Eating Disorders: Substance Use Following Bariatric Weight Loss Surgery.

Substance Use Following Bariatric Weight Loss Surgery.

Filed under: Eating Disorders

Arch Surg. 2012 Oct 15; 1-6
Conason A, Teixeira J, Hsu CH, Puma L, Knafo D, Geliebter A

OBJECTIVE To assess substance use before and after bariatric weight loss surgery (WLS). There is a paucity of research investigating the occurrence of substance use following bariatric WLS. It was hypothesized that patients who underwent WLS would exhibit an increase in substance use (drug use, alcohol use, and cigarette smoking) following surgery to compensate for a marked decrease in food intake. DESIGN Prospective study. SETTING A major urban community hospital. PARTICIPANTS A total of 155 participants (132 women and 23 men) who underwent WLS were recruited from a preoperative information session at a bariatric surgery center. INTERVENTION Participants received either laparoscopic Roux-en-Y gastric bypass surgery (n = 100) or laparoscopic adjustable gastric band surgery (n = 55). Participants completed questionnaires to assess eating behaviors and substance use at preoperative baseline and 1, 3, 6, 12, and 24 months after surgery. MAIN OUTCOME MEASURE Substance use as assessed by the Compulsive Behaviors Questionnaire. RESULTS Participants reported significant increases in the frequency of substance use (a composite of drug use, alcohol use, and cigarette smoking, hereafter referred to as composite substance use) 24 months after surgery. Specifically, participants experienced a significant increase in the frequency of composite substance use from baseline to 24 months after surgery (P = .02), as well as significant increases from 1 month, 3 months, and 6 months to 24 months after surgery (all P ? .002). In addition, participants who underwent laparoscopic Roux-en-Y gastric bypass surgery reported a significant increase in the frequency of alcohol use from baseline to 24 months after surgery (P = .011). The response rate to the survey was 61% at 1-month follow-up, 41% at 3-month follow-up, 43% at 6-month follow-up, 49% at 12-month follow-up, and 24% at 24-month follow-up. CONCLUSIONS Patients may be at increased risk for substance use following bariatric WLS. In particular, patients who undergo laparoscopic Roux-en-Y gastric bypass surgery may be at increased risk for alcohol use following WLS. Our study is among the first to document significant increases in substance use following WLS using longitudinal data.
HubMed – eating


Living Well: An Intervention to Improve Self-Management of Medical Illness for Individuals With Serious Mental Illness.

Filed under: Eating Disorders

Psychiatr Serv. 2012 Oct 15;
Goldberg RW, Dickerson F, Lucksted A, Brown CH, Weber E, Tenhula WN, Kreyenbuhl J, Dixon LB

OBJECTIVE: Individuals with serious mental illness have elevated rates of comorbid chronic general medical conditions and may benefit from interventions designed to support illness self-management. This study examined the effectiveness of a modified version of the Chronic Disease Self-Management Program called Living Well for individuals with serious mental illness. METHODS: A total of 63 mental health consumers with serious mental illness and at least one concurrent chronic general medical condition were randomly assigned to receive the 13-session peer-cofacilitated Living Well intervention or usual care. Participants were evaluated on attitudinal, behavioral, and functional outcomes at baseline, at the end of the intervention, and at a two-month follow-up. RESULTS: Living Well participants showed significant postintervention improvements across a range of attitudinal (self-efficacy and patient activation), behavioral (illness self-management techniques), and functional (physical and emotional well-being and general health functioning) outcomes. Although attenuation of effect was observed for most outcomes at two months postintervention, evidence was found of continued improvement in general self-management behaviors (use of action planning, brainstorming, and problem-solving). Continued advantage was found for the Living Well group in other areas, such as health-related locus of control and reports of healthy eating and physical activity. Receipt of Living Well was associated with a notable decrease in use of the emergency room for medical care, although the between-group difference was not statistically significant. CONCLUSIONS: Living Well shows promise in helping mental health consumers more effectively manage chronic general medical conditions and experience improved functioning and well-being.
HubMed – eating


Neural Correlates of Stress- and Food- Cue-Induced Food Craving In Obesity: Association with insulin levels.

