Objective To compare the effectiveness of cognitive behavioral therapy (CBT), exercise, and the c... more Objective To compare the effectiveness of cognitive behavioral therapy (CBT), exercise, and the combination of both for improving physical functioning and reducing the symptoms of GWVI.
Weight-loss surgery literature suggests that the majority of patients experience the changes that... more Weight-loss surgery literature suggests that the majority of patients experience the changes that occur as a result of dramatic weight loss after weight-loss surgery as being overwhelmingly positive. However, even positive change may pose a variety of psychosocial challenges. In the case of weight-loss surgery, these changes and challenges often manifest themselves in a variety of interpersonal realms, including everyday
ABSTRACT To the Editor:The authors of this study [1] are accurate in noting that there is signifi... more ABSTRACT To the Editor:The authors of this study [1] are accurate in noting that there is significant variability in preoperative psychological evaluation practices, as well as limited success to date in identifying preoperative psychosocial variables that predict weight loss outcomes after weight loss surgery (WLS). In this study, the authors used a “traffic light” system for classifying patients after psychological assessment for bariatric surgery, with “green light” (GL) indicating no apparent psychosocial contraindications, “yellow light” (YL) for individuals about whom there were concerns and thus psychological intervention was required prior to surgery, and “red light” (RL) for patients who were deemed unsuitable for WLS for psychosocial reasons. This classification system is appealing in its simplicity and straightforwardness. However, the study does raise some issues related to both its methodology and the potential conclusions that might be drawn from the findings. There are two very d ...
Although the health benefits of exercise for individuals with Persian Gulf War veterans illnesses... more Although the health benefits of exercise for individuals with Persian Gulf War veterans illnesses (GWVI) are documented, many of these individuals do not exercise regularly enough to obtain benefits. The purpose of this study was to investigate factors predicting exercise compliance among individuals with GWVI in a multicenter, randomized, clinical trial. Participants were 1,092 veterans who reported at least two of the following cardinal symptoms of GWVI: (1) fatigue, (2) musculoskeletal pain, and (3) cognitive problems. Participants received exercise alone or exercise and cognitive-behavioral therapy. The overall level of compliance was relatively low during the exercise treatment phase (46.2%) and decreased by one-half during the follow-up period (23.0%). Predictors of compliance during treatment included less pain and greater age, motivation, and body mass index. Predictors of compliance during the follow-up period included less pain and greater age. The results highlight factor...
The Primary Care Companion For CNS Disorders, 2014
To evaluate the effectiveness of specific self-report questionnaires in detecting DSM-5 eating di... more To evaluate the effectiveness of specific self-report questionnaires in detecting DSM-5 eating disorders identified via structured clinical interview in a weight-loss treatment-seeking obese sample, to improve eating disorder recognition in general clinical settings. Individuals were recruited over a 3-month period (November 2, 2011, to January 10, 2012) when initially presenting to a hospital-based weight-management center in the northeastern United States, which offers evaluation and treatment for outpatients who are overweight or obese. Participants (N = 100) completed the Structured Clinical Interview for DSM-IV eating disorder module, a DSM-5 feeding and eating disorders interview, and a battery of self-report questionnaires. Self-reports and interviews agreed substantially in the identification of bulimia nervosa (DSM-IV and DSM-5: tau-b = 0.71, P < .001) and binge-eating disorder (DSM-IV and DSM-5: tau-b = 0.60, P < .001), modestly for subthreshold binge-eating disorder (tau-b = 0.44, P < .001), and poorly for other subthreshold conditions (night-eating syndrome: tau-b = -0.04, P = .72, r = 0.06 [DSM-5]). Current self-report assessments are likely to identify full syndrome DSM-5 eating disorders in treatment-seeking obese samples, but unlikely to detect DSM-5 other specified feeding or eating disorders. We propose specific content changes that might enhance clinical utility as suggestions for future evaluation.
