Obesity research & clinical practice, Jan 16, 2015
This study aimed to determine whether motivational interviewing improved retention and/or outcome... more This study aimed to determine whether motivational interviewing improved retention and/or outcome in cognitive behaviour therapy for overweight and obese adolescents (M=14.4, SD=2.0; 52% female). The first 23 participants were allocated to a standard semi-structure assessment interview, the remaining 19 to a motivational interview, prior to commencing the intervention. The groups did not differ at baseline or on anthropometric (weight, BMI, BMI-z-score, waist circumference, waist-hip or waist-height ratio), body composition (percent body fat, fat mass, lean mass) or attrition measures post-treatment or post-maintenance (p>.01). MI did not improve retention or outcome of cognitive behaviour therapy for adolescent overweight and obesity.
The high attrition rates in obesity interventions are associated with poorer weight loss and main... more The high attrition rates in obesity interventions are associated with poorer weight loss and maintenance for the individual and poorer overall treatment effectiveness and cost-effectiveness for the treatment provider. Increased knowledge about factors associated with attrition can facilitate the identification of individuals at risk of drop-out and inform treatment program improvements with the aim of maximising treatment retention. To date, a relatively small body of literature has explored attrition from weight-loss interventions using two methods of attrition assessment: identification of pre-treatment predictors of attrition and eliciting post-treatment reasons for attrition. A range of attrition rates have been reported and no reliable or consistent predictors of attrition have been found. It is unknown whether the lack of consistent findings reflects population or treatment differences, or if the discrepant findings simply reflect differences in definition and measurement of attrition. Further research is required to address these limitations. There is a need for a recognised definition of obesity treatment attrition, the consideration of predictors that are theoretically and empirically associated with attrition, the development of a well-validated and standardised measure of barriers to attendance, and assessment of both treatment completers and drop-outs. Understanding the factors that influence attrition can be used to inform the modification of treatment programs and to target those most at risk of drop-out so as to maximise the success of obesity interventions.
The American Journal of Clinical Nutrition, May 1, 2008
Background: Cognitive behavioral therapy (CBT) teaches behavioral and cognitive strategies that f... more Background: Cognitive behavioral therapy (CBT) teaches behavioral and cognitive strategies that focus on achieving and maintaining lifestyle changes. Objective: We examined the effectiveness of a CBT program (CHOOSE HEALTH) for improving body composition, diet, and physical activity in overweight and obese adolescents. Design: Adolescents [16 male, 31 female; aged 14.5 Ȁ 1.6 y; body mass index (BMI; in kg/m 2 ) 30.9 Ȁ 4.2] were block-matched into 2 groups by age, sex, Tanner stage, BMI, and hip and waist circumferences and were randomly assigned to CBT or no treatment (control). CBT consisted of 10 weekly sessions, followed by 5 fortnightly telephone sessions. Results: Compared with the control, over 20 wk, CBT improved (significant group ҂ time interactions) BMI (CBT, Ҁ1.3 Ȁ 0.4; control, 0.3 Ȁ 0.3; P ҃ 0.007), weight (CBT, Ҁ1.9 Ȁ 1.0 kg; control, 3.8 Ȁ 0.9 kg; P ҃ 0.001), body fat (CBT, Ҁ1.5 Ȁ 0.9 kg; control, 2.3 Ȁ 1.0 kg; P ҃ 0.001), and abdominal fat (CBT, Ҁ124.0 Ȁ 46.9 g; control, 50.1 Ȁ 53.5 g; P ҃ 0.008). CBT showed a greater reduction in intake of sugared soft drinks as a percentage of total energy (CBT, Ҁ4.0 Ȁ 0.9%; control, Ҁ0.3 Ȁ 0.9%; P ҃ 0.005 for group ҂ time interaction), which was related to reductions in weight (r ҃ 0.48, P ҃ 0.04), BMI (r ҃ 0.53, P ҃ 0.02), and waist circumference (r ҃ 0.54, P ϭ 0.02). Physical activity did not change significantly. Conclusions: A 10-wk CBT program followed by 10 wk of fortnightly phone contact improved body composition in overweight and obese adolescents. Changes in soft drink consumption may have contributed to this benefit.
