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Background Candidates for bariatric surgery frequently have co-morbid psychiatric problems. Methods This study investigated the course and the prognostic significance of preoperative and postoperative anxiety and depressive disorders in 107 extremely obese bariatric surgery patients in a prospective design with face-to-face interviews (SCID) conducted prior to the surgery and postoperatively after 6–12 months and 24–36 months. Results The point prevalence of depressive disorders but not of anxiety disorders decreased significantly after surgery. Preoperative depressive disorders predicted depressive disorders 24–36 months but not 6–12 months after surgery, whereas preoperative anxiety significantly predicted postoperative anxiety disorders at both follow-up time points. Preoperative lifetime and current depressive disorders were unrelated to postoperative weight loss whereas preoperative lifetime, but not current anxiety disorders were of negative prognostic value for postoperative weight loss. Patients with both depressive and anxiety disorders at baseline (current and lifetime) lost significantly less weight after surgery. Postoperative anxiety disorder was not associated with the degree of weight loss at any follow-up time-point; however postoperative depressive disorder was negatively associated with weight loss at the 24–36 month follow-up assessment point. Limitations Missing data, limited statistical power, self-reported height and weight are the limitations of this study. Conclusions As opposed to anxiety disorders, the point prevalence of depressive disorders decreased significantly after bariatric surgery. However, the presence of depressive disorders after bariatric surgery significantly predicted attenuated post-surgical improvements and may signal a need for clinical attention.

OBJECTIVE: To evaluate the psychometric properties of a German version of the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire. METHOD: IWQOL-Lite scores were obtained from 351 overweight/obese individuals and 127 lean adult volunteers. In addition, a subgroup of 126 obese subjects completed also the German versions of the 36-item short-form health survey (SF-36), the Beck Depression Inventory (BDI), the Eating Disorder Examination-Questionnaire (EDE-Q), and the German validated version of the Three-Factor Eating Questionnaire (TFEQ). RESULTS: The German version of the IWQOL-Lite has psychometric properties comparable to those found for the original version and demonstrates high internal consistency and excellent construct validity. Furthermore, the German IWQOL-Lite clearly discriminates between groups based on BMI on all subscales and the total score. CONCLUSION: The results of the present study suggest that the German IWQOL-Lite is a psychometrically validated instrument with which to measure weight-specific health related quality of life.

The goal of the study was to determine the concordance between mental disorder assessed during clinical evaluation and those independently obtained by a SCID interview in morbidly obese patients prior to bariatric surgery. In 116 patients a SCID interview was conducted. The agreement was moderate for any current diagnosis (kappa 0.43) current affective disorder (kappa 0.41) and current eating disorders (kappa 0.47). For current anxiety disorders agreement was poor wit a kappa of 0.11. For anxiety disorders and eating disorders the use of SCID resulted in more diagnoses than did standard clinical evaluation. Generally, the SCID produced more current axis 1 diagnoses than the clinical evaluation. When conducting a clinical evaluation prior to bariatric surgery a structured clinical interview should be used to assess mental co-mobidity.

Objective This study aimed to assess the impact of mental disorders on weight loss maintenance among initially successful weight losers who participated in a very-low-calorie diet program. Method A total of 251 obese individuals were assessed in a prospective longitudinal study over a period of 4 years. Mental disorders and eating patterns were assessed by structured interviews at baseline and by standardized questionnaires at baseline ( T 1 ), after 1 year ( T 2 ) and on 3-year follow-up ( T 3 ). Analyses were performed with an intention-to-treat method. Results Based on the intention-to-treat sample, 166 successful weight losers at T 2 (weight loss ≥10%) were identified. Of those, 47 (28.3%) maintained a weight loss of ≥5% of their pretreatment weight, whereas 119 (71.7%) maintained a loss of less than 5% of their pretreatment weight at T 3 . History of substance abuse/dependence disorder and grazing prior to treatment increased the likelihood of successful weight loss maintenance. High levels of cognitive control, low levels of disinhibition on 3-year follow-up and initial body mass index also were associated with successful weight loss maintenance. Conclusion Strategies that helped individuals overcome earlier mental disorders might help to establish better self-regulation and maintain high cognitive control of eating and subsequently increase the possibility of maintaining weight loss in the long run.