Recent literature suggests that some patients may develop addictive disorders after bariatric sur... more Recent literature suggests that some patients may develop addictive disorders after bariatric surgery, in particular after Roux-en-Y gastric bypass (RYGB). These may include traditional addictions and so called "behavioral addictions," although prevalence data on the latter have not been published. The objective of this study was to establish the prevalence of addictive behaviors in adults after RYGB. Participants from a large observational study of bariatric surgery who had undergone RYGB were recruited to complete additional measures. Of 241 consented participants, 201 provided data (i.e., Structured Clinical Interview for DSM-IV Axis I [SCID], additional Impulsive Control Disorder Modules, and various self-report measures, including the Alcohol Use Disorder Identification Test [AUDIT]) to assess status before surgery and in the first 3 postoperative years. Based on the SCID, 16 (8.0%) developed alcohol use disorder [AUD] within 3 years post-RYGB, 7 (43.8%) of whom had no history of AUD. When both the SCID and AUDIT were used to identify AUD, the corresponding numbers/percentages were 32 (18.4%) and 13 (40.6%). Data on other behavioral addictive disorders indicated 19 (9.5%) had a postsurgery disorder, 6 (31.6%) of whom had no history. These data add to a growing literature suggesting there is a substantial risk for the development of AUD after bariatric surgery. Understanding the risk for nondrug-related addictive disorders requires more data from larger studies before clear conclusions can be drawn.
Overeating in response to distressing emotions affects about 40% of pre-surgical bariatric candid... more Overeating in response to distressing emotions affects about 40% of pre-surgical bariatric candidates and has been cited as the most common reason for delay of surgery. Emotional eating also has been shown to impede weight loss in gastric banding patients at one year follow-up. Psychological explanations of emotional eating conceptualize the behavior as a way to cope with pressure and regulate emotional states. However, recent advances in the basic science of appetite regulation provide a more comprehensive understanding of the behavior as a bio-behavioral phenomenon, and offer direction for the development of clinical interventions. The purpose of this symposium is to broaden the understanding of the multiple influences on emotional eating and translate scientific findings into clinical application for bariatric patients. Methods: The symposium, moderated by bariatric surgeon Adam Smith, DO will include: (1) "Appetite Regulation 101" (Joan Carroll, PhD), an overview of the physiological basis of appetite regulation and its interface with stress. (2) "Disinhibitory Eating and the Bariatric Patient" (Kathryn Kaiser, BS), covering the bio-behavioral perspective of disinhibition and its post-surgical impact.
Since the 1991 recommendation by the National Institutes of Health-sponsored consensus developmen... more Since the 1991 recommendation by the National Institutes of Health-sponsored consensus development conference, preoperative psychosocial evaluation of weight loss surgery patients has been adopted by >80% of weight loss surgery programs. Although some published suggestions for conducting evaluations exist, no formal guidelines have been published specifying the qualifications, content knowledge, or clinical experience for the behavioral health professionals who conduct them. As a result, the backgrounds of behavioral health professionals working with bariatric surgery patients are varied, and no mechanism exists to ensure consistent quality of care. To obtain expert opinion on this issue, a survey of the American Society for Metabolic and Bariatric Surgery membership was conducted using an Internet-based survey. American Society for Metabolic and Bariatric Surgery members of all disciplines were invited by electronic mail to complete an Internet-based survey. Separate forms were created for behavioral health providers and for members of other disciplines. A total of 409 American Society for Metabolic and Bariatric Surgery members responded (60 behavioral health and 349 nonbehavioral health). Of the 409 respondents, 95% indicated a belief that it is important for behavioral health providers to have specialty knowledge; 87% indicated a belief that specialty experience is important; and 70.6% favored the development of a specialty credential for bariatric behavioral health providers to regulate the quality of patient care. However, the respondents also reported concerns about creating such a credential. Our results reflect widespread opinion that the provision of bariatric behavioral health services requires specialty knowledge and experience and that a credentialing system would help regulate the standard of care in the field. However, some concerns about credential development remain.
The process of psychosocial evaluation for weight loss surgery (WLS) is one that goes beyond serv... more The process of psychosocial evaluation for weight loss surgery (WLS) is one that goes beyond serving the function of information-gathering (Bauchowitz et al. in This process offers myriad opportunities for delivering significant and powerful interventions that can enhance the patient's success in the WLS process. A discussion of the unique opportunities for psychosocial intervention afforded by the pre-surgical evaluation process is presented, using The Boston Interview for Bariatric Surgery (Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008) as the organizing framework.