Anorexia Nervosa (AN) is a severe and potentially chronic disorder characterised by low body weig... more Anorexia Nervosa (AN) is a severe and potentially chronic disorder characterised by low body weight and persistent behaviours that interfere with weight gain. Individuals with AN are often difficult to engage in treatment and display high rates of drop out. The Collaborative Case Conceptualisation (CCC) assessment approach was developed to target proposed AN maintaining factors with the aim of improving treatment motivation and engagement and consequently treatment outcomes in individuals with AN. The proposed study aims to examine the efficacy of CCC in improving a range of outcomes including Body Mass Index, eating disorder symptomatology, general psychopathology, quality of life and future treatment motivation and participation. Potential mediators will also be explored. Thirty-two participants will be recruited from Melbourne based specialist eating disorder services, community and university clinics, and health practitioner networks. Participants will be randomised to three individual sessions of either CCC or a standardised assessment condition (assessment as usual; AAU). The AAU assessment will include; a mental status examination, assessment of current disordered eating behaviours and cognitions, assessment of clinical history, and a physical examination. The CCC condition combines the AAU assessment components with shared collaborative formulation and tailored psychoeducation highlighting the consequences of the eating disorder on wellbeing and future goals in a supportive and motivating way. This intervention may provide an effective and feasible method of improving treatment engagement and outcomes for individuals suffering from AN, with the ultimate outcome of reducing the negative biopsychosocial impacts of this potentially severe and chronic disorder.
Adolescent obesity is a significant global health challenge and severely obese adolescents common... more Adolescent obesity is a significant global health challenge and severely obese adolescents commonly experience serious medical and psychosocial challenges. Consequently, severe adolescent obesity is increasingly being treated surgically. The limited available research examining the effectiveness of adolescent bariatric surgery focuses primarily on bio-medical outcomes. There is a need for a more comprehensive understanding of the behavioural, emotional and social factors which affect adolescents' and parents' experience of weight loss surgery. Patient and parents' perspectives of adolescent LAGB were examined using a qualitative research methodology. Individual, semi-structured interviews were conducted with eight adolescent patients and five parents. Thematic analysis was used to identify key themes in the qualitative data. Patients and parents generally considered adolescent laparoscopic adjustable gastric banding (LAGB) to be a life-changing experience, resulting in p...
Faculty of Health Institute of Health and Biomedical Innovation School of Exercise Nutrition Sciences, Mar 3, 2009
Objective: This review addresses the effect of overweight and obese weight status on pediatric he... more Objective: This review addresses the effect of overweight and obese weight status on pediatric health-related quality of life (HRQOL). Method: Web of Science, Medline, CINAHL, Cochrane Library, EMBASE, AMED and PubMed were searched for peer-reviewed studies in English reporting HRQOL and weight status in youth (o21 years), published before March 2008. Results: Twenty-eight articles were identified. Regression of HRQOL against body mass index (BMI) using pooled data from 13 studies utilizing the Pediatric Quality of Life Inventory identified an inverse relationship between BMI and pediatric HRQOL (r ¼ À0.7, P ¼ 0.008), with impairments in physical and social functioning consistently reported. HRQOL seemed to improve with weight loss, but randomized controlled trials were few and lacked long-term follow-up. Conclusions: Little is known about the factors associated with reduced HRQOL among overweight or obese youth, although gender, age and obesity-related co-morbidities may play a role. Few studies have examined the differences in HRQOL between community and treatment-seeking samples. Pooled regressions suggest pediatric self-reported HRQOL can be predicted from parent proxy reports, although parents of obese youths tend to perceive worse HRQOL than children do about themselves. Thus, future research should include both pediatric and parent proxy perspectives.
