- Email: [email protected]
Psychological Factors, Healthcare Disparities, and Weight Loss Surgery
S52
Preconference: Masters Course in Behavioral Health / Surgery for Obesity and Related Diseases 11 (2015) S49–S55
related to change in snacking behavior. Results from one-way ANOVA showed significant difference between the three groups. The participants with substantial decrease in snacking behavior perceived more triggers like food cues/being bored, social meals and hunger compared to the patients showing an increase or no change. Conclusion: Our findings indicate that although bariatric surgery restricts eating, difficulty in changing unhealthy eating behavior postoperatively can be related to different food triggers. That negative emotions were not related to unhealthy eating was quite unexpected and needs to be further explored. There is an increasing need for post-operative assessment of eating behavior and development of more tailored interventions in order to prevent individuals from regaining weight post surgery.
A188
DEPRESSION, EATING BEHAVIORS, SELF-ESTEEM AND EARLY BODY IMAGE CONCERNS AFTER BARIATRIC SURGERY. Julie Merrell Rish, PhD1; Ashleigh Pona, BS2; Megan Lavery, PsyD3; Leslie Heinberg, PhD3; Kathleen Ashton, PhD3; 1Cleveland Clinic Foundation, Cleveland, OH, USA; 2University of Missouri, Kansas City, MO, USA; 3 Cleveland Clinic, Cleveland, OH, USA Background: The relationships between eating disorders, depression, and body image have been well established. Most postbariatric surgery studies indicate improvement in body image; however, some individuals continue to struggle with body image after weight loss associated with bariatric surgery.These concerns have been associated with presurgical depression and lower selfesteem.Less is known of the relationship between eating disorders, depression, self-esteem, and body image early after bariatric surgery. Objective: This study sought to explore preoperative factors that may predict body image concerns 3-months after bariatric surgery. Setting: Academic Medical Center. Method: Data were analyzed from 390 patients evaluated for bariatric surgery who completed a 3-month postoperative psychology appointment and questionnaire, and the Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form (MMPI-2-RF). Scales measuring depression, persecution, self-doubt, and inefficacy were examined.Medical records were reviewed for demographics, current or lifetime depression diagnosis, and eating disorder not otherwise specified diagnosis (EDNOS).Patients who indicated post-surgery body image concerns were compared to patients not endorsing these symptoms. Results: Patients who preoperatively were diagnosed with EDNOS (X2¼4.42, po.05), major depressive disorder (X2¼13.62, po.001), and who scored higher on depression (F (1, 388) ¼ 30.24, po.001), ideas of persecution (F (1, 388) ¼ 12.73, po.001), self-doubt (F (1, 388) ¼ 29.07, po.001), and inefficacy (F (1, 388) ¼ 15.96, po.001) were significantly more likely to report body image concerns 3-months after bariatric surgery.The combined effects of these variables account for 14.9% of the variance in body image concerns (R2 ¼ 5.96, F(3, 374) ¼ 5.96, p o .001).
Conclusions: Patients with a pre-surgical depression diagnosis and symptoms of distress, EDNOS, and lower self-esteem are more likely to report body image concerns early after bariatric surgery. Future research should examine whether this relationship continues long term post-operatively.
TUESDAY, NOVEMBER 3, 2015
1:30pm-5:30pm
A189
PSYCHOLOGICAL FACTORS, HEALTHCARE DISPARITIES, AND WEIGHT LOSS SURGERY Kathleen Ashton, PhD1; Ryan Marek, MA2; Julie Merrell Rish, PhD3; Megan Lavery, PsyD3; Leslie Heinberg, PhD3; 1The Cleveland Clinic Foundation, Cleveland, OH, USA; 2Kent State University, Kent, OH, USA; 3Cleveland Clinic, Cleveland, OH, USA Objective: Previous studies examining healthcare disparities in weight loss surgery (WLS) have found that African Americans & Latinos, lower SES individuals, and the uninsured are more likely to qualify for, but less likely to receive, WLS. The current study sought to explore psychological factors that may contribute to healthcare disparities in WLS. Methods: Retrospective chart review at a large academic medical center examined 2690 consecutive patients. Gender, race (African American vs. Caucasian), disability, and education level were examined for surgery completion.Further, differences in denial due to psychological reasons, final psychological clearance, mental health treatment, and substance use history were examined as potential reasons for why patients did not complete surgery. Results: The sample was predominantly female (72%), with 24% of the sample African American, 67% with greater than a high school education, and 55% employed. African Americans(X2 ¼ 47.4, po.001), those on disability insurance (X2 ¼ 4.4, p o.05), and those with less education (X2 ¼ 14.4, p o.001) were significantly less likely to complete surgery.There were no differences between African Americans and Caucasians for denial of surgery based on psychological reasons (deemed not a candidate at initial visit by behavioral health). Moreover, African American and Caucasian patients were rated similarly on a scale of overall readiness for surgery.However, African American patients were significantly less likely to obtain final psychological clearance (i.e., started program but never completed psychological recommendations; X2 ¼ 62.9, p o.001).In addition, African American patients were less likely to have received mental health treatment (X2 ¼ 34.1, po.001) and more likely to have a substance abuse history (X2 ¼ 24.02, p o.05) when compared to Caucasian surgery candidates.Logistical regression analysis revealed significant main effects for race and outpatient mental health treatment predicting psychological clearance, as well as an interaction effect (p’so.001).African American candidates without mental health treatment were least likely to obtain final clearance by psychology; Caucasians receiving mental health treatment were the most likely group to receive psychological clearance. Discussion: Although African Americans show higher rates of obesity, they are less likely to obtain weight loss surgery.Factors such as lack of mental health treatment, whether due to access or
Preconference: Masters Course in Behavioral Health / Surgery for Obesity and Related Diseases 11 (2015) S49–S55
stigma, may be a barrier to psychological clearance for surgery. Psychological providers should be aware of barriers to surgery and work toward program interventions to improve access to WLS.
