Marlene Taube-Schiff

Binge eating in bariatric surgery candidates: The role of insecure attachment and emotion regulation.

Binge eating has a high prevalence among bariatric patients and is associated with post-surgical weight gain. This study examined the potential mediating role of emotion regulation difficulties in the relation between attachment insecurity and binge eating among this population. Participants were 1388 adult pre-bariatric surgery candidates from an accredited bariatric surgery assessment centre in Toronto, Ontario. Participants completed measures of psychological functioning, including attachment style and emotion regulation. Mediation analyses revealed that difficulties with emotion regulation mediated a positive association between insecure-anxious attachment and binge eating. An insecure-avoidant attachment was found to have a non-significant association with binge eating when examining the total effect. However, when difficulties with emotion regulation were controlled for in the model to examine its role as a mediator, this association became significant, and emotion regulation difficulties also mediated the relationship between attachment avoidance and binge eating. These findings suggest that difficulties in emotion regulation may be an important clinical issue to address in order to reduce binge eating in adult bariatric surgery candidates.

Attachment style and emotional eating in bariatric surgery candidates: The mediating role of difficulties in emotion regulation

OBJECTIVEnDifficulties with emotion regulation is a hypothesized mechanism through which attachment insecurity may affect emotional eating. No studies have yet investigated this effect in the bariatric population. Because many obese individuals engage in emotional eating, difficulty regulating emotion may be an important underlying mechanism through which attachment insecurity is linked to emotional eating in bariatric surgery candidates.nnnMETHODSnIn this cross-sectional study, 1393 adult bariatric surgery candidates from the Toronto Western Hospital were recruited to complete the Emotional Eating Scale (EES), Patient Health Questionnaire-9 (PHQ9), Generalized Anxiety Disorder-7 (GAD7), Difficulties in Emotion Regulation Scale (DERS), Eating Disorder Examination Questionnaire (EDE-Q), and the Experiences for Close Relationships 16-item Scale (ECR-16) in order to explore the mediating role of emotion regulation on the relationship between attachment insecurity and emotional eating. Path analysis within a structural equation modeling framework examined direct and indirect effects of attachment insecurity on emotional eating.nnnRESULTSnThe indices of this overall model indicated that the specified set of direct and indirect pathways and corresponding correlations were a good fit with the data (RMSEA<.06, CFI=1.00; SRMR<.08). Moreover, tests of all of the possible indirect pathways between attachment style and emotional eating were significant.nnnDISCUSSIONnFindings suggest that difficulties in emotion regulation may be an important mechanism to consider when examining the association between attachment insecurity and emotional eating in adult bariatric surgery candidates. Although causality cannot be concluded, these results shed light on the important role that emotion regulation may have in predicting problematic eating in bariatric patients.

Examining Nutrition Knowledge of Bariatric Surgery Patients: What Happens to Dietary Knowledge over Time?

BackgroundNutrition education is a standard of care in bariatric surgery clinical practice guidelines. Despite its known importance, no studies have documented the trajectory of nutrition knowledge over the course of the bariatric surgery process. Primary objectives included determining changes in bariatric surgery nutrition knowledge scores from the pre-surgical phase to 1-month post-surgical intervention and investigating the impact of time on nutrition education retention in bariatric patients. Secondary objectives focused on the relationship between patients’ pre-operative anxiety and depression on nutrition knowledge retention.MethodsPrior to data collection, patients attended a nutrition education class and met with a registered dietitian. One hundred and nineteen consented patients eligible for bariatric surgery completed a nutrition knowledge questionnaire, Eating After Bariatric Surgery (EABS) prior to and 1xa0month following bariatric surgery.ResultsAnalyses revealed (1) patients’ nutrition knowledge (measured by EABS) significantly increased from the pre-operative phase (Mu2009=u200946.9; SDu2009=u200914.4) to the post-operative phase ((Mu2009=u200956.9; SDu2009=u200914.1), t(118)u2009=u2009−8.01, pu2009<u2009.001); (2) time between the nutrition education class and patients’ surgery significantly impacted knowledge retained; (3) patients with higher pre-operative levels of depression and anxiety had significantly lower post-operative nutrition knowledge; and (4) gender differences in terms of patients’ nutrition knowledge.ConclusionsThis study confirmed that dietary knowledge significantly improves following surgical intervention. Furthermore, increased time in between receiving nutrition knowledge and surgery resulted in less retained knowledge 1-month post-op. Future education interventions for bariatric surgery programs should focus on addressing these factors to optimize patient knowledge and information retention after surgery.

Weight-based bullying and compromised peer relationships in young adult bariatric patients

The experience of weight-based bullying in young adult bariatric patients has not yet been examined. Thirteen young adults (age, 18–24) that were seeking or had undergone bariatric surgery participated in semi-structured in-depth interviews. A thematic analysis informed by grounded theory principles was conducted. Analysis revealed the following three major themes: (1) being the biggest kid, (2) coping through avoidance, and (3) compromised peer and intimate relationships. Victims of weight-based bullying often avoid and withdraw socially in response to persistent verbal abuse. The decision to pursue bariatric surgery at a relatively young age adds another dimension of difficulty when navigating peer relationships.