This study aimed to test the hypothesis that the amount of weight lost on a mandatory 2-week pre-... more This study aimed to test the hypothesis that the amount of weight lost on a mandatory 2-week pre-operative very-low-calorie diet (VLCD) would predict the longer-term outcomes of laparoscopic adjustable gastric banding (LAGB). All patients treated with a primary LAGB from 21 October 2008 until 30 June 2010, who were prescribed a 2-week pre-operative VLCD, have been included in the study. Patient age, weight, BMI and excess weight (defined as weight above a BMI of 25) were extracted on the day of first visit, day of surgery and at the post-operative visits at 3, 12 and 24 months. From these data, percent excess weight loss (EWL) was calculated and compared at all time points. The weight loss achieved on a mandatory 2-week pre-operative diet did not predict weight outcomes at 2 years (r = -0.008; p = 0.931). Using multivariate analysis, the best predictor of 24-month percent EWL was percent EWL at 3 months post operation (sr(2) = 0.34; p = 0.003). Results from a pre-operative diet should not be used to predict the ultimate outcome of bariatric surgery. The weight loss at 3 months following LAGB was a strong predictor of longer-term outcomes. There may be potential for improving longer-term results with LAGB by better supporting patients who are not achieving good weight loss at this early time point.
The Beck Depression Inventory (BDI) is one of the most commonly used instruments to assess depres... more The Beck Depression Inventory (BDI) is one of the most commonly used instruments to assess depression in persons with obesity. While it has been validated in normal and psychiatric populations, in obese populations, its validity remains uncertain. This study aimed to investigate the validity and reliability of the BDI-IA and BDI-II in severely obese bariatric surgery candidates. Consecutive new candidates at a bariatric surgery clinic were invited to participate in the study by their consulting surgeon. All candidates were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I); 118 completed the BDI-IA and 83 completed the BDI-II. Two hundred one patients (response rate, 88 %) participated in the study. The current sample (82 % female) had an average body mass index of 42.83 ± 6.34 and an average age of 45 ± 12 years. Based on the SCID-I, 54 candidates (26.9 %) met the criteria for a mood disorder, with 37 meeting the criteria for current major depressive disorder. Individuals diagnosed with a clinical mood disorder had significantly higher scores on the BDI (BDI-IA, 23.59 ± 9.69 vs. 12.76 ± 8.29; BDI-II, 22.93 ± 5.22 vs. 11.25 ± 8.44). Our results indicated that, as a screening tool for a clinical mood disorder, the BDI-II had an optimal cutoff of 13, with a sensitivity of 100 and specificity of 67.75. Results indicated that the BDI-IA should not be used as a tool to measure depressive symptomatology in obese bariatric surgery candidates. No cutoff was identified with adequate sensitivity and specificity, and over 20 % of patients were misclassified. As a screening tool for a clinical mood disorder, the BDI-II was adequate; however, prevalence rates were significantly overestimated.
Obesity is one of the leading causes of preventable diseases and disability worldwide, and depres... more Obesity is one of the leading causes of preventable diseases and disability worldwide, and depression is among the leading causes of burden of disease. Both disorders are increasingly prevalent and comorbid. This comorbidity compounds associated health. While there is consistent evidence of a bidirectional obesity depression relationship, little is known about the biopsychosocial variables associated with this relationship. A systematic review was undertaken to identify variables associated with the relationship between obesity (Body mass index > 30 kg m(-2) ) and depression. Forty-six studies were identified. Obesity, educational attainment, body image, binge eating, physical health, psychological characteristics and interpersonal effectiveness were consistently associated with the relationship between obesity and depression. The current review identified potential biopsychosocial variables associated with the relationship between obesity and depression. This knowledge can inform future research examining moderators, mediators and mechanisms of the relationship between obesity and depression. Improved understanding of this relationship will inform identification, prevention and intervention efforts.
Attendance and completion of weight loss intervention is associated with better weight loss outco... more Attendance and completion of weight loss intervention is associated with better weight loss outcomes; however, attrition is neither consistently reported nor comprehensively explored in the weight loss literature. A systematic review was undertaken to identify factors associated with attrition in weight loss interventions involving overweight or obese (body mass index ≥ 25) adults (18-65 years). Sixty-one studies published before May 2011 and addressing factors associated with weight loss programme attrition were identified. Conclusions were limited by the large number of variables explored, the small number of studies exploring each variable, the large variety of study settings and methodologies used, the inconsistent reporting of results, and the conflicting findings across studies. A consistent set of predictors has not yet been identified. The majority of studies relied on pre-treatment routinely collected data rather than variables selected because of their theoretical and/or empirical relationship with attrition. However, psychological and behavioural patient factors and processes associated with the treatment were more commonly associated with attrition than patient background characteristics. Future research should consider theoretically grounded social-psychological and behavioural processes as potential predictors of dropout. Identification of patients at risk of dropout will contribute to both the effectiveness and the cost-effectiveness of weight loss interventions.
