Wilfried Biebl

Psychosocial Predictors of Weight Loss after Bariatric Surgery

Background: The authors investigated the predictive value of various parameters such as age, preoperative weight, eating behavior, psychiatric disorders, adverse childhood experiences and self-efficacy with regard to weight loss after gastric restrictive surgery. Methods: After a minimum follow-up of 30 months (median follow-up 50 months; range 30-84 months), a questionnaire concerning extent of, satisfaction with, and consequences of weight loss was mailed to 220 morbidly obese female patients following laparoscopic Swedish adjustable gastric banding (SAGB). Results: Questionnaires were completed and returned by 140 patients (63%). Average BMI loss was 14.6 kg/m2. Most patients (85%) were happy with the extent of weight loss. Satisfaction with weight loss showed a significant correlation with extent of weight loss. BMI loss was greatest in the obese with an atypical eating disorder (20.0 kg/m2), and BMI loss was least in the obese with no eating-disordered behavior before surgery (13.4 kg/m2). Obese patients with two or more psychiatric disorders showed significantly less weight loss than did obese patients with one or no psychiatric disorder (BMI units 10.8 vs 14.0 vs 16.1; P=.047). Conclusions: The findings indicate a less successful outcome for obese patients with psychiatric disorders (particularly adjustment disorders, depression and/or personality disorders), compared to patients not mentally ill. An eating disorder preceding surgery, however, was not a negative predictor of success following bariatric surgery. To improve outcome of bariatric surgery in obese patients with psychiatric disorders, more individual psychosocial intervention strategies are necessary.

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.

Sexual dysfunctions: Relationship to childhood sexual abuse and early family experiences in a nonclinical sample

Studies investigating a possible relationship between childhood sexual abuse and adult sexual dysfunction have reported highly discrepant results. The purpose of the present study was to examine 202 female university students for early familial experience and childhood sexual abuse in relation to adult sexual disorders. Each student was asked to complete three questionnaires on victimization, sexual dysfunction, early familial experiences. Results indicated that: (a) victims of multiple CSA more frequently reported sexual desire disorders and orgasm disorders than did single-incident victims and nonvictims; (b) single-incident victims and nonvictims reported no significantly different rates for any kind of sexual dysfunction; (c) negative early familial experiences were significantly related to any kind of sexual disorder; and (d) women who reported orgasm disorders more often reported an inadequate sex education than did women with another or no sexual dysfunction. The data suggest that both family dysfunction and sexual victimization contribute to sexual disorders in adulthood, and that later sexual disorders are to a large extent the result of sexual abuse-related factors in particular and family dysfunction in general.

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.

Body Image and Psychopathology in Male Bodybuilders

Background: To compare male bodybuilders to men with eating disorders and control men regarding body image, psychopathology and sexual history. Method: We compared 28 male bodybuilders, 30 men with eating disorders (anorexia nervosa, bulimia or binge eating disorder defined by DSM-IV), and 30 controls, using a battery of questionnaires covering weight history, eating behavior, body image, lifetime history of psychiatric disorders, and sexuality. Eating-disordered and control men were recruited from a college student population and studied during the course of an earlier investigation. Results: Bodybuilders exhibited a pattern of eating and exercising as obsessive as that of subjects with eating disorders, but with a ‘reverse’ focus of gaining muscle as opposed to losing fat. Bodybuilders displayed rates of psychiatric disorders intermediate between men with eating disorders and control men. In measures of body image, the bodybuilders closely resembled the men with eating disorders, but significantly differed from the control men, with the former two groups consistently displaying greater dissatisfaction than the latter. Sexual functioning did not distinguish the three groups except for the item ‘lack of sexual desire’ which was reported significantly more often by both bodybuilders and men with eating disorders. Conclusion: On measures of body image and eating behavior, bodybuilders share many features of individuals with eating disorders.

Functional Aphonia: Psychosomatic Aspects of Diagnosis and Therapy

The study aim at investigating whether functional aphonia has a homogeneous clinical picture, patients share particular personality traits, and the period before the outbreak of illness is characterized by a lack of support from the environment and by an increase in stressors

Significance of vomiting for hyperamylasemia and sialadenosis in patients with eating disorders

The authors investigated the significance of vomiting for hyperamylasemia and sialadenosis in patients with bulimia nervosa. Hyperamylasemia was found in 61% of the bulimics and in 20% of the restrictor anorectics but in no patients with binge-eating syndrome. In more than three fourths of the bulimics there was a close positive correlation between the frequency of vomiting and total serum amylase levels. Both frequency and type of vomiting seem to be relevant to the extent of salivary gland enlargement. The significance of vomiting for the etiopathology of hyperamylasemia and for the diagnosis of eating disorders will be discussed.

Long-term effects of incest: life events triggering mental disorders in female patients with sexual abuse in childhood

The authors studied several psychosocial, psychosomatic, and psychodynamic factors in 33 female psychiatric patients who had been victims of incest. Abuse was almost exclusively severe and prolonged. Three quarters of the female patients had been abused by their biological fathers or stepfathers. Sexual abuse experiences in childhood are connected with feelings of anxiety, helplessness, and powerlessness. Together with a lack of support on the part of the mother, these experiences lead to ego weakness, an autoplastic mode of coping with aggression and to patterns of objectal relationships which predispose them to object loss. The links between a girls traumatic experiences in relationships and her vulnerability to separation in later life and their importance for the incidence of mental disorders will be discussed on the basis of Bowlbys attachment theory.

Eating-disordered behavior in males: The impact of adverse childhood experiences

OBJECTIVE The authors examined the possible relationship of childhood sexual abuse, physical abuse, and dysfunctional family background and the risk for developing an eating disorder in adult males. METHOD Several anonymous questionnaires were distributed to male university students. RESULTS Of the 301 men, 12 (4.0%) had experienced childhood sexual abuse, 11 (3.6%) had been victims of physical abuse, 79 (26.2%) reported an adverse family background, and 14 (4.6%) had an increased risk for developing an eating disorder. There were no significant differences in the risk for developing an eating disorder and in total EDI between victims and nonvictims, but a significantly increased risk for eating disorders in men with an adverse family background. DISCUSSION The findings suggest that long-lasting negative familial relationships, particularly in connection with physically abusive experiences, may increase the risk for eating disorders.