Morbid obesity is a rapidly escalating problem in the United States, one with serious health rami... more Morbid obesity is a rapidly escalating problem in the United States, one with serious health ramifications. Due to the lack of empirical support for the long-term efficacy of non-surgical interventions for obesity, gastric bypass surgery has been pursued with increasing frequency as a treatment for morbid obesity. Because surgery is a high-risk, invasive treatment option, medical, psychological and behavioral factors must be carefully considered in pre-surgical evaluations. Although psychological evaluations are requested by surgical teams, there is currently no commonly used, standardized protocol for this type of assessment. Further, there is little empirical data specifying which factors predict successful surgical outcomes. A general overview of a semi-structured interview for presurgical gastric bypass evaluation, developed by the Medical Psychology Service at the VA Boston Healthcare System, is provided in this paper. This standardized approach has many advantages: it ensures comprehensive assessment of relevant factors; it facilitates both research and training; and it facilitates patient education about the procedure.
Rapid shifts in the demographics and techniques of weight loss surgery (WLS) have led to new issu... more Rapid shifts in the demographics and techniques of weight loss surgery (WLS) have led to new issues, new data, new concerns, and new challenges. In 2004, this journal published comprehensive evidence-based guidelines on WLS. In this issue, we've updated those guidelines to assure patient safety in this fast-changing field. WLS involves a uniquely vulnerable population in need of specialized resources and ongoing multidisciplinary care. Timely best-practice updates are required to identify new risks, develop strategies to address them, and optimize treatment. Findings in these reports are based on a comprehensive review of the most current literature on WLS; they directly link patient safety to methods for setting evidence-based guidelines developed from peer-reviewed scientific publications. Among other outcomes, these reports show that WLS reduces chronic disease risk factors, improves health, and confers a survival benefit on those who undergo it. The literature also shows that laparoscopy has displaced open surgery as the predominant approach; that government agencies and insurers only reimburse procedures performed at accredited WLS centers; that best practice care requires close collaboration between members of a multidisciplinary team; and that new and existing facilities require wide-ranging changes to accommodate growing numbers of severely obese patients. More than 100 specialists from across the state of Massachusetts and across the many disciplines involved in WLS came together to develop these new standards. We expect them to have far-reaching effects of the development of health care policy and the practice of WLS.
Journal of Clinical Psychology in Medical Settings, 2005
The purpose of this paper is to introduce the Structured Interview for the Treatment of the Hepat... more The purpose of this paper is to introduce the Structured Interview for the Treatment of the Hepatitis C Virus (SIT-HCV). This comprehensive interview expands upon a standard psychiatric interview by including those medical, psychological, and behavioral factors that are essential to determining a patient’s psychological appropriateness for interferon therapy. A detailed description of the SIT-HCV is provided, highlighting its utility
Objective To compare the effectiveness of cognitive behavioral therapy (CBT), exercise, and the c... more Objective To compare the effectiveness of cognitive behavioral therapy (CBT), exercise, and the combination of both for improving physical functioning and reducing the symptoms of GWVI.
Background Weight loss surgery (WLS) outcomes are poorly understood. This study aimed to evaluate... more Background Weight loss surgery (WLS) outcomes are poorly understood. This study aimed to evaluate the relationship of well-documented (e.g., health, diet, physical activity) and theoretically relevant variables (e.g., substance use and "food addiction") with both weight nadir and weight regain (WR) following WLS. Methods A sample of 97 Roux-en-Y gastric bypass patients (M time since surgery =8.86 years) were surveyed about pre-and post-WLS weight, health, self-management behaviors, alcohol problems, and clinical symptoms. Results Patients lost a mean of 42 % (SD=10.71 %) of total weight at weight nadir, but 26 % (SD=19.66 %) of the lost weight was regained by the time of the survey. Correlates of lower weight nadir and WR differed considerably, with minor overlap. Weight nadir was associated with pre-WLS drug use and post-WLS medical comorbidities. WR, on the other hand, was associated with post-WLS adherence to dietary and physical activity modification. Post-WLS nocturnal eating, depression, and problematic alcohol use were also associated with WR. With all associated variables in regression models, number of post-WLS medical comorbidities (β=−.313, p<0.01) and post-WLS depression (β=0.325, p<0.01) accounted for the most variance and remained as significant predictors of weight nadir and WR, respectively. Conclusions While weight nadir was associated with relatively few and largely nonmodifiable variables, WR was significantly associated with adherence-related behaviors, mood symptoms, and pathological patterns of food and alcohol use, all of which are potentially modifiable. These findings underscore the importance of long-term behavioral and psychosocial monitoring after surgery.