... behaviour therapy, which indicates that both quantity and quality of homework is important to... more ... behaviour therapy, which indicates that both quantity and quality of homework is important to treatment outcome (Kazantzis, Deane & Ronan, 2004; Kazantzis, MacEwan & Dattilio, 2005). Mary Sandilands, Leah Brennan, Jeff Walkley, Steve F. Fraser, and Kate Greenway 104 ...
ABSTRACT Aim: This paper explored the relationship between maternal controlling feeding behaviour... more ABSTRACT Aim: This paper explored the relationship between maternal controlling feeding behaviours and child eating and weight in preschool-aged children. Methods: Ninety mothers of 2- to 5-year-old children (M = 3.48, SD = 0.84, 54.4% males) completed self-report measures assessing maternal controlling feeding behaviours, child eating patterns and weight. Results: Univariate analyses indicated that child food neophobia was associated with authoritarian feeding (r= 0.29), pressure to eat (r= 0.28) and restriction (r= 0.34). Child food pickiness was associated with authoritarian feeding (r= 0.35). No association was found between maternal feeding strategies and child weight. Multivariate regression analyses indicated that authoritarian feeding, restriction and pressure to eat were significantly associated with the variance in child food neophobia (adjusted R2= 12.6%) and pickiness (adjusted R2= 12.0%). Conclusions: The findings suggest that maternal control in feeding is associated with undesirable eating patterns in preschool-aged children. Interventions targeting reduction in maternal controlling feeding may promote desirable eating patterns in preschool-aged children.
While evidence regarding associations between weight stigma and biopsychosocial outcomes is accum... more While evidence regarding associations between weight stigma and biopsychosocial outcomes is accumulating, outcomes are considered in isolation. Thus, little is known about their complex relationships. This article extends existing work by systematically reviewing the biopsychosocial consequences of stigma in adults with overweight/obesity. Articles were identified through Medline, CINAHL, PsycINFO, Embase, Web of Science, and Cochrane databases. Independent extraction of articles was conducted using predefined data fields, including data on biopsychosocial correlates in each study. Twenty-three studies published from 2001 and addressing correlates of stigma in adults with overweight/obesity (body mass index ≥25 kg m(-2); 18-65 years) were identified. Numerous biopsychosocial correlates of weight stigma were studied, particularly in treatment-seeking individuals. Available research shows that weight stigma is consistently associated with medication non-adherence, mental health, anxiety, perceived stress, antisocial behavior, substance use, coping strategies, and social support. Biopsychosocial correlates were not considered in combination in research. Psychological correlates were well documented in comparison to biological and social correlates for each weight stigma type. There were some indications that associations are stronger once stigma is internalized. While there is evidence for biopsychosocial correlates of weight stigma, these are not considered in combination in research; thus their inter-relationships are unknown. Conclusions from the review are limited by this and the small number of studies, types of designs, and variables considered.
Cognitive behavioural models suggest that individuals abandon their weight loss efforts because t... more Cognitive behavioural models suggest that individuals abandon their weight loss efforts because they fail to achieve their weight loss goal, their perceived benefits of weight loss (primary goals), or both. There are currently no published tools available to adequately ...
Economic evaluation is the systematic assessment of the costs and consequences of alternative cou... more Economic evaluation is the systematic assessment of the costs and consequences of alternative courses of action. In health and healthcare, the results can be used to inform clinicians and policy makers about the relative cost-effectiveness of options under consideration [1]. Many economic evaluations are undertaken alongside randomised controlled trials (RCTs); the advantages of this approach are that i) prospective, accurate data can be collected on costs and effects and ii) appropriate outcome measures for use in economic evaluation can be chosen. The outcome of an economic evaluation is usually described as a ratio of the costs and effects – often called the incremental cost-effectiveness ratio (ICER). The ICER is determined by calculating the differences in the costs and effects of both intervention and control groups and dividing the former by the latter. In designing an economic evaluation, the important questions to resolve are: which costs should be included and which outco...