Objective To investigate the prevalence of Axis I psychopathology in bariatric surgery candidates and to compare our results with the findings of the few studies published thus far. Method Structured clinical interviews (SCID) were conducted in 146 consecutive bariatric surgery candidates [71.9% women; mean age: 38.7 years (S.D.=10.0); mean BMI: 49.3 kg/m2 (S.D.=7.8)] between September 2004 and January 2007 at the University Hospital of Erlangen. Assessments were administered independently of the preoperative screening and approval process. Results The overall prevalence of current Axis I disorders was 55.5%; 72.6% had a lifetime history of at least one Axis I disorder. Axis I psychopathology was related to gender (with women reporting higher prevalence rates) and was positively associated with a lifetime history of any eating disorder. We compared our results with the findings of the three published studies having used structured clinical interviews to assess psychiatric comorbidity in bariatric surgery candidates. The authors provide an overview of evidence so far and highlight some details in the assessment and comparisons of different samples in different countries. Conclusion About one half of the bariatric surgery candidates in Germany presented with a current Axis I disorder. Prevalence rates reported in the literature so far are based on different premises. Details for example about the evaluation should be taken into account when interpreting the results.

PURPOSE In clinical practice it is often debated if problematic eating behavior should be considered as a contraindication for bariatric surgery. RESULTS Even though there is clear evidence for a high prevalence rate of abnormal eating behavior such as binge eating, sweet eating, and night eating in morbidly obese patients prior to bariatric surgery, preoperative abnormal eating behavior does not seem to be a predictor for the postoperative weight course. CONCLUSION There is currently sufficient evidence that mental disorders including eating disorders and abnormal eating behavior have less influence on the postoperative course in morbidly obese patients after bariatric surgery than might be expected.

Trotz des wachsenden Bewusstseins, dass psychologische Betreuung zur Optimierung des Diabetes-Selbstmanagements der Patienten notwenig ist gibt es Probleme bei der Interpretation der aktuellen Datenlage und Probleme bei der Ubernahme der Erkenntnisse in den klinischen Alltag. Die besten Wirksamkeitsnachweise wurden fur die Techniken der kognitiven Verhaltenstherapie, vermittelt von erfahrenen Therapeuten, sowie fur familienbasierte Interventionen bei Kindern und Heranwachsenden gefunden. In den nachsten Jahren sollte eine Kombination von qualitativer und quantitativer Forschung helfen, die Techniken weiter zu verfeinern und genau zu bestimmen, welche Intervention fur welchen Patienten mit welchem Therapieziel am besten wirksam ist.

Compulsive buying is an excessive behavior that has begun to receive attention from researchers in recent years. The current study provides an overview of research on compulsive buying and examines the psychiatric co-morbidity in a German female treatment seeking compulsive buying sample in comparison with age and gender-matched normal buying control groups. Thirty women suffering from compulsive buying disorder, 30 community controls, and 30 bariatric surgery candidates were assessed with the German versions of the Structured Clinical Interview for DSM-IV diagnoses (SCID). Women with compulsive buying disorder showed significantly higher prevalence rates of affective, anxiety, and eating disorders compared to community controls, and suffered significantly more often from affective and anxiety disorders compared to bariatric surgery candidates. The compulsive buying group presented with the highest rates of personality disorders, most commonly avoidant, depressive, obsessive-compulsive, and borderline personality disorder, and reported the highest prevalence rates of other impulse control disorders, especially for intermittent explosive disorder. The findings suggest an elevated psychiatric co-morbidity in patients with compulsive buying disorder.

In the first description of the night eating syndrome (NES) 1955 by Stunkard et al. the criteria included (1) consumption of at least 25% of the total calories for the day after the evening meal, (2) sleeplessness, at least until midnight more than one half of the time and (3) morning anorexia with negligible food intake at breakfast. Further studies altered these criteria step by step, without ever relating to the changes already made by other authors. So today our knowledge about NES and its related features is based on an amazing variety of constructs merely referred to by the same term. However, there seems to be an agreement about a higher prevalence of the NES in overweight and obese treatment seeking samples. The relationship between NES, body weight and a possible influence of NES on overweight and obesity remains unclear and needs to be further examined. In addition to the research activities regarding NES as a possible eating disorder, sleep disorder specialists showed a growing interest in patients with sleeplessness and nocturnal eating episodes. New definitions were developed: the "night eating/drinking syndrome" (synonymous: NES), a disorder occurring mainly in infancy and early childhood but also seen in adults. Today the less restrictive concept "sleep related eating disorder" (SRED) eliminated the NES-concept, but also states a sleep disorder that is not clearly distinguishable from NES described by several authors as a possible eating disorder. In psychosomatic research the criteria of nocturnal eating (recurrent awakenings & getting up to eat) was included in the NES by a growing number of authors in the last 15 years. Based on this diversity of diagnostic criteria in two different fields of expertise a lot of research was done do investigate the prevalence of NES and further describe patients with NES. Today a meaningful summary of these findings is not possible and despite a growing number of research in NES and obesity the clinical relevance of the concept NES remains unclear. In this article diagnostic criteria so far will be summarized and a rough differentiation of NES to related constructs and disorders will be given.