Objective To compare the effectiveness of cognitive behavioral therapy (CBT), exercise, and the c... more Objective To compare the effectiveness of cognitive behavioral therapy (CBT), exercise, and the combination of both for improving physical functioning and reducing the symptoms of GWVI.
Weight-loss surgery literature suggests that the majority of patients experience the changes that... more Weight-loss surgery literature suggests that the majority of patients experience the changes that occur as a result of dramatic weight loss after weight-loss surgery as being overwhelmingly positive. However, even positive change may pose a variety of psychosocial challenges. In the case of weight-loss surgery, these changes and challenges often manifest themselves in a variety of interpersonal realms, including everyday
ABSTRACT To the Editor:The authors of this study [1] are accurate in noting that there is signifi... more ABSTRACT To the Editor:The authors of this study [1] are accurate in noting that there is significant variability in preoperative psychological evaluation practices, as well as limited success to date in identifying preoperative psychosocial variables that predict weight loss outcomes after weight loss surgery (WLS). In this study, the authors used a “traffic light” system for classifying patients after psychological assessment for bariatric surgery, with “green light” (GL) indicating no apparent psychosocial contraindications, “yellow light” (YL) for individuals about whom there were concerns and thus psychological intervention was required prior to surgery, and “red light” (RL) for patients who were deemed unsuitable for WLS for psychosocial reasons. This classification system is appealing in its simplicity and straightforwardness. However, the study does raise some issues related to both its methodology and the potential conclusions that might be drawn from the findings. There are two very d ...
Although the health benefits of exercise for individuals with Persian Gulf War veterans illnesses... more Although the health benefits of exercise for individuals with Persian Gulf War veterans illnesses (GWVI) are documented, many of these individuals do not exercise regularly enough to obtain benefits. The purpose of this study was to investigate factors predicting exercise compliance among individuals with GWVI in a multicenter, randomized, clinical trial. Participants were 1,092 veterans who reported at least two of the following cardinal symptoms of GWVI: (1) fatigue, (2) musculoskeletal pain, and (3) cognitive problems. Participants received exercise alone or exercise and cognitive-behavioral therapy. The overall level of compliance was relatively low during the exercise treatment phase (46.2%) and decreased by one-half during the follow-up period (23.0%). Predictors of compliance during treatment included less pain and greater age, motivation, and body mass index. Predictors of compliance during the follow-up period included less pain and greater age. The results highlight factor...
The Primary Care Companion For CNS Disorders, 2014
To evaluate the effectiveness of specific self-report questionnaires in detecting DSM-5 eating di... more To evaluate the effectiveness of specific self-report questionnaires in detecting DSM-5 eating disorders identified via structured clinical interview in a weight-loss treatment-seeking obese sample, to improve eating disorder recognition in general clinical settings. Individuals were recruited over a 3-month period (November 2, 2011, to January 10, 2012) when initially presenting to a hospital-based weight-management center in the northeastern United States, which offers evaluation and treatment for outpatients who are overweight or obese. Participants (N = 100) completed the Structured Clinical Interview for DSM-IV eating disorder module, a DSM-5 feeding and eating disorders interview, and a battery of self-report questionnaires. Self-reports and interviews agreed substantially in the identification of bulimia nervosa (DSM-IV and DSM-5: tau-b = 0.71, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) and binge-eating disorder (DSM-IV and DSM-5: tau-b = 0.60, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), modestly for subthreshold binge-eating disorder (tau-b = 0.44, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), and poorly for other subthreshold conditions (night-eating syndrome: tau-b = -0.04, P = .72, r = 0.06 [DSM-5]). Current self-report assessments are likely to identify full syndrome DSM-5 eating disorders in treatment-seeking obese samples, but unlikely to detect DSM-5 other specified feeding or eating disorders. We propose specific content changes that might enhance clinical utility as suggestions for future evaluation.
