2011 â¢ NYS Psychologist - New York State Psychological Association

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drome may differ in diverse populations (Jermendy, Littvay, Steinbach, Jermendy, Tarnoki, Tarnoki, Metneki and Osztovits, 2011). In a twin study researchers studying the heritability of the risk factors characteristic of the metabolic syndrome on 101 (63 monozygotic and 38 dizygotic) adult twin pairs found that genetic factors have significant influence on waist circumference and blood pressure values while environmental factors had effect on the cholesterol levels, triglycerides and glucose values of the candidate (Jermendy et al. 2011). Consequently, those hereditary factors may explain why some people have slower metabolic rates than others. Although substantial progress is made in understanding the physiology of metabolic syndrome, the pathophysiology of abdominal obesity still remains unclear. This is because of the mutations of the candidate’s gene that seems to be the result of interplay between genes in families. So, the search is focused on families with the genetic risk of developing abdominal obesity (Groop, 2000). According to set point theory (Weinsler, Hunter, Heini, Goran & Sell,1998) the brain regulates body weight around a genetic predetermined level or set point. When weight gain and loss occurs, the brain adjusts a basic metabolic rate to keep body weight around its set point. It seems that this mechanism may have protected our ancestors to ensure energy during the times of starvation, famines and difficult times (Coleman, 1979). Since obese women and men have more fat cells than average women and men they feel hungry sooner than those with fewer fat cells. Thus, heredity and excessive eating in childhood may play a role in the amount of fat cells we have but still pathophysiological events play the greater factor (Groop, 2000). In conclusion obesity causes multiple diseases in many organ systems in the body. Actually, almost every organ system we have is impaired by having excess body fat. Psychological factors related to obesity include emotional states for excessive eating and environmental cues of food can trigger hunger craving for food even when we are not hungry. Also, anger (at self- others or society) can make people eat more. Fear for gaining weight of becoming fat is another factor. low self esteem, anxiety and depression. Other factors are:body Dimorphic Disorder, social Stigmatization, crisis and stressful events in life and guilt or anxiety about personal appearance. Disordered eating refers to abnormal eating patterns and is difficult to classify using criteria of DSM-IV-TR (APA, 2000). According to Toth & Schwartz (2006) restrictive dieting, binging and purging are all common and types of disordered eating. In addition, changes in eating patterns can occur because of illness, depression, guilt, anxiety, crisis and stressful events in life (loss of job) guilt and anxiety about perceptions about appearance. The above authors suggest that new eating disorders should be added to DSM such as binge-eating and night eating syndrome. Prochaska and DiClemente's (1982) offers a model of change (transtheoretical) model, that most likely will be helpful in working with people with obesity problems. It seems to this author that in maintenance phase the individual that has gone through the program of weight loss or bariatric surgery is trying to maintain the healthy behaviors. Finally in the termination phase is to resolve the issues related to food and validate the very difficult work that he/she has accomplished during the action phase. Other treatment procedure for obesity includes the Roux-en- Y gastric bypass, stapled gastroplasty, and adjustable gastric banding, all of which are designed to reduce stomach size and control calorie intake. Although complication rates of almost 40% over a 180-day period have been reported, substantial health benefits are common, including excess weight loss of up to 70% and resolution of diabetes in 77% of patients. Over 200,000 procedures are performed annually, and almost $1 billion was spent on such surgeries in 2002. However, only 0.6% of eligible adults underwent a procedure, suggesting a huge untapped market. In early 1985, Dr. Dag Hallberg applied for a patent for the Swedish Adjustable Gastric Band (SAGB) within Scandinavian countries. In late March, Dr. Hallberg presented his idea of the "balloon band" at the Swedish Surgical Society and started to use the SAGB in a controlled series of 50 procedures. During this time, laparoscopic surgery was not common and Dr. Hallberg and his assistant, Dr. Peter Forsell, started performing the open technique to implant the SAGB. In 1992, Dr. Forsell was in contact with different surgeons in Switzerland, Italy and Germany who