ZusammenfassungNach heutiger Datenlage kann man bei Patienten, die Behandlung aufgrund ihres Übergewichts suchen, von einer deutlich erhöhten psychischen Komorbidität im Vergleich zu den Prävalenzraten in der Allgemeinbevölkerung ausgehen. Entgegen früherer Befunde finden sich in neueren bevölkerungsbasierten Untersuchungen deutliche Hinweise darauf, dass adipöse Personen in der Allgemeinbevölkerung höhere Prävalenzraten an affektiven Störungen und Angststörungen zeigen als normalgewichtige Personen. Dies trifft vor allem auf Frauen zu und hängt außerdem mit der Schwere des Übergewichts zusammen (vor allem Adipositas Grad II und III).

Nocturnal eating is common among obese patients prior to bariatric surgery. Little is known about the relationship between nocturnal eating, eating-related and general psychopathology, and health-related quality of life (HRQOL). A group of 148 obese patients (mean BMI 49.3, SD 7.8) prior to bariatric surgery were investigated. We compared patients who reported nocturnal eating at least once in the last 4 weeks with patients without nocturnal eating episodes. Patients completed a battery of questionnaires assessing eating related and general psychopathology and quality of life. Twenty-nine (19.6 %) patients reported nocturnal eating (eating after waking up at night) during the last 28 nights, men and women did not differ in frequency of nocturnal eating. Patients with nocturnal eating reported a significantly higher BMI (kg/m 2 ), more feelings of hunger, and significantly more impairment in the mental aspects of HRQOL. The other measures of HRQOL showed only minor differences. Measures of general psychopathology (depression and anxiety) also differed significantly with nocturnal eating patients reporting significantly more impairment. Binge eating disorder and nocturnal eating showed no association.

The objective was to compare two methods for assessing eating disorder psychopathology in pre-gastric banding surgery patients. 93 morbidly obese patients were assessed with the German versions of the Eating Disorder Examination (EDE) and the Eating Disorder Examination-Questionnaire (EDE-Q). The EDE and the EDE-Q were significantly correlated on the restraint, eating concern, shape concern and weight concern subscales, although the questionnaire scores were significantly higher. Frequencies of objective bulimic episodes were slightly but significantly correlated and the difference between EDE and EDE-Q was not significant. When participants were classified as binge eaters based on a cut-off of two binges per week on average in the last 28 days, the concordance between EDE and EDE-Q was moderate. The EDE-Q seems well-suited in assessing eating disorder psychopathology in obese pre-gastric banding patients. Yet, for the assessment of binge eating episodes the use of the questionnaire alone can not be recommended.

Die Kasuistik beschreibt eine 43-jahrige Patientin, die sich 5 Jahre nach Magenbandimplantation mit einer bulimischen Essstorung und einer depressiven Episode in der Psychosomatik vorstellte. In der Exploration wurde deutlich, dass sie bereits seit dem fruhen Erwachsenenalter die Kriterien fur eine non-purging Bulimia nervosa (BN) erfullte. Eine psychische Begutachtung vor der Operation fand jedoch nie statt. Nach Magenbandimplantation war die Essstorung ohne Unterbrechung weiterhin vorhanden, hat aber, auch durch die chirurgisch bedingte Restriktion, ihr Bild verandert. Es kamen anorektische Symptome hinzu, wie etwa die Unzufriedenheit mit dem Gewicht trotz eines Gewichtsverlusts in einen fast anorektischen Bereich mit einem minimalen BMI von 18.4 kg/m2. Zudem entwickelte die Patientin postoperativ ein bulimisches Kompensationsverhalten im Sinne von selbst induziertem Erbrechen mit dem Ziel, eine raschere und ausgepragtere Gewichtsreduktion zu erreichen. Die Patientin hat diese Verhaltensweisen lange Zeit verheimlicht. Die Patientin litt auserdem an einer rezidivierenden depressiven Storung, einer haufigen Komorbiditat bei bulimischen Patientinnen. Die Essstorung sowie die depressive Episode konnten erfolgreich mit Therapieansatzen behandelt werden, die sich bei BN und Depression generell bewahrt haben – storungsorientierte kognitive Verhaltenstherapie und Serotonin- Wiederaufnahmehemmer. Der Fallbericht macht deutlich, dass vor chirurgischer Adipositastherapie eine psychische Evaluation durchgefuhrt werden sollte und dass postoperativ bei Bedarf rasch und uber einen ausreichend langen Zeitraum psychische Betreuung angeboten werden sollte.

