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Being overweight increases the risk of developing many common diseases including type-2 diabetes mellitus, hypertension, coronary heart disease, gallstones and various cancers of the gastrointestinal and urogenital tracts. It can also cause or exacerbate osteoarthritis, breathlessness, heartburn, sleep apnoea, venous thromboembolism and psychological distress, particularly anxiety and depression. It makes anaesthesia and surgery more hazardous, and in pregnancy increases the risks associated with childbirth. Being overweight can also complicate day-to-day social functioning such as negotiating seats on public transport or purchasing clothes. In this article, we review the evidence that weight loss is beneficial and how this might be achieved using lifestyle changes, drug therapy, or surgery.
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PMID:Why and how should adults lose weight? 1056 62

BACKGROUND: Although treatment failure after Vertical Banded Gastroplasty (VBG) is not uncommon, the safety of the procedure makes it the most widely used form of bariatric surgery. The reasons for failure may be either technical, such as staple-line dehiscence, or psychological inability on the part of the patient to adjust to the small stomach pouch and to its consequences. METHODS: We carried out prospective testing of a cohort of consecutive VBG candidates, using a battery of psychological tests consisting of the 'Three Factor Eating Questionnaire', 'Hopkins Symptom Check List (HSCL)', 'Mood Adjective Check List (MACL)', 'Karolinska Scales of Personality (KSP)', and two projective tests, the 'MetaContrast Technique (MCT)' and the 'Perceptgenetic Object Relation Test (PORT)'. The patients had been scheduled for surgery on clinical considerations only, and the results of the psychological testing were not disclosed to the surgeons until after the follow-up. RESULTS: Mean preoperative Body Mass Index (BMI) was 42.0 (SD 9.9). Patients were extensively tested during the 3 weeks prior to surgery. There were no operative complications. Patients were tested psychologically again after 3 years. Their mean BMI then was 32.3 (SD 6.6). Thirteen patients had lost more than 50% of their overweight (BMI mean 29.6; SD 1.1), seven patients had lost less than 50% (BMI mean 37.0; SD 1.6; p = 0.0043). These two groups were compared. The single factor that correlated consistently with an unsatisfactory weight loss was preoperative signs of depression (p = 0.04). Stepwise discriminant analysis using three preoperative factors (Hunger, Verbal aggression and Socialization) correctly classified 90% of the patients who had lost < 50% of their overweight. Other variables (impulsivity, Emotional detachment and Maladaptive psychological defense) identified patients who were later to suffer from dysphoric mood (n=5) or disturbed eating behavior (n=ll).These factors may compromise a sustained ability to tolerate food restriction. Despite the operation's disadvantages, all patients considered it worthwhile and displayed improved psychosocial adaptation post-operatively. CONCLUSION: We conclude that extensive psychological testing can accurately predict the intermediate-term weight outcome following VBG and that even patients who show little weight loss benefit from the procedure.
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PMID:Weight Loss After Vertical Banded Gastroplasty Can Be Predicted: A Prospective Psychological Study. 1072 65

It has long been believed that food restriction leads to psychological disturbances, including depression, preoccupation with food, and binge eating. However, recent studies suggest that comprehensive weight loss programs that incorporate behavioral treatment, diet change, and encouragement of physical activity in fact can improve the psychological state, including mood. A study conducted on subjects participating in the Weight Watchers program demonstrated positive psychological changes and improved quality of life. These changes may help motivate overweight people to maintain the physical activity and nutritional practices necessary to lose and maintain weight. Programs that include group support, like Weight Watchers, have been associated with psychological benefits independent of the amount of weight lost. Furthermore, dieters who regain lost weight do not appear to experience adverse psychological consequences. The development or exacerbation of bulimia has been linked by some authors to strict dieting, but more moderate weight control programs do not appear to produce disordered eating and may help reduce binge eating among overweight people. Individuals who successfully lose and maintain weight have been shown to experience improved mood, self-confidence, and quality of life. Additionally, decreasing levels of psychological and behavioral symptoms have been associated with increasing duration of weight loss maintenance. It can be concluded that quality of life and other psychological measures improve in individuals on comprehensive weight management programs.
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PMID:The psychological ramifications of weight management. 1083 2