began to implant the SAGB with the laparoscopic technique. Dr. Forsell fully owned the patent at this time. In 1994, Dr. Forsell presented the SAGB at an international workshop for bariatric surgery in Sweden, and from then on, the SAGB started to be implanted laparoscopically. During this time, the SAGB was manufactured by a Swedish company, ATOS Medical. Laparoscopic Adjustable Gastric Banding, or (LAGB), is a form of restrictive weight loss surgery (bariatrics) designed for obesity patients with a body mass index (BMI) of 40 or greater - or between 35 – 40 with those who have comorbidities that are known to improve with weight loss. Pharmacological Treatment for Obesity One of the drugs to treat obesity is Oleylethanolamide (OEA), Sibutramine, Orlistat and Dexfenflu an SSRI’s (Serotonin Reuptake Inhibitors). Researchers from University of California, Irvine’s College of medicine lead by pharmacology professor Dr. Piomelli found a chemical that naturally exists in the body and can be proved effective in the treatment of obesity it is call OEA- Oleylethanolamide, a regulator of eating behavior. So this chemical was found to make rats to eat less and consequently there was a decrease in their weight gain (Cristol, 2002). According to Dr. Piomelli “This suggested that OEA is an important regulator of eating behavior and could be used as a tool to design new antiobesity medicines” and the assumption is because the OEA did not affect the nervous system of the rats would be appropriate for humans since it does not causes side effects as other drugs (O’Brien et al., 2005; Mayer & Walsh, 1998). Bariatric Evaluations Walfish,Vance and Fabricatore, (2007) conducted a study among 103 mental health professionals who had done psychological evaluations for bariatric surgery. The measures by 103 psychologists were: -MMPI-2, Beck Depression Inventory -Millon Behavioral Medicine Diagnostic -Personality Assessment Inventory -Eating Disorder Inventory -Clinical Interview -Millon Clinical Multiaxial Inventory -Beck Anxiety Inventory -Weight and Lifestyle Inventory -Quality of Life Inventory -Millon Behavioral Health Inventory -Shipley Institute of Living Scale -Mini mental Status Examination According to (Walfish,Vance & Fabricatore, 2007), MMPI-2 was used by most psychologists doing bariatric evaluations. It Page 6 Vol. XXIII No. 2 • Fall 2011 • NYS Psychologist
seems that the validity scales is part of the appeal of the MMPI-2. Those scales can detect overly defensive or otherwise unreliable response sets. This is important because some of the participants can fake good meaning they want to minimize any emotional difficulties they may be experiencing in life. Who should be delay or deny bariatric surgery: According to (Walfish,Vance & Fabricatore, 2007), the most common reason they recommended to delay or deny the surgery was significant psychopathology (psychosis or bipolar disorder), untreated or undertreated depression, lack of understanding about the risks and postoperative requirements of the surgery, active eating disorder, and active substance abuse questionable ability to comply with a post-surgical regimen, chaotic lifestyle or significant situational stressors, unrealistic expectations about weight loss or postoperative life, unsupportive or conflictual family environment, and cognitive impairment (Walfish et al., 2007). Who should be considered for Bariatric surgery? a) a patient who has medical, physical or psychosocial problems associated with their obesity, b) a patient who have made prolonged but not successful efforts to relieve those problems by non-surgical means and c)when serious comorbidities between obesity and diabetes 2 mellitus , are present. Pre-Surgical Psychological Assessments of Bariatric Surgery: (American Society for Bariatric Surgery 2004), Eating Attitudes and Behaviors, Binge Eating Scale (BES), Binge Eating Questionnaire (BEQ), Three-Factor Eating Questionnaire (TFEQ), Eating Inventory (EI), Questionnaire on Eating and Weight Patterns- Revised (QEWP-R), Eating Disorder Examination-Questionnaire (EDE-Q), Eating Disorder Inventory - 2 (EDI-2), Eating Disorder Symptom Checklist (EDI-SC) Weight and Lifestyle inventory (WALI), Suggestions for Pre- Surgical Psychological Psychological Assessments of Bariatric Surgery (Walfish,Vance & Fabricatore, 2007) Structured Clinical Interview for DSM-IV, Biosocial History, Eating Attitudes Test-Eating Disorders, Mental Status Exam, , The Burns Anxiety Inventory,Personality And Psychopathology, Basic Personality Inventory (BPI), Personality Assessment Inventory (PAI), - Axis I, Clinical Version (SCID-I:CV), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Minnesota Multiphasic Personality Inventory - 2 (MMPI- 2), Millon Behavioral Medicine Diagnostic (MBMD), Rosenberg Self-Esteem Scale (SES)(RSE), Symptom Checklist 90 -R (SCL- 90-R), Beck Depression Inventory (BDI), Eating Expectancy Questionnaire, Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Multidimensional Health Locus of Control (MHLC) Scales, Shipley Institute of Living Scale, Spielberger State-Trait Anger Expression Inventory (STAXI), Spielberger State-Trait Anxiety Inventory (STAI), and Weight and Lifestyle Inventory (WALI). Health Related Quality of Life Assessment (Walfish,Vance & Fabricatore, 2007). Quality of Life Questionnaire (QLQ), Quality of Life Inventory (QOLI), Impact of Weight on Quality of Life (IWQOL), Impact of Weight on Quality of Life (IWQOL-Lite), Impact of Weight on Quality of Life-Kids (IWQOL-Kids), OMS 36-item Short Form Health Survey (SF-36), Moorehead-Ardelt Quality of life Questionnaire (M-A QoLQ), Moorehead-Ardelt Quality of life Questionnaire II (M-A QoLQ II). After bariatric surgery measures: Bariatric Analysis and Reporting Outcome System (BAROS), Assessment Batteries,VA Bariatric Surgery Workgroup 2007,Alcohol Use Disorder Testcore (AUDIT-C), Drug Abuse Screening Test (DASTC), Millon Behavioral Medicine Diagnostic (MBMD), Multidimensional Health Locus of Control (MHLC), Questionnaire on Weight and Eating Patterns-Revised (QEWP-R). Conclusion In conclusion, obesity epidemic in the US and Worldwide has multifactorial causes and is linked to serious health consequences for women and men. The financial cost of obesity is about 100 billion (CDC, 2006) and because of that cost the situation is urgent to take action. Health insurers should provide enhanced coverage for obesity prevention and treatment. Psychologists, healthcare providers, educators, legislators, and social advocates should make a dedicated effort to deal with the urgent problem of obesity. Also, the weight loss industry must offer affordable programs for women and men who need to take care of their weight and general health. REFERENCE: Banks, E., Beral, V., Brown, A., Bull, D., Cameron, B., Crossley,B., Deciacco, D., Ewart,D., Gerrard, L., Hall, J., Hall, S., Hilton, E., Ann Hogg, Keene, C., Langley,N., Langston, N., Reeves, G., Moya Simmonds, (1999) . M. The Million Women Study: design and characteristics of the study population.The Million Women Study Collaborative Group. University of Oxford, Oxford, UK. Breast Cancer Res, 1:73- 80doi:10.1186/bcr16 The electronic version of this article is the complete one and can be found online at: http://breast-cancerresearch.com/content/1/1/73 © 1999 Current Science Ltd. Coleman, D. (1979). Obesity genes: beneficial effects in heterozygous mice. Science 203, 663-665. Cristol, H.(2002). Trends in Global Obesity: developing nations are gaining on U.S. in a weighty matter. Donohoe, M. Medscape Ob/Gyn & Women's Health 2008 www.medscape.com/viewarticle/566349 http://www.usa.gov/Citizen/ Topics/New_Years_Resolutions.shtml Retrieved 7/30/2011 Center for Disease Control and prevention. (2006). Overweight and obesity: Defining overweight and obesity. http://www.cdc.gov/nccdphp/ dnpa/obesity/defining.htm Retrieved 7/29/2011 Donohoe, Martin, MD, FACP Weighty Matters: Public Health Aspects of the Obesity Epidemic: Part II -- Treatments and Approaches to Combating the Problem Posted 01/04/2008 Department of Health and Human Services. www.womenshealth.gov Groop, L.(2000). Genetics of the metabolic syndrome. British Journal of Nutrition, 83, Suppl. 1, S39-S48 http://journals.cambridge.org. Retrieved 8/2/2011 Grundy, S.M., Cannon, C.P., Klein, S., Pi-Sunyer, X.F., (2007). Managing obesity as a chronic disease: A Pathophysiologic approach to cardiometabolic risk reduction. Schimed retrieved from Medscape 2/20/08 Mayer, L. E., Walsh, B.T., (1998) The use of selective serotonin reuptake inhibitors in eating disorders. J Clin Psychiatry, 59 suppl 15 28-34. Kulie, T., Slattengren, A., Redmer, J., Counts, H., Eglash, A., MD, and Schrager, S. (J Am Board Fam Med. 2011;24(1):75- 85. © 2011 American Board of Family Medicine, Retrieved from http://www.medscape.com/viewarticle/735689, Retrieved 7/30/2011 Lakka T, Laaksonen DE. Physical activity in prevention and treatment of the metabolic syndrome. Appl Physiol Nutr Metab. 2007;32(1):76-8 : 17332786 www.ncbi.nih.gov/pubmed 177332786 Jermendy, G., Littvay, L., Steinbach, R., Jermendy, A., Tarnoki, A., Tarnoki, D., Metneki and Osztovits, J. (2011). Heritability of the risk factors characteristic for the metabolic syndrome: a twin study.[Article in Hungarian] Fővárosi Bajcsy-Zsilinszky Kórház III. Belgyógyászati Osztály Budapest Maglódi út 89-91. 1106. http:// www.ncbi.nlm.nih.gov/pubmed/21803723 Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Page 7 Vol. XXIII No. 2 • Fall 2011 • NYS Psychologist
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2011 â¢ NYS Psychologist - New York State Psychological Association