c Summary Objective: To investigate the impact of current mental disorders on weight loss with special consideration of depressive and/or anxiety disorders as well as binge eat- ing behavior in obese individuals undergoing different weight loss treatments. Methods: Three different sam- ples of obese individuals were investigated in a prospec- tive, longitudinal study: participants in a conventional weight loss treatment program (CONV TREAT; n = 250), obesity surgery patients (OBES SURG; n = 153), and obese control individuals (OC; n = 128). Current men- tal disorders and BMI were assessed at baseline and at 4-year follow-up. Results: OBES SURG patients with a depressive and/or anxiety disorder lost significantly less weight compared with those without a comorbid mental diagnosis. This result was not detected for CONV TREAT participants. A trend to gain weight was seen in OC participants with a depressive and/or anxiety disorder, whereas OC participants without current mental disor- ders at baseline lost some weight. Binge eating behavior at baseline did not predict weight loss at 4-year follow- up. Conclusions: These results underline the importance of addressing current depressive and anxiety disorders in obese patients, especially when such patients are un- dergoing obesity surgery.

The goal of the study was to determine the concordance between mental disorder assessed during clinical evaluation and those independently obtained by a SCID interview in morbidly obese patients prior to bariatric surgery. In 116 patients a SCID interview was conducted. The agreement was moderate for any current diagnosis (kappa 0.43) current affective disorder (kappa 0.41) and current eating disorders (kappa 0.47). For current anxiety disorders agreement was poor wit a kappa of 0.11. For anxiety disorders and eating disorders the use of SCID resulted in more diagnoses than did standard clinical evaluation. Generally, the SCID produced more current axis 1 diagnoses than the clinical evaluation. When conducting a clinical evaluation prior to bariatric surgery a structured clinical interview should be used to assess mental co-mobidity.

The aim of the study was to explore the nature and extent of the association between night eating, other forms of disordered eating and obstructive sleep apnea (OSAS).Eighty-one participants (20 women and 61 men), mean age 53.7 years diagnosed with OSAS were assessed prior to starting treatment. Using a cut-off of > or =25 on the Night Eating Questionnaire (NEQ), 8.6% of the participants screened positive for night eating syndrome (NES). In addition, 7.5% met criteria for a daytime eating disorder. NES was significantly associated with diagnoses of depression, anxiety and eating disorders and was significantly correlated with an impairment of mental quality of life. No associations were found between NES and gender, BMI and the severity of the OSAS. NES does not appear to be closely linked to OSAS; however, in patients with OSAS and NES a significant co-morbidity with psychiatric disorders can be expected which might require additional treatment.

Compulsive buying is an excessive behavior that has begun to receive attention from researchers in recent years. The current study provides an overview of research on compulsive buying and examines the psychiatric co-morbidity in a German female treatment seeking compulsive buying sample in comparison with age and gender-matched normal buying control groups. Thirty women suffering from compulsive buying disorder, 30 community controls, and 30 bariatric surgery candidates were assessed with the German versions of the Structured Clinical Interview for DSM-IV diagnoses (SCID). Women with compulsive buying disorder showed significantly higher prevalence rates of affective, anxiety, and eating disorders compared to community controls, and suffered significantly more often from affective and anxiety disorders compared to bariatric surgery candidates. The compulsive buying group presented with the highest rates of personality disorders, most commonly avoidant, depressive, obsessive-compulsive, and borderline personality disorder, and reported the highest prevalence rates of other impulse control disorders, especially for intermittent explosive disorder. The findings suggest an elevated psychiatric co-morbidity in patients with compulsive buying disorder.

