal and acceptable body sizes across a wide subject age span were examined. METHOD Ratings of ideal and socially acceptable body sizes were elicited from 303 children, 427 adolescents, 261 young adults, and 326 middle-age adults. Line drawing arrays of babies, children, young adults, middle-age, and older adults were portrayed, ranging in size from very thin to very obese. RESULTS All subject groups selected, in all arrays, similar ideal body sizes, rated sizes in the midrange of fatness as socially acceptable, and were least accepting of very thin and obese body sizes. Tolerance for body size variations increased with subject age. DISCUSSION Continuity throughout a wide subject age span was observed in evaluations of body sizes. However, adults were more accepting of body size variations than younger subjects, especially children. Implications of endorsing midrange body sizes for the fashion industry are discussed.

Epidemiology of bulimia and symptoms in a general population: Sex, age, race, and socioeconomic status

The prevalence of bulimia (as defined by DSM-/I/ [American Psychiatric Association 1980. Diagnostic and statistical manual of mental disorders (3rd ed.). Washing- ton, D.C.: Author]) was estimated by structured interview in a random sample of 2,715 adults in the general population, aged 18-96. Prevalence was 1.1% for the total sample, and among women aged 18-30, 4.1%. Bulimic behaviors and symptoms were more common among women than men, younger than older respondents, and, on some items, lower socioeconomic status (SES) than higher SES respondents. There was no difference in prevalence of bulimia between women students and same-aged non-students. No racial differences were found. There were more cases of bulimia in the older population than expected.

The Influence of Dumping on Weight Loss After Gastric Restrictive Surgery for Morbid Obesity

Background: The dumping syndrome that follows Roux-en-Y gastric bypass for morbid obesity is considered to be the primary mechanism of improved weight loss as compared with the purely restrictive vertical banded gastroplasty. To evaluate the influence of dumping on post-operative weight loss, severity of dumping was determined using Sigstads clinical diagnostic index. Methods: One hundred and thirty seven gastric bypass and 19 gastroplasty patients were assessed 18-24 months following surgery. Sigstads criteria for the dumping syndrome were met by 75.9% of gastric bypass and no gastroplasty patients. Among gastric bypass patients, no relationships were found between severity of dumping and weight loss, as measured by per cent of excess body weight loss or change in body mass index. Weight loss was significantly greater with gastric bypass than gastroplasty patients (72.5 compared to 47.9% of excess body weight loss). All gastroplasty and 24.1% of gastric bypass patients were classified as nondumpers. The difference in weight loss between surgical procedures was not related to dumping: gastric bypass non-dumpers lost significantly more weight (69.1% excess body weight loss) than gastroplasty patients. Conclusions: This study fails to demonstrate a significant relationship between dumping severity and weight loss. It is inferred that the superior weight loss of gastric bypass compared to gastroplasty has some other etiology.

Restrained eating (weight concerns) in the general population and among students

Restrained eating in a random sample of 2115 adults was studied as part of a broad health survey. Interview questions were derived from Herman and Polivys Restraint Scale (1975, 1980). Restrained eaters were predominantly normal and overweight women under 65 years of age. Significantly more women (20.7%) than men (8.9%) were restrained eaters. A similar prevalence of restrained eating was observed in students and same-age nonstudents. There was substantial overlap (but not congruence) between respondents who were dieting and being a restrained eater. Binge eating was reported more often by restrained eaters than unrestrained subjects. The relationship between restrained eating and bulimia-related atypical eating disorders is discussed.

Thinner females and heavier males: Who says? A comparison of female to male ideal body sizes across a wide age span

OBJECTIVE To examine the possibility of a more restrictive thinness standard for females than males across a wide age span. METHOD Ratings of ideal male and female body sizes were elicited from 303 children, 427 adolescents, 261 young adults, and 326 middle-age adults. Line drawings of babies, children, young adults, and middle-age and older adults were portrayed, ranging in size from very thin to very obese. RESULTS Most subjects irrespective of gender selected similar ideal body sizes for males and females in each comparison. Very few consistently selected a thinner female than male ideal size. Young adults were more likely than other groups to prefer thinner females. DISCUSSION The selection of similar thinness standards for both genders is encouraging from a health perspective. However, in all groups, a small bias existed favoring thinner females. This bias may contribute to body concerns in the female population.

Characteristics of marital improvement following obesity surgery

Three years after obesity surgery, 14 of 41 married patients considered their marriage satisfactory and attributed marital improvement to the surgery. This selected group was contacted at five years to expand upon aspects of improvement and current marital satisfaction. Increased frequency and enjoyment of social activities, improved sexual relationships, and positive personal changes such as increased self-confidence were described. Differences between patients in improved and deteriorated marriages are discussed.

Obesity and post-operative pain

Patients underwent elective abdominal surgery for morbid obesity (mean = 154 kgs, n = 55) or cholecystectomy (mean = 71 kgs, n = 54). Post-operative narcotics were transformed into morphine equivalent units (ME). Morbidly obese patients received significantly fewer total doses than cholecystectomy patients and less total mg ME/kg over a five-day period. Sedative use for both groups was comparable. In the morbidly obese patients, preoperative psychiatric and drug usage data predicted 67% of the variance in number of doses and 69% of the variance in total mg ME/kg.

Revision of Staple Line Failure Following Roux-en-Y Gastric Bypass for Obesity: a follow-up of weight loss

Eighty-one patients with primary Roux-en-Y gastric bypass for obesity underwent revisional surgery for staple line failure. All patients (100%) were included in the follow-up. Two years later, patients had an excess weight loss of 77%; 91% of the patients had a final weight loss of 50% or more of their excess weight. Weight loss of revision patients was comparable to that reported for patients with primary operations. It was concluded that revision for staple line failure is clearly justified.

Jejunoileal bypass: General and psychiatric outcome after one year

Abstract The authors studied 80 morbidly obese patients before and one year after jejunoileostomy. Most patients lost weight and improved in psychiatric status, although changes in such status often seemed to be related to causes other than the jejunoileostomy. The data indicate that, after a year, the complex interactions between physical, psychiatric, and psychosocial factors are often still changing and require continuing psychiatric assessment and intervention. The role of the psychiatrist before and after the surgery will become clearer as more data on long-term outcome become available.