The rapidly rising prevalence of obesity, worldwide, has prompted re-evaluations of the definitions and diagnostic criteria, and of the extent of the burden it contributes to health care services. Although categorized arbitrarily for epidemiological purposes according to BMI > 25 kg/m2 ('overweight') and BMI > 30 kg/m2 ('obese'), the disease itself (ICD code E.66) is the process of excess fat accumulation. It leads to multiple organ-specific pathological consequences, particularly if there is a tendency to intra-abdominal fat accumulation. The simplest field method to identify obesity and risk of medical problems is the waist circumference, and this method has found a special role in health promotion. Risks begin with waist > 80 cm (women) or > 94 cm (men). As a broad generalization, obesity produces few symptoms below the age of 40 years, but then several symptoms often develop; tiredness, breathlessness, back pain, arthritis, sweatiness, poor sleeping, depression and menstrual disorders all being common. The symptoms are often attributed to diseases in other body systems. Metabolic diseases like diabetes, hyperlipidaemia and, hypertension develop later, but the mean BMI at diagnosis of diabetes is 28 kg/m2. Ultimately, obesity increases the likelihood of myocardial infarction, stroke and several major cancers, but its biggest impact on health, especially in the elderly, is probably the multiplicity of effects on other body systems. The greatest challenge for public health is to develop effective preventive measures, recognizing that BMI > 25 kg/m2 before the age of 20 years is a very strong predictor of obesity and ill health in adulthood.
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PMID:Pathophysiology of obesity. 1099 48

The present investigation tested a 12-wk. treatment protocol which employed low intensity cardiovascular and resistance exercise as well as cognitive-behavior modification on 13 obese, previously sedentary women. Separate analyses were conducted on program maintenance, emotional change, and physiological change. Although self motivation was lower in the treatment group than in the control group (n=35), measures of exercise maintenance were significantly higher. Analyses within the treatment group only indicated significant improvements in measures of State Anxiety, Depression, Anger, Fatigue, Tension, and Vigor, also Health Evaluation, Body Area Satisfaction, and heightened Overweight Preoccupation, over the 12 weeks. Their feelings after individual bouts of exercise indicated significantly increased Positive Engagement, Revitalization, and Tranquility, and reduced Physical Exhaustion. Maximum volume of oxygen uptake (VO2max) significantly increased (2nd to 10th percentile), but not resting heart rate. No significant correlation was found between cardiorespiratory change and change in scores on depression and anxiety. No significant association was found between physiological change and change in body image. Preliminary evaluation of the minimal exercise treatment was given. The need to replicate findings with larger and different samples was emphasized.
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PMID:Effects of minimal exercise and cognitive behavior modification on adherence, emotion change, self-image, and physical change in obese women. 1101 3

Over the last 50 years, the nutritional and socioeconomic conditions have dramatically changed in all industrialized countries. As a consequence, there has been a sharp rise in the prevalence of obesity. Simultaneously, social and cultural pressures to maintain a thin body shape have significantly increased. This untoward situation is largely responsible for the steady increase of eating disorders, especially bulimia nervosa and binge-eating disorder, which are common disorders among normal or overweight individuals. Although the criteria for bulimia nervosa were first described in the DSM-III in 1980 (APA, 1980), recent studies have demonstrated that only about 12% of these patients are detected by their GP's. One reason for this low rate of detection may be due to the tendency of patients to conceal their illness from others. It is also possible, however, that general practitioners lack sufficient knowledge about bulimia nervosa, preventing proper identification. To help improve this situation, diagnostic guidelines and therapeutic options were summarized. Binge-eating disorder (BED), which is classified as an "eating disorder not otherwise specified" in the DSM-IV (APA, 1994), has been described as the most relevant eating disorder for overweight individuals. It has been estimated that approximately 20-30% of overweight persons seeking help at weight loss programs are classified as binge eaters. Initial results from these studies suggest that binge eaters may require a modified psychotherapeutic approach which focuses on normalizing disordered eating patterns before attempting weight loss. In addition to the importance of screening for eating disorder behaviors, overweight patients should be assessed for other comorbid conditions, such as depression and anxiety. Further, body image disturbances should be assessed during the evaluation. In the event that comorbid disorders are present, it is recommended that specific psychotherapeutic interventions which target these problems be integrated into the overall weight reduction program.
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PMID:[Eating behavior, eating disorders and obesity]. 1102 87

This study investigated the effect of a weight reduction diet on cognitive performance and psychological well-being among overweight women. A total of 42 women undertook a 12-week weight reduction diet while 21 women maintained their usual diet and exercise habits for 12 weeks. All women completed neuropsychologcial tests of speed of information processing, executive function, working memory, immediate and delayed recall and recognition, and verbal ability. They also completed measures of weight locus of control, dieting beliefs, self-esteem, mood and dysfunctional attitudes, before and after the 12-week interval. Being on the diet had a minimal impact on cognitive performance and a positive effect on emotional eating, feelings of depression and dysfunctional attitudes. A sense of control over weight and eating behaviour increased among the dieters, but an internal locus of control was negatively related to self-esteem.
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PMID:The effect of weight-loss dieting on cognitive performance and psychological well-being in overweight women. 1123 50