Obesity research & clinical practice, Jan 16, 2015
This study aimed to determine whether motivational interviewing improved retention and/or outcome... more This study aimed to determine whether motivational interviewing improved retention and/or outcome in cognitive behaviour therapy for overweight and obese adolescents (M=14.4, SD=2.0; 52% female). The first 23 participants were allocated to a standard semi-structure assessment interview, the remaining 19 to a motivational interview, prior to commencing the intervention. The groups did not differ at baseline or on anthropometric (weight, BMI, BMI-z-score, waist circumference, waist-hip or waist-height ratio), body composition (percent body fat, fat mass, lean mass) or attrition measures post-treatment or post-maintenance (p>.01). MI did not improve retention or outcome of cognitive behaviour therapy for adolescent overweight and obesity.
The high attrition rates in obesity interventions are associated with poorer weight loss and main... more The high attrition rates in obesity interventions are associated with poorer weight loss and maintenance for the individual and poorer overall treatment effectiveness and cost-effectiveness for the treatment provider. Increased knowledge about factors associated with attrition can facilitate the identification of individuals at risk of drop-out and inform treatment program improvements with the aim of maximising treatment retention. To date, a relatively small body of literature has explored attrition from weight-loss interventions using two methods of attrition assessment: identification of pre-treatment predictors of attrition and eliciting post-treatment reasons for attrition. A range of attrition rates have been reported and no reliable or consistent predictors of attrition have been found. It is unknown whether the lack of consistent findings reflects population or treatment differences, or if the discrepant findings simply reflect differences in definition and measurement of attrition. Further research is required to address these limitations. There is a need for a recognised definition of obesity treatment attrition, the consideration of predictors that are theoretically and empirically associated with attrition, the development of a well-validated and standardised measure of barriers to attendance, and assessment of both treatment completers and drop-outs. Understanding the factors that influence attrition can be used to inform the modification of treatment programs and to target those most at risk of drop-out so as to maximise the success of obesity interventions.
The American Journal of Clinical Nutrition, May 1, 2008
Background: Cognitive behavioral therapy (CBT) teaches behavioral and cognitive strategies that f... more Background: Cognitive behavioral therapy (CBT) teaches behavioral and cognitive strategies that focus on achieving and maintaining lifestyle changes. Objective: We examined the effectiveness of a CBT program (CHOOSE HEALTH) for improving body composition, diet, and physical activity in overweight and obese adolescents. Design: Adolescents [16 male, 31 female; aged 14.5 Ȁ 1.6 y; body mass index (BMI; in kg/m 2 ) 30.9 Ȁ 4.2] were block-matched into 2 groups by age, sex, Tanner stage, BMI, and hip and waist circumferences and were randomly assigned to CBT or no treatment (control). CBT consisted of 10 weekly sessions, followed by 5 fortnightly telephone sessions. Results: Compared with the control, over 20 wk, CBT improved (significant group ҂ time interactions) BMI (CBT, Ҁ1.3 Ȁ 0.4; control, 0.3 Ȁ 0.3; P ҃ 0.007), weight (CBT, Ҁ1.9 Ȁ 1.0 kg; control, 3.8 Ȁ 0.9 kg; P ҃ 0.001), body fat (CBT, Ҁ1.5 Ȁ 0.9 kg; control, 2.3 Ȁ 1.0 kg; P ҃ 0.001), and abdominal fat (CBT, Ҁ124.0 Ȁ 46.9 g; control, 50.1 Ȁ 53.5 g; P ҃ 0.008). CBT showed a greater reduction in intake of sugared soft drinks as a percentage of total energy (CBT, Ҁ4.0 Ȁ 0.9%; control, Ҁ0.3 Ȁ 0.9%; P ҃ 0.005 for group ҂ time interaction), which was related to reductions in weight (r ҃ 0.48, P ҃ 0.04), BMI (r ҃ 0.53, P ҃ 0.02), and waist circumference (r ҃ 0.54, P ϭ 0.02). Physical activity did not change significantly. Conclusions: A 10-wk CBT program followed by 10 wk of fortnightly phone contact improved body composition in overweight and obese adolescents. Changes in soft drink consumption may have contributed to this benefit.