Filed under: Eating Disorders

Diabetes Care. 2012 Oct 15;
Jastreboff AM, Sinha R, Lacadie C, Small DM, Sherwin RS, Potenza MN

OBJECTIVEObesity is associated with alterations in corticolimbic-striatal brain regions involved in food motivation and reward. Stress and the presence of food cues may each motivate eating and engage corticolimibic-striatal neurocircuitry. It is unknown how these factors interact to influence brain responses and whether these interactions are influenced by obesity, insulin levels, and insulin sensitivity. We hypothesized that obese individuals would show greater responses in corticolimbic-striatal neurocircuitry after exposure to stress and food cues and that brain activations would correlate with subjective food craving, insulin levels, and HOMA-IR.RESEARCH DESIGN AND METHODSFasting insulin levels were assessed in obese and lean subjects who were exposed to individualized stress and favorite-food cues during functional MRI.RESULTSObese, but not lean, individuals exhibited increased activation in striatal, insular, and hypothalamic regions during exposure to favorite-food and stress cues. In obese but not lean individuals, food craving, insulin, and HOMA-IR levels correlated positively with neural activity in corticolimbic-striatal brain regions during favorite-food and stress cues. The relationship between insulin resistance and food craving in obese individuals was mediated by activity in motivation-reward regions including the striatum, insula, and thalamus.CONCLUSIONSThese findings demonstrate that obese, but not lean, individuals exhibit increased corticolimbic-striatal activation in response to favorite-food and stress cues and that these brain responses mediate the relationship between HOMA-IR and food craving. Improving insulin sensitivity and in turn reducing corticolimbic-striatal reactivity to food cues and stress may diminish food craving and affect eating behavior in obesity.
HubMed – eating


Eating disorder risk and the role of clothing in collegiate cheerleaders’ body images.

Filed under: Eating Disorders

J Athl Train. 2012; 47(5): 541-8
Torres-McGehee TM, Monsma EV, Dompier TP, Washburn SA

With increased media coverage and competitive opportunities, cheerleaders may be facing an increase in eating disorder (ED) prevalence linked to clothing-related body image (BI).To examine ED risk prevalence, pathogenic weight control behaviors, and variation in clothing-specific BI across position and academic status among collegiate cheerleaders.Cross-sectional study.National Collegiate Athletic Association Division I and II institutions. Patients or Other Participants: Female collegiate cheerleaders (n = 136, age = 20.4 ± 1.3 years, height = 160.2 ± 8.1 cm, weight = 57.2 ± 8.3 kg). Main Outcome Measure(s): Participants self-reported height, weight, and desired weight and completed the Eating Attitudes Test. Body image perceptions in 3 clothing types (daily clothing, midriff uniform, full uniform) were assessed using sexbased silhouettes (body mass index = 18.3 kg/m(2) for silhouette 1, 23.1 kg/m(2) for silhouette 4).The ED risk for cheerleaders was estimated at 33.1%. However, when body mass index was controlled using backward stepwise logistic regression, flyers had greater odds (odds ratio = 4.4, 95% confidence interval = 1.5, 13.2, P = .008) of being at risk compared with bases, but no difference was noted between the base and back-spot positions (odds ratio = 1.9, 95% confidence interval= 0.5, 6.6, P = .333). A main effect of BI perceptions was seen (P < .001), with a significant interaction by clothing type (F(2,133) = 22.5, P < .001, ?(2) = 0.14). Cheerleaders desired to be smaller than their perceived BIs for each clothing type, with the largest difference for midriff uniform (2.6 ± 0.8 versus 3.7 ± 0.9), followed by full uniform (2.7 ± 0.8 versus 3.5 ± 0.9) and daily clothing (2.8 ± 0.8 versus 3.5 ± 0.9).Cheerleaders, especially flyers, appear to be at risk for EDs, with greatest BI dissatisfaction when wearing their most revealing uniforms (ie, midriffs). Universities, colleges, and the national governing bodies of these squads need to focus on preventing eating disorders and BI dissatisfaction and promoting self-esteem. HubMed – eating



Let’s Talk About: Eating Disorders – “What Are They and What Can We Do?” (1/3) – The St. Paul’s Hospital Community Forums are informal information sessions that provide an opportunity to ask experts about specific issues that may affect patients (and their family members). Each month features a different medical concern and talk about recent advances in treatment and research. Part 1 – Dr. Samantha Kelleher with Dr. Julia Rauzus, specialist psychiatrists in the Department of Psychiatry at St. Paul’s Hospital discuss what eating disorders are; the signs and the symptoms; and the role of the psychiatrist in the treatment of eating disorders. Part 2 – Dr. Ric Arseneau with Drs. Jane McKay and D. Rosenbaum, general internal medicine specialists within the Division of General Medicine at St. Paul’s Hospital and UBC, discuss the medical risks, complications and treatment of eating disorders. Part 3 – The third video is a Q & A session on eating disorders. The St. Paul’s Hospital Community Forums are informal information sessions that provide an opportunity to ask experts about specific health issues. For more information, please visit:


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