The objective of this study was to assess the associations and population attributable risks (PAR) of risk factor combinations and ischemic heart disease (IHD) mortality in the United States. We used logistic regression models to assess the association of risk factors with IHD in the First National Health and Nutrition Examination Survey (1971-1974) and Epidemiologic Follow-up Study (1982-1992) among white and black men and women. We examined eight modifiable risk factors: hypertension, elevated serum cholesterol, diabetes, overweight, current smoking, physical inactivity, depression, and nonuse of replacement hormones. Risk factors associated with IHD mortality were the same among white and black men (i.e., age, education, smoking, diabetes, hypertension, and serum cholesterol). Age, education, smoking, diabetes, and hypertension were the risk factors among white and black women. Physical inactivity, nonuse of replacement hormones, serum cholesterol, and overweight were the additional risk factors among white women. Adjusted for demographic risk factors, overall PARs for study risk factors were 41.2% for white men, 60.5% for white women (with five risk factors only), 49.2% for black men, and 71.2% for black women. Much IHD mortality attributable to individual risk factors is caused by those factors in combination with other risk factors; relatively little mortality is attributable to each risk factor in isolation. Analysis that does not examine risk factor combinations may greatly overestimate PARs associated with individual risk factors.
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PMID:Multiple risk factors and population attributable risk for ischemic heart disease mortality in the United States, 1971-1992. 1137 25

The aim of this work was to search for eating disorders, DSM III-R Axis I mental disorders, personality disorders, and addictive behavior, in self-labeled "chocolate addicts". Subjects were recruited through advertisements placed in a university and a hospital. Fifteen subjects were included, 3 men and 12 women aged between 18 and 49. Most of them were not overweight, although 7 thought they had a weight problem. They consumed an average of 50 g per day of pure cacao and, for 13 subjects, this consumption was lasting since childhood or adolescence. The psychological effects of chocolate, as indicated by the subjects, consisted in feelings of increased energy or increased concentration ability, and in an anxiolytic effect during stress. Seven subjects described minor withdrawal symptoms. None of the subjects reached the thresholds for eating disorders on the EAT and BULIT scales. The structured interview (MINI) identified an important ratio of subjects with a history of major depressive episode (13/15), and one woman was currently experiencing a major depressive episode. Four people suffered, or had suffered from anxiety disorders. Although only one subject satisfied all criteria for a personality disorder on the DIP-Q, seven displayed some pathological personality features. The self-labeled "chocoholics" do not seem to suffer from eating disorders, but may represent a population of psychologically vulnerable and depression--or anxiety--prone people. They seem to use chocolate as a light psychotropic drug able to relieve some of their distress. The amount of cacao consumed, although very chronically, remains moderate, and they rarely display other addictive behaviors.
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PMID:[Is cocoa a psychotropic drug? Psychopathologic study of a population of subjects self-identified as chocolate addicts]. 1140 71

Binge eating disorder (BED) was included in the DSM IV as a proposed diagnostic category for further study and as an example for an eating disorder not otherwise specified (EDNOS). BED is characterized by recurrent episodes of binge eating in the absence of regular compensatory behavior such as vomiting or laxative abuse. Related features include eating until uncomfortably full, eating when not physically hungry, eating alone and feelings of depression or guilt. BED is associated with increased psychopathology including depression and personality disorders. Although BED is not limited to obese individuals, it is most common in this group and those who seek help do so for treatment of overweight rather than for binge eating. In community samples, the prevalence of BED has been found to be 2-5%, in individuals who seek weight control treatment the prevalence is 30%. BED is more equal in gender ratio than bulimia nervosa. Eating disorder treatments such as cognitive behavior therapy (CBT) or interpersonal psychotherapy (IPT) improve binge eating with abstinence rates of about 50%. Antidepressants are also effective in reducing binge eating, though less so than psychotherapy. Standard weight loss treatments including bariatric surgery do not seem to exacerbate binge eating problems. Thus, both eating disorder and obesity treatments seem to be beneficial in BED. However, it is recommended today that treatment should first be directed at the disordered eating and associated psychopathology.
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PMID:Binge eating disorder and obesity. 1146 89


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