Anorexia Nervosa (AN) is a severe and potentially chronic disorder characterised by low body weig... more Anorexia Nervosa (AN) is a severe and potentially chronic disorder characterised by low body weight and persistent behaviours that interfere with weight gain. Individuals with AN are often difficult to engage in treatment and display high rates of drop out. The Collaborative Case Conceptualisation (CCC) assessment approach was developed to target proposed AN maintaining factors with the aim of improving treatment motivation and engagement and consequently treatment outcomes in individuals with AN. The proposed study aims to examine the efficacy of CCC in improving a range of outcomes including Body Mass Index, eating disorder symptomatology, general psychopathology, quality of life and future treatment motivation and participation. Potential mediators will also be explored. Thirty-two participants will be recruited from Melbourne based specialist eating disorder services, community and university clinics, and health practitioner networks. Participants will be randomised to three individual sessions of either CCC or a standardised assessment condition (assessment as usual; AAU). The AAU assessment will include; a mental status examination, assessment of current disordered eating behaviours and cognitions, assessment of clinical history, and a physical examination. The CCC condition combines the AAU assessment components with shared collaborative formulation and tailored psychoeducation highlighting the consequences of the eating disorder on wellbeing and future goals in a supportive and motivating way. This intervention may provide an effective and feasible method of improving treatment engagement and outcomes for individuals suffering from AN, with the ultimate outcome of reducing the negative biopsychosocial impacts of this potentially severe and chronic disorder.
Adolescent obesity is a significant global health challenge and severely obese adolescents common... more Adolescent obesity is a significant global health challenge and severely obese adolescents commonly experience serious medical and psychosocial challenges. Consequently, severe adolescent obesity is increasingly being treated surgically. The limited available research examining the effectiveness of adolescent bariatric surgery focuses primarily on bio-medical outcomes. There is a need for a more comprehensive understanding of the behavioural, emotional and social factors which affect adolescents' and parents' experience of weight loss surgery. Patient and parents' perspectives of adolescent LAGB were examined using a qualitative research methodology. Individual, semi-structured interviews were conducted with eight adolescent patients and five parents. Thematic analysis was used to identify key themes in the qualitative data. Patients and parents generally considered adolescent laparoscopic adjustable gastric banding (LAGB) to be a life-changing experience, resulting in p...
Faculty of Health Institute of Health and Biomedical Innovation School of Exercise Nutrition Sciences, Mar 3, 2009
Objective: This review addresses the effect of overweight and obese weight status on pediatric he... more Objective: This review addresses the effect of overweight and obese weight status on pediatric health-related quality of life (HRQOL). Method: Web of Science, Medline, CINAHL, Cochrane Library, EMBASE, AMED and PubMed were searched for peer-reviewed studies in English reporting HRQOL and weight status in youth (o21 years), published before March 2008. Results: Twenty-eight articles were identified. Regression of HRQOL against body mass index (BMI) using pooled data from 13 studies utilizing the Pediatric Quality of Life Inventory identified an inverse relationship between BMI and pediatric HRQOL (r ¼ À0.7, P ¼ 0.008), with impairments in physical and social functioning consistently reported. HRQOL seemed to improve with weight loss, but randomized controlled trials were few and lacked long-term follow-up. Conclusions: Little is known about the factors associated with reduced HRQOL among overweight or obese youth, although gender, age and obesity-related co-morbidities may play a role. Few studies have examined the differences in HRQOL between community and treatment-seeking samples. Pooled regressions suggest pediatric self-reported HRQOL can be predicted from parent proxy reports, although parents of obese youths tend to perceive worse HRQOL than children do about themselves. Thus, future research should include both pediatric and parent proxy perspectives.