A190
A PILOT RANDOMIZED CONTROLLED TRIAL OF TELEPHONE-BASED COGNITIVE BEHAVIORAL THERAPY FOR PREOPERATIVE BARIATRIC SURGERY PATIENTS Sanjeev Sockalingam, MD1; Stephanie Cassin, PhD1; Chau Du, MSc2; Susan Wnuk, PhD2; Raed Hawa, MD, FRCPC2; Timothy Jackson, MD2; Sagar Parikh, MD2; 1Ryerson University,
S53
Toronto, ON, Canada; 2University Health Network, Toronto, ON, Canada Background: Accumulating evidence suggests that psychosocial interventions such as cognitive behavioral therapy can improve eating behaviors and psychosocial functioning in bariatric surgery candidates (e.g., Ashton, Drerup, Windover, & Heinberg, 2009). However, the mobility issues and practical barriers faced by many patients highlight the need for novel methods for delivering psychosocial interventions that have the potential to improve access to treatment. Objectives: The objective of this study was to examine the efficacy of a pre-operative telephone-based cognitive behavioural therapy (Tele-CBT) intervention versus standard pre-operative care for improving eating pathology and psychosocial functioning.
Table 1 Comparison of Tele-CBT (N = 16) and Control (N = 17) Groups at Baseline and Immediately Following the Intervention
Preconference: Masters Course in Behavioral Health / Surgery for Obesity and Related Diseases 11 (2015) S49–S55
related to change in snacking behavior. Results from one-way ANOVA showed significant difference between the three groups. The participants with substantial decrease in snacking behavior perceived more triggers like food cues/being bored, social meals and hunger compared to the patients showing an increase or no change. Conclusion: Our findings indicate that although bariatric surgery restricts eating, difficulty in changing unhealthy eating behavior postoperatively can be related to different food triggers. That negative emotions were not related to unhealthy eating was quite unexpected and needs to be further explored. There is an increasing need for post-operative assessment of eating behavior and development of more tailored interventions in order to prevent individuals from regaining weight post surgery.
A188
DEPRESSION, EATING BEHAVIORS, SELF-ESTEEM AND EARLY BODY IMAGE CONCERNS AFTER BARIATRIC SURGERY. Julie Merrell Rish, PhD1; Ashleigh Pona, BS2; Megan Lavery, PsyD3; Leslie Heinberg, PhD3; Kathleen Ashton, PhD3; 1Cleveland Clinic Foundation, Cleveland, OH, USA; 2University of Missouri, Kansas City, MO, USA; 3 Cleveland Clinic, Cleveland, OH, USA Background: The relationships between eating disorders, depression, and body image have been well established. Most postbariatric surgery studies indicate improvement in body image; however, some individuals continue to struggle with body image after weight loss associated with bariatric surgery.These concerns have been associated with presurgical depression and lower selfesteem.Less is known of the relationship between eating disorders, depression, self-esteem, and body image early after bariatric surgery. Objective: This study sought to explore preoperative factors that may predict body image concerns 3-months after bariatric surgery. Setting: Academic Medical Center. Method: Data were analyzed from 390 patients evaluated for bariatric surgery who completed a 3-month postoperative psychology appointment and questionnaire, and the Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form (MMPI-2-RF). Scales measuring depression, persecution, self-doubt, and inefficacy were examined.Medical records were reviewed for demographics, current or lifetime depression diagnosis, and eating disorder not otherwise specified diagnosis (EDNOS).Patients who indicated post-surgery body image concerns were compared to patients not endorsing these symptoms. Results: Patients who preoperatively were diagnosed with EDNOS (X2¼4.42, po.05), major depressive disorder (X2¼13.62, po.001), and who scored higher on depression (F (1, 388) ¼ 30.24, po.001), ideas of persecution (F (1, 388) ¼ 12.73, po.001), self-doubt (F (1, 388) ¼ 29.07, po.001), and inefficacy (F (1, 388) ¼ 15.96, po.001) were significantly more likely to report body image concerns 3-months after bariatric surgery.The combined effects of these variables account for 14.9% of the variance in body image concerns (R2 ¼ 5.96, F(3, 374) ¼ 5.96, p o .001).
