Gretchen E. Ames

The relationship among food addiction, negative mood, and eating-disordered behaviors in patients seeking to have bariatric surgery

BACKGROUND Food addiction (FA) may be related to poor weight loss outcomes; however, the literature on food addiction in bariatric surgery-seeking populations is limited. OBJECTIVES The aim of the present study was to identify the prevalence of FA in a bariatric surgery-seeking population and its association with mood, problematic eating behaviors, and substance use. The relationship between prebariatric surgery food addiction screening and postsurgical outcomes was assessed. SETTING Academic medical center. METHODS Adult outpatients (n = 923) seeking bariatric surgery underwent psychological evaluation between January 2012 and May 2014. Patients were administered the Yale Food Addiction Scale (YFAS) to assess FA. Of the original sample, 195 patients underwent Roux-en-Y gastric bypass surgery. Patients returned for medical follow-up at 6 (n = 169) and 12 (n = 113) months postsurgery; 26 (13%) patients at 6 months and 82 (42%) patients at 12 months were lost to follow-up or had not reached 1 year postsurgery. RESULTS Fourteen percent of patients met FA criteria. Patients positive for FA were more likely to endorse greater levels of depression, anxiety, binge eating episodes, nighttime eating syndrome, and low eating self-efficacy. No relationship was observed between FA and current substance use. FA did not predict postoperative outcomes including weight loss, rehospitalization, or attendance at follow-up medical appointments. CONCLUSIONS FA is related to psychological distress and eating disordered behaviors among bariatric patients. However, FA was not predictive of short-term (6-12 mo) bariatric surgery outcomes. Future research should determine how FA affects long-term postoperative outcomes and mood stability.

Eating self-efficacy: Development of a short-form WEL

Self-efficacy for eating is an important predictor of the successful adoption and maintenance of weight management behaviors. The Weight Efficacy Lifestyle Questionnaire (WEL) is a commonly used measure of eating self-efficacy consisting of 20-items and five situational factors. The aim of this study was to develop a short-form WEL (WEL-SF) for use in clinical practice and research. Factor analysis methodology was used with a sample of obese patients (N=1012) seeking weight loss treatment to develop the WEL-SF. The hypothesis was that the WEL would contain highly correlated items within the factors, and consequently could be shortened with minimal loss of clinically important information. Results revealed a one-factor solution. Given this unexpected finding, factor analysis was abandoned and alternative selection criteria were implemented. WEL-SF items were selected based upon: (1) lack of a ceiling effect for individual items, (2) high variability in patient responses, (3) lack of a strong correlation with other WEL items, (4) strong correlation with total WEL score, and (5) clinical judgment regarding importance and interpretability of individual items. These criteria resulted in an 8-item measure. The correlation between the WEL-SF total score and WEL total score was extremely strong, with a Pearsons r value of 0.968 and corresponding r(2) value of 0.937. Based on these findings, the 8-item WEL-SF appears to be a psychometrically valid measure of eating self-efficacy that accounts for 94% of the variability in the original version.

Quality of life of men with biochemical recurrence of prostate cancer.

Abstract This investigation evaluated the psychological needs of men (n = 28) with biochemical recurrence of prostate cancer. A mixed qualitative-quantitative approach was employed. The qualitative component consisted of focus groups and the quantitative component included administration of standardized measures assessing quality of life (QOL), anxiety, and mood. Participants reported substantial anxiety and other negative moods secondary to prostate cancer. Responses from the quantitative instruments suggest participants experience significant health problems specific to prostate cancer, while their general QOL is superior to other chronically ill medical populations. In contrast to the qualitative data, participants rated their mood as favorable on the quantitative measures. Data were used to guide development of a novel QOL intervention.

A pilot investigation of a multidisciplinary quality of life intervention for men with biochemical recurrence of prostate cancer.

Objective: This pilot project evaluated the acceptability and estimated the effect size of a tailored multidisciplinary quality of life (MQOL) intervention for men who have biochemical recurrence of prostate cancer.

Further statistical and clinical validity for the Weight Efficacy Lifestyle Questionnaire-Short Form.