Advancing Care Within an Adult Mental Health Day Hospital: Program Re-Design and Evaluation

Day hospital mental health programs provide alternate care to individuals of high acuity that do not require an inpatient psychiatric stay. Ensuring provision of best practice within these programs is essential for patient stabilization and recovery. However, there is scant literature to review when creating such a program. This paper provides an overview of the steps an acute care hospital took when designing and implementing new programming within a day hospital program. Qualitative data was collected following initial program rollout. This data helped to inform the ongoing modification of groups offered, group scheduling and content, as well as ensuring patient satisfaction and adequate skill delivery during the rollout period and beyond. The goal of this paper is to inform health service delivery for other programs when attempting to build or re-design a day hospital program.

The Checklist of Unit Behaviours (CUB): Validation within a Canadian outpatient day hospital programme

WHAT IS KNOWN ON THE SUBJECT?: The psychometrics of the CUB measure have been tested within an inpatient psychiatric setting. Results show that the CUB has two factors that reflect patients approach and avoidance of dimensions of the treatment milieu, and that an increase of approach and decrease of avoidance are correlated with discharge. No empirical research has examined the validity of the CUB in a day hospital programme. WHAT THIS ARTICLE ADDS TO EXISTING KNOWLEDGE?: This study was the first to address the validity of this questionnaire within a psychiatric day hospital setting. This now allows other mental health service providers to use this questionnaire following administration of patient engagement interventions (such as behavioural activation), which are routinely used within this type of a setting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Our results can enable healthcare providers to employ an effective and psychometrically validated tool in a day hospital setting to measure treatment outcomes and provide reflections of patients approach behaviours and avoidance behaviours.nnnABSTRACTnIntroduction We evaluated the Checklist of Unit Behaviours (CUBs) questionnaire in a novel mental health setting: a day hospital within a large acute care general hospital. No empirical evidence exists, as of yet, to look at the validity of this measure in this type of a treatment setting. The CUB measures two factors, avoidance or approach, of the patients engagement with the treatment milieu within the previous 24xa0hr. Aim A confirmatory factor analysis (CFA) was conducted to validate the CUBs original two factor structure in an outpatient day programme. Methods Psychiatric outpatients (nxa0=xa0163) completed the CUB daily while participating in a day hospital programme in Toronto, Canada. Results A CFA was used to confirm the CUB factors but resulted in a poor fitting model for our sample, χ2 (103)xa0=xa0278.59, pxa0<xa0.001, CFIxa0=xa00.80, RMSEAxa0=xa00.10, SRMRxa0=xa00.10. Questions 5, 8 and 10 had higher loadings on a third factor revealed through exploratory factor analysis. We believe this factor, Group Engagement, reflects the construct of group-related issues. Discussion The CUB was a practical and useful tool in our psychiatric day hospital setting at a large acute care general hospital. Implications for practice Our analysis identified group engagement, a critical variable in day programmes, as patients have autonomy regarding staying or leaving the programme.

Young Adulthood and Obesity Management: Developmental Issues and Transition of Care

In this chapter, we provide the reader with an overview of issues facing young obese adults from both a developmental and social perspective. We then review transitions of care, as individuals with chronic health issues that reach adulthood are often faced with several difficulties in making the leap from paediatric care to the adult healthcare system. Transition guidelines and their effectiveness are described to allow the reader to begin to understand key elements. Finally, we provide the reader with the journey of “Sally” as she transferred her care from a paediatric centre in Toronto to an adult bariatric surgery centre. In doing so, we illustrate the program that was developed at the Toronto Western Hospital and data from the patient narrative to illustrate the impact of this type of a program. We hope this case study will bring to life for the reader the type of program components to consider creating as a model of care for young adult bariatric patients undergoing a transition of obesity management treatment.

Motivational Interviewing for Severe Obesity

In this chapter, we provide an overview of motivational interviewing (MI) and the rationale for integrating it into the management of severe obesity. We then review the empirical evidence supporting the effectiveness of MI in both paediatric and adult populations with obesity. Finally, we provide a dialogue between Mr. Davis and his family physician in order to illustrate the application of MI techniques in clinical practice.

A Qualitative Study of Young Adult Experiences in the Bariatric Healthcare System: Psychosocial Challenges and Developmental Difficulties

OBJECTIVESnBariatric surgery is an evidence-based treatment for severe obesity; however, the unique developmental and psychosocial needs of young adults often complicate care and, as yet, are not well understood. We sought to identify themes in young adult patients undergoing bariatric surgery regarding: 1) the psychosocial experiences of obese young adults (18 to 24) seeking bariatric surgery; 2) the experiences during the preoperative bariatric surgery process and 3) the postoperative experiences of young adult patients.nnnMETHODSnIn-depth, semistructured individual interviews were conducted with 13 young adult bariatric patients who were seeking or had undergone bariatric surgery within the past 5 years. Interviews were analyzed using a qualitative methodology.nnnRESULTSnWe found the following themes in our analyses: 1) the impact of relationships (with families and healthcare providers) on the bariatric healthcare experience; 2) preoperative experiences by young adults prior to undergoing surgery and 3) postoperative reflections and challenges experienced by young adult patients.nnnCONCLUSIONSnResults revealed that patients experiences appear to encompass impact on familial relationships, needs sought to be fulfilled by healthcare providers, and various preoperative and postoperative psychosocial concerns. By understanding the experiences of young adults, healthcare providers might be able to provide better care for these patients.