Conclusions: Patients with a pre-surgical depression diagnosis and symptoms of distress, EDNOS, and lower self-esteem are more likely to report body image concerns early after bariatric surgery. Future research should examine whether this relationship continues long term post-operatively.
TUESDAY, NOVEMBER 3, 2015
1:30pm-5:30pm
A189
PSYCHOLOGICAL FACTORS, HEALTHCARE DISPARITIES, AND WEIGHT LOSS SURGERY Kathleen Ashton, PhD1; Ryan Marek, MA2; Julie Merrell Rish, PhD3; Megan Lavery, PsyD3; Leslie Heinberg, PhD3; 1The Cleveland Clinic Foundation, Cleveland, OH, USA; 2Kent State University, Kent, OH, USA; 3Cleveland Clinic, Cleveland, OH, USA Objective: Previous studies examining healthcare disparities in weight loss surgery (WLS) have found that African Americans & Latinos, lower SES individuals, and the uninsured are more likely to qualify for, but less likely to receive, WLS. The current study sought to explore psychological factors that may contribute to healthcare disparities in WLS. Methods: Retrospective chart review at a large academic medical center examined 2690 consecutive patients. Gender, race (African American vs. Caucasian), disability, and education level were examined for surgery completion.Further, differences in denial due to psychological reasons, final psychological clearance, mental health treatment, and substance use history were examined as potential reasons for why patients did not complete surgery. Results: The sample was predominantly female (72%), with 24% of the sample African American, 67% with greater than a high school education, and 55% employed. African Americans(X2 ¼ 47.4, po.001), those on disability insurance (X2 ¼ 4.4, p o.05), and those with less education (X2 ¼ 14.4, p o.001) were significantly less likely to complete surgery.There were no differences between African Americans and Caucasians for denial of surgery based on psychological reasons (deemed not a candidate at initial visit by behavioral health). Moreover, African American and Caucasian patients were rated similarly on a scale of overall readiness for surgery.However, African American patients were significantly less likely to obtain final psychological clearance (i.e., started program but never completed psychological recommendations; X2 ¼ 62.9, p o.001).In addition, African American patients were less likely to have received mental health treatment (X2 ¼ 34.1, po.001) and more likely to have a substance abuse history (X2 ¼ 24.02, p o.05) when compared to Caucasian surgery candidates.Logistical regression analysis revealed significant main effects for race and outpatient mental health treatment predicting psychological clearance, as well as an interaction effect (p’so.001).African American candidates without mental health treatment were least likely to obtain final clearance by psychology; Caucasians receiving mental health treatment were the most likely group to receive psychological clearance. Discussion: Although African Americans show higher rates of obesity, they are less likely to obtain weight loss surgery.Factors such as lack of mental health treatment, whether due to access or
Preconference: Masters Course in Behavioral Health / Surgery for Obesity and Related Diseases 11 (2015) S49–S55
stigma, may be a barrier to psychological clearance for surgery. Psychological providers should be aware of barriers to surgery and work toward program interventions to improve access to WLS.
A190
A PILOT RANDOMIZED CONTROLLED TRIAL OF TELEPHONE-BASED COGNITIVE BEHAVIORAL THERAPY FOR PREOPERATIVE BARIATRIC SURGERY PATIENTS Sanjeev Sockalingam, MD1; Stephanie Cassin, PhD1; Chau Du, MSc2; Susan Wnuk, PhD2; Raed Hawa, MD, FRCPC2; Timothy Jackson, MD2; Sagar Parikh, MD2; 1Ryerson University,
S53
Toronto, ON, Canada; 2University Health Network, Toronto, ON, Canada Background: Accumulating evidence suggests that psychosocial interventions such as cognitive behavioral therapy can improve eating behaviors and psychosocial functioning in bariatric surgery candidates (e.g., Ashton, Drerup, Windover, & Heinberg, 2009). However, the mobility issues and practical barriers faced by many patients highlight the need for novel methods for delivering psychosocial interventions that have the potential to improve access to treatment. Objectives: The objective of this study was to examine the efficacy of a pre-operative telephone-based cognitive behavioural therapy (Tele-CBT) intervention versus standard pre-operative care for improving eating pathology and psychosocial functioning.
Table 1 Comparison of Tele-CBT (N = 16) and Control (N = 17) Groups at Baseline and Immediately Following the Intervention