Identifying barriers to long-term adherence to reduced energy intake and increased physical activity level is critically important for obese patients seeking weight loss treatment. Previous research has identified that one such barrier is low eating self-efficacy or poor confidence in ones ability to control eating behavior in the presence of challenging situations. Accordingly, a valid, brief measure of eating self-efficacy for longitudinal assessment of weight loss and regain is needed. The purpose of this study was to test the internal consistency and clinical validity of the Weight Efficacy Lifestyle Questionnaire-Short Form (WEL-SF). Participants were 1740 consecutive obese patients who presented for a psychological evaluation in consideration for bariatric surgery. Median BMI was 44.9 (range: 35.0-111.9), age 48.7years (range: 18.9-77.3years), and patients were predominantly female (71.1%) and Caucasian (90.8%). The median WEL-SF total score was 56 (range: 0-80) and Cronbachs alpha measuring internal consistency was 0.92 with a one-factor structure. In terms of clinical validation, lower WEL-SF total scores were significantly associated with higher rates of binge eating episodes (P<0.0001), food addiction severity and dependence (P<0.0001), night eating syndrome (P<0.0001), depression (P<0.0001), and anxiety (P<0.0001). In contrast, higher WEL-SF total scores were associated with higher weight management self-efficacy (P<0.0001) and motivation to make positive lifestyle changes (P<0.0001). Taken together, these findings suggest that the WEL-SF is a psychometrically valid clinically meaningful measure of eating self-efficacy.

Quality of Life of Patients Undergoing Surgical Treatment for Newly-Diagnosed, Clinically Localized Renal Cell Carcinoma

This investigation sought to evaluate the psychological needs of individuals (N = 28) undergoing nephrectomy for newly diagnosed, localized renal cell carcinoma (RCC) using a mixed qualitative-quantitative approach. The qualitative component consisted of individual semi-structured interviews ≥4 weeks postnephrectomy. The quantitative component involved standardized measures assessing anxiety, depressive symptoms, psychological distress, and general and disease specific quality of life (QOL) prior to nephrectomy and at 4, 12, and 24 weeks postnephrectomy. This investigation provides a unique view of the experiences and needs of persons undergoing surgery for newly diagnosed, localized RCC and reveals that these individuals experience fatigue, anxiety, and depressive symptoms.

Effect of expressive writing as a treatment adjunct for reducing smoking cessation related weight gain in young adult smokers.

This investigation evaluated the effect of expressive writing on weight gain in young adults being treated for smoking cessation. This study was conducted between July 2001 and June 2005. Participants (N = 196) ages 18–24 years (M = 20.8, SD = 2.0 years), who were recruited from a large city in the southeastern United States were randomized to brief office intervention or expressive writing plus brief office intervention. The sample was 56% female, 93% Caucasian, smoked a mean of 18.1 cigarettes per day (SD = 6.1), and had a mean body mass index of 24.9 (SD = 5.6). Participants who received the expressive writing plus brief office intervention gained significantly less weight than those receiving the brief office interventions from week 3 to 24, but did not significantly differ at week 52. A limitation of this investigation relates to the fact that the impact of expressive writing on weight was an unanticipated treatment effect that was evaluated in post-hoc analyses. Although the findings suggest that expressive writing holds promise as a treatment adjunct to decrease weight gain associated with smoking cessation, further research is warranted.

Improving maintenance of lost weight following a commercial liquid meal replacement program: A preliminary study

Clinic-based liquid meal replacement (800kcals/day) programs produce substantial weight loss. Nevertheless, long-term maintenance remains a challenge. A limitation of maintenance programs is that they continue to promote large behavior changes that are initially required to induce weight loss which may be unsustainable long-term. The study aims were to conduct a preliminary assessment of the feasibility, acceptability, and effectiveness of a small changes maintenance intervention (SCM) for 30 patients who completed liquid meal replacement program (LMR). The 20-session SCM delivered over 52 weeks offered no preset goals for maintenance behaviors and all changes in behavior were self-selected. Participants had a median BMI of 40.9 kg/m(2) and weight of 111 kg at the start of LMR. At LMR completion, they lost 18% (21 kg) of body weight. The SCM was completed by 22 patients (73%); 19 completers (86%) attended ≥ 17 of 20 sessions with a median satisfaction rating of 9 (on a scale of 1 to 9). Completers were asked to record self-selected maintenance behaviors daily (median 351 days recorded). The most commonly reported daily behaviors were self-weighing, use of meal replacements and step counting. Median percent regain at week 52 was 14% (2.8 kg) of lost weight (range, -42 to 74%), significantly less than a median of 56% (11 kg) percent regain of lost weight (range, -78 to 110%) in a demographically similar historical control group with no maintenance intervention after LMR completion (P<0.001). Thus, SCM holds promise for improving weight maintenance. Future research should compare SCM to standard maintenance programs that promote large program-directed changes.