This study aimed to test the hypothesis that the amount of weight lost on a mandatory 2-week pre-... more This study aimed to test the hypothesis that the amount of weight lost on a mandatory 2-week pre-operative very-low-calorie diet (VLCD) would predict the longer-term outcomes of laparoscopic adjustable gastric banding (LAGB). All patients treated with a primary LAGB from 21 October 2008 until 30 June 2010, who were prescribed a 2-week pre-operative VLCD, have been included in the study. Patient age, weight, BMI and excess weight (defined as weight above a BMI of 25) were extracted on the day of first visit, day of surgery and at the post-operative visits at 3, 12 and 24 months. From these data, percent excess weight loss (EWL) was calculated and compared at all time points. The weight loss achieved on a mandatory 2-week pre-operative diet did not predict weight outcomes at 2 years (r = -0.008; p = 0.931). Using multivariate analysis, the best predictor of 24-month percent EWL was percent EWL at 3 months post operation (sr(2) = 0.34; p = 0.003). Results from a pre-operative diet should not be used to predict the ultimate outcome of bariatric surgery. The weight loss at 3 months following LAGB was a strong predictor of longer-term outcomes. There may be potential for improving longer-term results with LAGB by better supporting patients who are not achieving good weight loss at this early time point.
The Beck Depression Inventory (BDI) is one of the most commonly used instruments to assess depres... more The Beck Depression Inventory (BDI) is one of the most commonly used instruments to assess depression in persons with obesity. While it has been validated in normal and psychiatric populations, in obese populations, its validity remains uncertain. This study aimed to investigate the validity and reliability of the BDI-IA and BDI-II in severely obese bariatric surgery candidates. Consecutive new candidates at a bariatric surgery clinic were invited to participate in the study by their consulting surgeon. All candidates were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I); 118 completed the BDI-IA and 83 completed the BDI-II. Two hundred one patients (response rate, 88 %) participated in the study. The current sample (82 % female) had an average body mass index of 42.83 ± 6.34 and an average age of 45 ± 12 years. Based on the SCID-I, 54 candidates (26.9 %) met the criteria for a mood disorder, with 37 meeting the criteria for current major depressive disorder. Individuals diagnosed with a clinical mood disorder had significantly higher scores on the BDI (BDI-IA, 23.59 ± 9.69 vs. 12.76 ± 8.29; BDI-II, 22.93 ± 5.22 vs. 11.25 ± 8.44). Our results indicated that, as a screening tool for a clinical mood disorder, the BDI-II had an optimal cutoff of 13, with a sensitivity of 100 and specificity of 67.75. Results indicated that the BDI-IA should not be used as a tool to measure depressive symptomatology in obese bariatric surgery candidates. No cutoff was identified with adequate sensitivity and specificity, and over 20 % of patients were misclassified. As a screening tool for a clinical mood disorder, the BDI-II was adequate; however, prevalence rates were significantly overestimated.
Obesity is one of the leading causes of preventable diseases and disability worldwide, and depres... more Obesity is one of the leading causes of preventable diseases and disability worldwide, and depression is among the leading causes of burden of disease. Both disorders are increasingly prevalent and comorbid. This comorbidity compounds associated health. While there is consistent evidence of a bidirectional obesity depression relationship, little is known about the biopsychosocial variables associated with this relationship. A systematic review was undertaken to identify variables associated with the relationship between obesity (Body mass index > 30 kg m(-2) ) and depression. Forty-six studies were identified. Obesity, educational attainment, body image, binge eating, physical health, psychological characteristics and interpersonal effectiveness were consistently associated with the relationship between obesity and depression. The current review identified potential biopsychosocial variables associated with the relationship between obesity and depression. This knowledge can inform future research examining moderators, mediators and mechanisms of the relationship between obesity and depression. Improved understanding of this relationship will inform identification, prevention and intervention efforts.
Attendance and completion of weight loss intervention is associated with better weight loss outco... more Attendance and completion of weight loss intervention is associated with better weight loss outcomes; however, attrition is neither consistently reported nor comprehensively explored in the weight loss literature. A systematic review was undertaken to identify factors associated with attrition in weight loss interventions involving overweight or obese (body mass index ≥ 25) adults (18-65 years). Sixty-one studies published before May 2011 and addressing factors associated with weight loss programme attrition were identified. Conclusions were limited by the large number of variables explored, the small number of studies exploring each variable, the large variety of study settings and methodologies used, the inconsistent reporting of results, and the conflicting findings across studies. A consistent set of predictors has not yet been identified. The majority of studies relied on pre-treatment routinely collected data rather than variables selected because of their theoretical and/or empirical relationship with attrition. However, psychological and behavioural patient factors and processes associated with the treatment were more commonly associated with attrition than patient background characteristics. Future research should consider theoretically grounded social-psychological and behavioural processes as potential predictors of dropout. Identification of patients at risk of dropout will contribute to both the effectiveness and the cost-effectiveness of weight loss interventions.