Recent literature suggests that some patients may develop addictive disorders after bariatric sur... more Recent literature suggests that some patients may develop addictive disorders after bariatric surgery, in particular after Roux-en-Y gastric bypass (RYGB). These may include traditional addictions and so called &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;behavioral addictions,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; although prevalence data on the latter have not been published. The objective of this study was to establish the prevalence of addictive behaviors in adults after RYGB. Participants from a large observational study of bariatric surgery who had undergone RYGB were recruited to complete additional measures. Of 241 consented participants, 201 provided data (i.e., Structured Clinical Interview for DSM-IV Axis I [SCID], additional Impulsive Control Disorder Modules, and various self-report measures, including the Alcohol Use Disorder Identification Test [AUDIT]) to assess status before surgery and in the first 3 postoperative years. Based on the SCID, 16 (8.0%) developed alcohol use disorder [AUD] within 3 years post-RYGB, 7 (43.8%) of whom had no history of AUD. When both the SCID and AUDIT were used to identify AUD, the corresponding numbers/percentages were 32 (18.4%) and 13 (40.6%). Data on other behavioral addictive disorders indicated 19 (9.5%) had a postsurgery disorder, 6 (31.6%) of whom had no history. These data add to a growing literature suggesting there is a substantial risk for the development of AUD after bariatric surgery. Understanding the risk for nondrug-related addictive disorders requires more data from larger studies before clear conclusions can be drawn.
Overeating in response to distressing emotions affects about 40% of pre-surgical bariatric candid... more Overeating in response to distressing emotions affects about 40% of pre-surgical bariatric candidates and has been cited as the most common reason for delay of surgery. Emotional eating also has been shown to impede weight loss in gastric banding patients at one year follow-up. Psychological explanations of emotional eating conceptualize the behavior as a way to cope with pressure and regulate emotional states. However, recent advances in the basic science of appetite regulation provide a more comprehensive understanding of the behavior as a bio-behavioral phenomenon, and offer direction for the development of clinical interventions. The purpose of this symposium is to broaden the understanding of the multiple influences on emotional eating and translate scientific findings into clinical application for bariatric patients. Methods: The symposium, moderated by bariatric surgeon Adam Smith, DO will include: (1) "Appetite Regulation 101" (Joan Carroll, PhD), an overview of the physiological basis of appetite regulation and its interface with stress. (2) "Disinhibitory Eating and the Bariatric Patient" (Kathryn Kaiser, BS), covering the bio-behavioral perspective of disinhibition and its post-surgical impact.
Since the 1991 recommendation by the National Institutes of Health-sponsored consensus developmen... more Since the 1991 recommendation by the National Institutes of Health-sponsored consensus development conference, preoperative psychosocial evaluation of weight loss surgery patients has been adopted by &amp;amp;amp;amp;gt;80% of weight loss surgery programs. Although some published suggestions for conducting evaluations exist, no formal guidelines have been published specifying the qualifications, content knowledge, or clinical experience for the behavioral health professionals who conduct them. As a result, the backgrounds of behavioral health professionals working with bariatric surgery patients are varied, and no mechanism exists to ensure consistent quality of care. To obtain expert opinion on this issue, a survey of the American Society for Metabolic and Bariatric Surgery membership was conducted using an Internet-based survey. American Society for Metabolic and Bariatric Surgery members of all disciplines were invited by electronic mail to complete an Internet-based survey. Separate forms were created for behavioral health providers and for members of other disciplines. A total of 409 American Society for Metabolic and Bariatric Surgery members responded (60 behavioral health and 349 nonbehavioral health). Of the 409 respondents, 95% indicated a belief that it is important for behavioral health providers to have specialty knowledge; 87% indicated a belief that specialty experience is important; and 70.6% favored the development of a specialty credential for bariatric behavioral health providers to regulate the quality of patient care. However, the respondents also reported concerns about creating such a credential. Our results reflect widespread opinion that the provision of bariatric behavioral health services requires specialty knowledge and experience and that a credentialing system would help regulate the standard of care in the field. However, some concerns about credential development remain.
The process of psychosocial evaluation for weight loss surgery (WLS) is one that goes beyond serv... more The process of psychosocial evaluation for weight loss surgery (WLS) is one that goes beyond serving the function of information-gathering (Bauchowitz et al. in This process offers myriad opportunities for delivering significant and powerful interventions that can enhance the patient's success in the WLS process. A discussion of the unique opportunities for psychosocial intervention afforded by the pre-surgical evaluation process is presented, using The Boston Interview for Bariatric Surgery (Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008) as the organizing framework.
