Hinrich Köhler

Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups

Background: Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning. Methods: In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery who underwent subsequent BCS (n = 62). All participants completed self-report questionnaires assessing body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ), quality of life (IWQOL-Lite), symptoms of depression (PHQ-9), and anxiety (GAD-7). Results: Overall, 62 patients (19.2%) reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%), thigh lifts (24.2%), and breast lifts (16.1%). Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients. Although there were fewer differences between patients with and without BCS, patients after BCS reported better appearance evaluation (AE), body area satisfaction (BAS), and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better AE and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole.

Food-independent tendency to disadvantageous decisions in obese individuals with regular binge eating

OBJECTIVE The objective of this study was to explore whether or not obese patients with and without regular binge eating differ with regard to their decision-making abilities. METHODS Decision-making was measured by using a computerized version of the Iowa Gambling task (IGT) in 34 obese patients with regular binge eating (BE(+)) and 34 obese individuals without binge eating (BE(-)) matched for age and sex. In addition, computerized versions of the Auditory Verbal Learning Test and the Corsi Block Tapping Test were administered. Participants further answered questionnaires concerning eating disorder symptoms (Eating Disorder Examination-Questionnaire) and depression (Patient Health Questionnaire depression scale). RESULTS The BE(+) group reported more eating disorder and depressive symptoms than the BE(-) group but did not differ with regard to BMI, working memory deficits, depressive symptoms, somatic comorbidity (i.e., hypertension, diabetes, sleep apnea, hyperlipidemia, pain disorder), or education. Binge eating participants showed poorer decision-making abilities based on the total IGT net scores. However, they did not differ from those without regular binge eating in improving their choice behavior over the task. CONCLUSIONS The group difference in total IGT net scores suggests more general, food-independent decision making problems in obese individuals with regular binge eating compared to those without. Treatment of obese patients with BED could be enhanced by training them to better control risky decisions, to delay gratification in an effortful way and to activate appropriate alternative behaviors.

Comparing Self-Report Measures of Internalized Weight Stigma: The Weight Self-Stigma Questionnaire versus the Weight Bias Internalization Scale.

Background Internalized weight stigma has gained growing interest due to its association with multiple health impairments in individuals with obesity. Especially high internalized weight stigma is reported by individuals undergoing bariatric surgery. For assessing this concept, two different self-report questionnaires are available, but have never been compared: the Weight Self-Stigma Questionnaire (WSSQ) and the Weight Bias Internalization Scale (WBIS). The purpose of the present study was to provide and to compare reliability, convergent validity with and predictive values for psychosocial health outcomes for the WSSQ and WBIS. Methods The WSSQ and the WBIS were used to assess internalized weight stigma in N = 78 prebariatric surgery patients. Further, body mass index (BMI) was assessed and body image, quality of life, self-esteem, depression, and anxiety were measured by well-established self-report questionnaires. Reliability, correlation, and regression analyses were conducted. Results Internal consistency of the WSSQ was acceptable, while good internal consistency was found for the WBIS. Both measures were significantly correlated with each other and body image. While only the WSSQ was correlated with overweight preoccupation, only the WBIS was correlated with appearance evaluation. Both measures were not associated with BMI. However, correlation coefficients did not differ between the WSSQ and the WBIS for all associations with validity measures. Further, both measures significantly predicted quality of life, self-esteem, depression, and anxiety, while the WBIS explained significantly more variance than the WSSQ total score for self-esteem. Conclusions Findings indicate the WSSQ and the WBIS to be reliable and valid assessments of internalized weight stigma in prebariatric surgery patients, although the WBIS showed marginally more favorable results than the WSSQ. For both measures, longitudinal studies on stability and predictive validity are warranted, for example, for weight-related and psychosocial outcomes.

Status of bariatric surgery in Germany--results of the nationwide survey on bariatric surgery 2005-2007.

Background: Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany) since January 1, 2005. Methods: In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an internet online data registry. Perioperative characteristics such as the spectrum of diagnostic measurements, type of surgical procedures, and short-and long-term out comes were investigated. Results: During the study period 3,123 surgical procedures were performed. In 2005 and 2006, gastric banding (GB) was the operation performed most frequently, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean BMI ranged from 48.5 kg/m2 in 2005 to 48.0 kg/m2 in 2007. Follow-up data after 12 months were available for 63.8% of the patients operated in 2005 and 2006. The mortality was 0.1% (30 days) and 0.16% (overall). Conclusion: As indicated by the worldwide trend, there is an ongoing change from GB to sleeve gastrectomy (SG) and malabsorptive procedures. The BMI of German bariatric surgical patients is substantially higher than that of patients from most other countries. There were no differences in overall outcomes during follow-up as compared to published studies.