... behaviour therapy, which indicates that both quantity and quality of homework is important to... more ... behaviour therapy, which indicates that both quantity and quality of homework is important to treatment outcome (Kazantzis, Deane & Ronan, 2004; Kazantzis, MacEwan & Dattilio, 2005). Mary Sandilands, Leah Brennan, Jeff Walkley, Steve F. Fraser, and Kate Greenway 104 ...
ABSTRACT Aim: This paper explored the relationship between maternal controlling feeding behaviour... more ABSTRACT Aim: This paper explored the relationship between maternal controlling feeding behaviours and child eating and weight in preschool-aged children. Methods: Ninety mothers of 2- to 5-year-old children (M = 3.48, SD = 0.84, 54.4% males) completed self-report measures assessing maternal controlling feeding behaviours, child eating patterns and weight. Results: Univariate analyses indicated that child food neophobia was associated with authoritarian feeding (r= 0.29), pressure to eat (r= 0.28) and restriction (r= 0.34). Child food pickiness was associated with authoritarian feeding (r= 0.35). No association was found between maternal feeding strategies and child weight. Multivariate regression analyses indicated that authoritarian feeding, restriction and pressure to eat were significantly associated with the variance in child food neophobia (adjusted R2= 12.6%) and pickiness (adjusted R2= 12.0%). Conclusions: The findings suggest that maternal control in feeding is associated with undesirable eating patterns in preschool-aged children. Interventions targeting reduction in maternal controlling feeding may promote desirable eating patterns in preschool-aged children.
While evidence regarding associations between weight stigma and biopsychosocial outcomes is accum... more While evidence regarding associations between weight stigma and biopsychosocial outcomes is accumulating, outcomes are considered in isolation. Thus, little is known about their complex relationships. This article extends existing work by systematically reviewing the biopsychosocial consequences of stigma in adults with overweight/obesity. Articles were identified through Medline, CINAHL, PsycINFO, Embase, Web of Science, and Cochrane databases. Independent extraction of articles was conducted using predefined data fields, including data on biopsychosocial correlates in each study. Twenty-three studies published from 2001 and addressing correlates of stigma in adults with overweight/obesity (body mass index ≥25 kg m(-2); 18-65 years) were identified. Numerous biopsychosocial correlates of weight stigma were studied, particularly in treatment-seeking individuals. Available research shows that weight stigma is consistently associated with medication non-adherence, mental health, anxiety, perceived stress, antisocial behavior, substance use, coping strategies, and social support. Biopsychosocial correlates were not considered in combination in research. Psychological correlates were well documented in comparison to biological and social correlates for each weight stigma type. There were some indications that associations are stronger once stigma is internalized. While there is evidence for biopsychosocial correlates of weight stigma, these are not considered in combination in research; thus their inter-relationships are unknown. Conclusions from the review are limited by this and the small number of studies, types of designs, and variables considered.
Cognitive behavioural models suggest that individuals abandon their weight loss efforts because t... more Cognitive behavioural models suggest that individuals abandon their weight loss efforts because they fail to achieve their weight loss goal, their perceived benefits of weight loss (primary goals), or both. There are currently no published tools available to adequately ...
Economic evaluation is the systematic assessment of the costs and consequences of alternative cou... more Economic evaluation is the systematic assessment of the costs and consequences of alternative courses of action. In health and healthcare, the results can be used to inform clinicians and policy makers about the relative cost-effectiveness of options under consideration [1]. Many economic evaluations are undertaken alongside randomised controlled trials (RCTs); the advantages of this approach are that i) prospective, accurate data can be collected on costs and effects and ii) appropriate outcome measures for use in economic evaluation can be chosen. The outcome of an economic evaluation is usually described as a ratio of the costs and effects – often called the incremental cost-effectiveness ratio (ICER). The ICER is determined by calculating the differences in the costs and effects of both intervention and control groups and dividing the former by the latter. In designing an economic evaluation, the important questions to resolve are: which costs should be included and which outco...
Uploads
Papers by Leah Brennan