In the first description of the night eating syndrome (NES) 1955 by Stunkard et al. the criteria included (1) consumption of at least 25% of the total calories for the day after the evening meal, (2) sleeplessness, at least until midnight more than one half of the time and (3) morning anorexia with negligible food intake at breakfast. Further studies altered these criteria step by step, without ever relating to the changes already made by other authors. So today our knowledge about NES and its related features is based on an amazing variety of constructs merely referred to by the same term. However, there seems to be an agreement about a higher prevalence of the NES in overweight and obese treatment seeking samples. The relationship between NES, body weight and a possible influence of NES on overweight and obesity remains unclear and needs to be further examined. In addition to the research activities regarding NES as a possible eating disorder, sleep disorder specialists showed a growing interest in patients with sleeplessness and nocturnal eating episodes. New definitions were developed: the "night eating/drinking syndrome" (synonymous: NES), a disorder occurring mainly in infancy and early childhood but also seen in adults. Today the less restrictive concept "sleep related eating disorder" (SRED) eliminated the NES-concept, but also states a sleep disorder that is not clearly distinguishable from NES described by several authors as a possible eating disorder. In psychosomatic research the criteria of nocturnal eating (recurrent awakeningsgetting up to eat) was included in the NES by a growing number of authors in the last 15 years. Based on this diversity of diagnostic criteria in two different fields of expertise a lot of research was done do investigate the prevalence of NES and further describe patients with NES. Today a meaningful summary of these findings is not possible and despite a growing number of research in NES and obesity the clinical relevance of the concept NES remains unclear. In this article diagnostic criteria so far will be summarized and a rough differentiation of NES to related constructs and disorders will be given.

Der uberwiegende Anteil der Patienten, die sich heute zur ambulanten Behandlung vorstellen, erfullt nicht die vollen Kriterien einer klassischen Essstorung. Atypische oder nicht naher bezeichnete Essstorungenkonnen daher nicht als „Restkategorie“ angesehen werden, stellen sie doch bei exakter Diagnosestellung die haufigste Essstorungskategorie dar. Sie beinhalter eine auserst heterogene Gruppe an Storungsbildern. Experten stimmen darin uber-ein, dass die Anorexia nervosa (AN) und die Bulimia nervosa (BN) nur die Spitze des Eisbergs innerhalb eines weiten Essstorungsspektrums darstellen. In der Forschung werden jedoch uberwiegend Patientinnen mit den Vollbildern einer Anorexie oder Bulimie untersucht. Unser Wissen uber atypische oder nicht naher bezeichnete Essstorungen ist daher begrenzt.

Nocturnal eating is common among obese patients prior to bariatric surgery. Little is known about the relationship between nocturnal eating, eating-related and general psychopathology, and health-related quality of life (HRQOL). A group of 148 obese patients (mean BMI 49.3, SD 7.8) prior to bariatric surgery were investigated. We compared patients who reported nocturnal eating at least once in the last 4 weeks with patients without nocturnal eating episodes. Patients completed a battery of questionnaires assessing eating related and general psychopathology and quality of life. Twenty-nine (19.6%) patients reported nocturnal eating (eating after waking up at night) during the last 28 nights, men and women did not differ in frequency of nocturnal eating. Patients with nocturnal eating reported a significantly higher BMI (kg/m(2)), more feelings of hunger, and significantly more impairment in the mental aspects of HRQOL. The other measures of HRQOL showed only minor differences. Measures of general psychopathology (depression and anxiety) also differed significantly with nocturnal eating patients reporting significantly more impairment. Binge eating disorder and nocturnal eating showed no association.

The objective was to compare two methods for assessing eating disorder psychopathology in pre-gastric banding surgery patients. 93 morbidly obese patients were assessed with the German versions of the Eating Disorder Examination (EDE) and the Eating Disorder Examination-Questionnaire (EDE-Q). The EDE and the EDE-Q were significantly correlated on the restraint, eating concern, shape concern and weight concern subscales, although the questionnaire scores were significantly higher. Frequencies of objective bulimic episodes were slightly but significantly correlated and the difference between EDE and EDE-Q was not significant. When participants were classified as binge eaters based on a cut-off of two binges per week on average in the last 28 days, the concordance between EDE and EDE-Q was moderate. The EDE-Q seems well-suited in assessing eating disorder psychopathology in obese pre-gastric banding patients. Yet, for the assessment of binge eating episodes the use of the questionnaire alone can not be recommended.