Ernestine Trefalt

Partnership, Sexuality, and Sexual Disorders in Morbidly Obese Women: Consequences of Weight Loss After Gastric Banding

Background: A study was performed to determine what consequences surgery for morbid obesity has on sexual attitudes and partnership in obese female patients. Method: Semi-structured interviews concerning sociodemographic data, sexuality and relationship were conducted on 82 female patients preoperatively and at least 1 year postoperatively. Results: Physical appearance played the main role in the decision to undergo weight reduction surgery in only 17% of the study patients. Postoperatively, half of the patients were satisfied with their physical appearance 1 year after surgery, the other half not. Preoperatively, 44% of the patients stated that sexuality with their partners was satisfying and the frequency of sexual intercourse was regular. Postoperatively, 63% of the patients stated that they enjoyed sex more, compared with 12% of the patients who enjoyed sex less than before surgery. Postoperatively, 20% of the patients reported that partnership had changed positively, 10% negatively. Conclusions: The results indicate that many of the sexual problems in obese individuals are the result of an underlying lack of self-esteem, unsatisfactory relationships, or collective stigmatization of obese individuals. Binge eating, often found in morbidly obese patients, seems to be less the result of or compensation for sexual problems but is more likely to stem from other psychosocial or psychological problems.

Psychosocial Consequences of Weight Loss following Gastric Banding for Morbid Obesity

Background: This study was performed to determine what consequences surgery for morbid obesity has on weight loss, problems in eating behavior, quality of life, physical appearance and mental state. Method: After a minimum follow-up of >8 months (median follow-up 21 months, range 8-48 months), a questionnaire concerning extent of, satisfaction with and consequences of weight loss was mailed to 250 morbidly obese patients after laparoscopic Swedish adjustable gastric banding (SAGB). In addition, the partners opinion regarding the operation was evaluated as well as the consequences of weight loss for partnership and sexual relationship. Results: 160 patients (64%) completed and returned the questionnaire. Most patients (87%) were happy with the extent of weight loss. Weight loss, however, was connected with negative consequences for the body such as flabby skin (53%), abdominal skin overhang (47%) and pendulous breasts (42%). Patients who were satisfied with their postoperative physical appearance showed significantly less weight loss than did patients who were unhappy with their appearance (38 vs 54 kg). Most of the partners (91%) believed that the decision for SAGB was right. An improvement in partnership was reported by more than half of the partners (59%), and an improved sexual relationship by 45%. Conclusion: Laparoscopic SAGB is an effective surgical treatment for morbid obesity. However, the consequences of excess and rapid weight loss for physical appearance are negative in many cases. Well-directed information about the consequences of excess weight loss before SAGB and the possibilities and limits of plastic surgery must be given preoperatively to offset high and often unrealistic expectations.

Binge eating disorder in females: a population-based investigation.

OBJECTIVE The authors investigated the prevalence of binge eating behavior in a general female Austrian population. METHOD A random sample of 1,000 women (age range 15a to 85a) was interviewed by dieticians over the phone. Some screening instruments were used to detect binge eating behavior. RESULTS Of the entire sample, 122 met the diagnostic criteria for binge eating, 84 for binge eating syndrome, and 33 for binge eating disorder (BED). The point prevalence of bulimia nervosa was 1.5%. Women with binge eating episodes carried out more frequently one or more diets within the previous year, and more frequently exhibited a restrained eating behavior than did women without binge eating behavior. Underweight women more often met the diagnostic criteria for bulimia nervosa nonpurging type than did normal weight, overweight, and obese women, while overweight and obese women more frequently met the diagnostic criteria for BED. DISCUSSION Our findings indicate that binge eating appears to be a fairly common behavior in women. Dieting, chronic restrained eating, and excessive exercise may be important triggers for BED and bulimia nervosa.

Significance of working conditions on burnout in anesthetists

Background:  The influence of working conditions on the development of burnout syndrome was assessed in anesthetists working at a university hospital.