Performance in Neurocognitive Tasks in Obese Patients. Does Somatic Comorbidity Matter

The aim of the present study was to examine if obese individuals with obesity-related somatic comorbidity (i.e., hypertension, diabetes, sleep apnea, dyslipidemia, pain disorder) perform worse in neurocognitive tasks compared to obese individuals without any somatic disorder. Neurocognitive functioning was measured by a computerized test battery that consisted of the following tasks: Corsi Block Tapping Test, Auditory Word Learning Task, Trail Making Test-Part B, Stroop Test, Labyrinth Test, and a four-disk version of the Tower of Hanoi. The total sample consisted of 146 patients, the majority (N = 113) suffered from obesity grade 3, 26 individuals had obesity grade 2, and only 7 individuals obesity grade 1. Ninety-eight participants (67.1%) reported at least one somatic disorder (Soma+-group). Hypertension was present in 75 individuals (51.4%), type 2 diabetes in 34 participants (23.3%), 38 individuals had sleep apnea (26.0%), 16 suffered from dyslipidemia (11.0%), and 14 individuals reported having a chronic pain disorder (9.6%). Participants without a coexisting somatic disorder were younger [MSoma− = 33.7, SD = 9.8 vs. MSoma+ = 42.7, SD = 11.0, F(1, 144) = 23.01, p < 0.001] and more often female [89.6 and 62.2%, χ2(1) = 11.751, p = 0.001] but did not differ with respect to education, regular binge eating, or depressive symptoms from those in the Soma+-group. The Soma−-group performed better on cognitive tasks related to memory and mental flexibility. However, the group differences disappeared completely after controlling for age. The findings indicate that in some obese patients increasing age may not only be accompanied by an increase of obesity severity and by more obesity-related somatic disorders but also by poorer cognitive functioning.

Physical activity is unrelated to cognitive performance in pre-bariatric surgery patients.

OBJECTIVE To investigate the relationship between physical activity (PA) and cognitive performance in extreme obesity. METHODS Seventy-one bariatric surgery candidates (77.5% women) with a mean body mass index (BMI) of 46.9 kg/m2 (SD=6.0) and a mean age of 41.4 (SD=11.9) years completed SenseWear Pro2 activity monitoring for seven days. Cognitive functioning was assessed by a computerized test battery including tasks of executive function (Iowa Gambling Task), visuospatial short-term memory (Corsi Block Tapping Test) and verbal short-term memory (Auditory-Verbal Learning Test). Questionnaires assessing eating disturbances and depressive symptoms were administered. Somatic comorbidities were assessed by medical chart review. RESULTS The level of PA was low with mean steps per day within wear time being 7140 (SD=3422). Most patients were categorized as sedentary (31.0%) or low active (26.8%). No significant association between PA estimates and cognitive performance was found. Lower PA was modestly correlated with higher BMI but not with age, somatic comorbidity or depressive symptoms. Moderated regression analyses suggested a significant interaction effect between depression and PA in predicting performance on the Corsi Block Tapping Test. Patients with (29.6%) and without (70.4%) regular binge eating did not differ with respect to PA or cognitive function. CONCLUSION The findings indicate no association between daily PA and cognitive performance in morbidly obese patients. Future studies should explore the relationship between the variables with regard to dose-response-questions, a broader BMI range and with respect to potential changes after substantial weight loss due to bariatric surgery.

Cognitive function and nonfood-related impulsivity in post-bariatric surgery patients

Initial evidence that cognitive function improves after bariatric surgery exists. The post-surgery increase in cognitive control might correspond with a decrease of impulsive symptoms after surgery. The present study investigated cognitive function and nonfood-related impulsivity in patients with substantial weight loss due to bariatric surgery by using a comparative cross-sectional design. Fifty post-bariatric surgery patients (postBS group) who had significant percent weight loss (M = 75.94, SD = 18.09) after Roux-en-Y gastric bypass (body mass index, BMI Mpost = 30.54 kg/m2, SDpost = 5.14) were compared with 50 age and gender matched bariatric surgery candidates (preBS group; BMI Mpre = 48.01 kg/m2, SDpre = 6.56). To measure cognitive function the following computer-assisted behavioral tasks were utilized: Iowa Gambling Task, Tower of Hanoi, Stroop Test, Trail Making Test-Part B, and Corsi Block Tapping Test. Impulsive symptoms and behaviors were assessed using impulsivity questionnaires and a structured interview for impulse control disorders (ICDs). No group differences were found with regard to performance-based cognitive control, self-reported impulsive symptoms, and ICDs. The results indicate that the general tendency to react impulsively does not differ between pre-surgery and post-surgery patients. The question of whether nonfood-related impulsivity in morbidly obese patients changes post-surgery should be addressed in longitudinal studies given that impulsive symptoms can be considered potential targets for pre- as well post-surgery interventions.

Studie zur Qualitätskontrolle der operativen Therapie der Adipositas – Ergebnisse der Pilotphase 2005

Since January 1, 2005, the situation of bariatric surgery has been examined in Germany. The data are registered in cooperation with the An-Institute of Quality Assurance in the Surgery Department at the Otto-von-Guericke-University Magdeburg. Materials and Methods: The data registration occurs prospectively in an internet online data bank. All clinics performing bariatric procedures in Germany were asked to submit their data All primary bariatric procedures that have been performed since January 1, 2005 as well as re-operations in patients that have been operated before this time were analyzed. Results: During the first year of the study 629 patients were operated in 21 hospitals. The most frequently performed operation in the first year was gastric banding with 44.1% followed by Roux-en-Y-Gastric Bypass with 43.8%. 74.4% of the patients were female. The mediumBMI of all patients was 48.5 kg/m2. Conclusion: During the first year of the study, there is a trend from restrictive bariatric procedures to the malabsorptive approach. In Germany the BMI of the patients undergoing bariatric surgery is higher than in the most countries worldwide. Form and frequency of intra- and postoperative complications were not different from those described in the literature.