Morbid obesity is a rapidly escalating problem in the United States, one with serious health rami... more Morbid obesity is a rapidly escalating problem in the United States, one with serious health ramifications. Due to the lack of empirical support for the long-term efficacy of non-surgical interventions for obesity, gastric bypass surgery has been pursued with increasing frequency as a treatment for morbid obesity. Because surgery is a high-risk, invasive treatment option, medical, psychological and behavioral factors must be carefully considered in pre-surgical evaluations. Although psychological evaluations are requested by surgical teams, there is currently no commonly used, standardized protocol for this type of assessment. Further, there is little empirical data specifying which factors predict successful surgical outcomes. A general overview of a semi-structured interview for presurgical gastric bypass evaluation, developed by the Medical Psychology Service at the VA Boston Healthcare System, is provided in this paper. This standardized approach has many advantages: it ensures comprehensive assessment of relevant factors; it facilitates both research and training; and it facilitates patient education about the procedure.
Rapid shifts in the demographics and techniques of weight loss surgery (WLS) have led to new issu... more Rapid shifts in the demographics and techniques of weight loss surgery (WLS) have led to new issues, new data, new concerns, and new challenges. In 2004, this journal published comprehensive evidence-based guidelines on WLS. In this issue, we've updated those guidelines to assure patient safety in this fast-changing field. WLS involves a uniquely vulnerable population in need of specialized resources and ongoing multidisciplinary care. Timely best-practice updates are required to identify new risks, develop strategies to address them, and optimize treatment. Findings in these reports are based on a comprehensive review of the most current literature on WLS; they directly link patient safety to methods for setting evidence-based guidelines developed from peer-reviewed scientific publications. Among other outcomes, these reports show that WLS reduces chronic disease risk factors, improves health, and confers a survival benefit on those who undergo it. The literature also shows that laparoscopy has displaced open surgery as the predominant approach; that government agencies and insurers only reimburse procedures performed at accredited WLS centers; that best practice care requires close collaboration between members of a multidisciplinary team; and that new and existing facilities require wide-ranging changes to accommodate growing numbers of severely obese patients. More than 100 specialists from across the state of Massachusetts and across the many disciplines involved in WLS came together to develop these new standards. We expect them to have far-reaching effects of the development of health care policy and the practice of WLS.
Journal of Clinical Psychology in Medical Settings, 2005
The purpose of this paper is to introduce the Structured Interview for the Treatment of the Hepat... more The purpose of this paper is to introduce the Structured Interview for the Treatment of the Hepatitis C Virus (SIT-HCV). This comprehensive interview expands upon a standard psychiatric interview by including those medical, psychological, and behavioral factors that are essential to determining a patient’s psychological appropriateness for interferon therapy. A detailed description of the SIT-HCV is provided, highlighting its utility
Objective To compare the effectiveness of cognitive behavioral therapy (CBT), exercise, and the c... more Objective To compare the effectiveness of cognitive behavioral therapy (CBT), exercise, and the combination of both for improving physical functioning and reducing the symptoms of GWVI.
Background Weight loss surgery (WLS) outcomes are poorly understood. This study aimed to evaluate... more Background Weight loss surgery (WLS) outcomes are poorly understood. This study aimed to evaluate the relationship of well-documented (e.g., health, diet, physical activity) and theoretically relevant variables (e.g., substance use and "food addiction") with both weight nadir and weight regain (WR) following WLS. Methods A sample of 97 Roux-en-Y gastric bypass patients (M time since surgery =8.86 years) were surveyed about pre-and post-WLS weight, health, self-management behaviors, alcohol problems, and clinical symptoms. Results Patients lost a mean of 42 % (SD=10.71 %) of total weight at weight nadir, but 26 % (SD=19.66 %) of the lost weight was regained by the time of the survey. Correlates of lower weight nadir and WR differed considerably, with minor overlap. Weight nadir was associated with pre-WLS drug use and post-WLS medical comorbidities. WR, on the other hand, was associated with post-WLS adherence to dietary and physical activity modification. Post-WLS nocturnal eating, depression, and problematic alcohol use were also associated with WR. With all associated variables in regression models, number of post-WLS medical comorbidities (β=−.313, p<0.01) and post-WLS depression (β=0.325, p<0.01) accounted for the most variance and remained as significant predictors of weight nadir and WR, respectively. Conclusions While weight nadir was associated with relatively few and largely nonmodifiable variables, WR was significantly associated with adherence-related behaviors, mood symptoms, and pathological patterns of food and alcohol use, all of which are potentially modifiable. These findings underscore the importance of long-term behavioral and psychosocial monitoring after surgery.
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Papers by Stephanie Sogg