Psychotherapeutic Treatment of Morbidly Obese Patients after Gastric Banding

Background: Surgery is the most effective therapeutic option for weight reduction in carefully selected patients with morbid obesity resistant to conventional treatment. However, surgical treatment is not the solution but an important precondition for successful management of morbid obesity. Methods: All patients undergo a psychiatric examination before laparoscopic gastric banding. At the first examination we inform all patients about the various forms of psychological support offered before and especially after gastric banding. Results: A majority of the obese individuals are interested in psychological support postoperatively, but only a minority of this patient group (about onequarter) ultimately enlists psychological support on a regular or irregular basis. Some specific psychological topics have proved to be particularly important such as change of self-esteem as a consequence of weight loss, problems in adopting new eating behaviors and the risk for developing a new eating disordered behavior, and problems involving adequate problem-solving. Conclusions: In many cases, some form of psychological support is necessary in order to cope with the new postoperative demands and to find more adequate coping strategies for underlying psychological, psychosocial and environmental problems. The different kinds of psychological support and psychotherapeutic treatment available at Innsbruck University Hospital for obese patients after gastric banding are discussed here.

Binge eating disorder in males: A population-based investigation

The authors investigated the prevalence of binge eating behavior in a general male Austrian population. A randomly selected sample of 1000 male adults aged 18 to 88 was interviewed by dieticians over the phone. Some screening instruments were used to detect binge eating behavior. The results showed a total prevalence of eating disorders of 14.9%. Eight subjects (0.8%) met the full diagnostic criteria for binge eating disorder (BED), 42 (4.2%) exhibited a partial binge eating syndrome, 94 (9.4%) an Eating Disorder Not Otherwise Specified, and five subjects (0.5%) a bulimia nervosa. Most subjects with a eating disorder were overweight or obese, particularly those with a full BED syndrome. Our findings indicate that full BED syndromes are very rare in a nonclinical male sample, whereas partial syndromes are fairly common in males.

Dietitians: are they a risk group for eating disorders?

The present study examined the eating behaviour and eating disorders of Austrian dietitians. Questionnaires were distributed to 500 Austrian dietitians and completed by 320 (64 per cent) subjects. Of the entire sample, 21 (6.6 per cent) of the dietitians were underweight, more than two-thirds normal in weight, and 40 (12.3 per cent) overweight, while 24 (7.5 per cent) met the EDI criteria for being at risk for developing an eating disorder. The prevalence rates of eating disorders in the past or present were 2.5 per cent (n=8) for anorexia nervosa and 3.4 per cent (n=11) for bulimia nervosa. Of the 40 overweight dietitians, six (15 per cent) met the diagnostic criteria for binge eating syndrome. The findings show that, on the one hand, dietitians are quite similar in their weight, eating attitudes and eating behaviour to other women, and that, on the other hand, some dietitians may be considered at risk for developing eating disorders or having an eating disorder. Copyright

Eßstörungen bei Frauen: Eine Repräsentativerhebung

Summary The authors examined the prevalence rates of binge-eating behavior, binge-eating disorder (BED), and bulimia nervosa in a female representative random sample in Tyrol. The data were collected ba telephone. Of the 1.000 women, 3 (0.3%) met the DSM-IV diagnostic criteria for anorexia nervosa, 15 (1.5%) for bulimia nervosa, and 33 (3.3%) for binge-eating disorder. While bulimics were young and found in all weight groups, women with BED were mostly overweight or obese and found in all age groups. The findings show that restrained eating, dieting, and/or excessive exercise are risk fators for developing eating disorders.Zusammenfassung Diese Arbeit berichtet über die Ergebnisse einer Umfrage zur Prävalenz des “Binge-Eating”-Verhaltens, der “Binge-Eating”-Störung (BED) und der Bulimia nervosa in einer repräsentativen Zufallsstichprobe Tiroler Frauen. Die Daten wurden mit Hilfe telefonischer Interviews erhoben. Von den 1.000 Frauen erfüllten 3 (0,3%) die diagnostischen Kriterien des DSM-IV für eine Anorexia nervosa, 15 (1,5%) für eine Bulimia nervosa und 33 (3,3%) für eine “Binge-Eating”-Störung. Während Bulimikerinnen vor allem den jüngeren Altersgruppen angehören und in allen Gewichtsgruppen etwa gleich häufig vorkommen, sind Frauen mit BED in allen Altersgruppen etwa gleichmäßig vertreten und haben meist ein Übergewicht oder eine Fettsucht. Die Ergebnisse zeigen, daß ein gezügeltes Eßverhalten, das Einhalten von Diäten und/oder eine übermäßige körperliche Aktivität das Risiko erhöhen, eine Eßstörung zu entwickeln.