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Weight-related abuse is defined as verbal or physical maltreatment specific to one's weight. The Weight-Related Abuse Questionnaire (WRAQ) is an instrument specifically designed to measure weight-related abuse. The main goal of this research was to study the factor structure and measurement invariance of the Spanish version of the WRAQ in a non-clinical and a clinical sample. The clinical sample included 150 participants with obesity (60 % women) from the Hospital de Valme (Sevilla, Spain). The non-clinical sample included 301 students (79 % women) from the Spanish Open University (UNED). Scales to measure weight self-stigma and fear of gaining weight were used to analyze the convergent validity of the WRAQ. A confirmatory factor analysis showed that a two-factor model (verbal and physical abuse) was an acceptable fit for the data in both the clinical and non-clinical samples. Multigroup Confirmatory Factor Analysis revealed scalar measurement invariance by sample and gender. Cronbach's alpha coefficients and composite reliability for both samples were found to be good, with values ranging from 0.83 to 0.96. Fear of gaining weight was correlated to verbal (r = 0.36, p < .01) and physical (r = 0.12, p < .05) abuse, and weight self-stigma was also related to physical (r = 0.21, p < .01) and verbal (r = 0.41, p < .01) abuse. These results suggest that the WRAQ can be used in clinical and non-clinical samples to assess verbal and physical abuse in both men and women.

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BACKGROUND: Prior to undergoing bariatric surgery, many insurance companies require patients to attend medically supervised weight management visits for 3-6 months to be eligible for surgery. There have been few studies that have looked specifically at the relationship between medically supervised weight management visit attendance and postoperative outcomes, and the current literature reports discrepant findings. OBJECTIVES: This project aimed to better characterize the relationship between preoperative medically supervised weight management visit attendance and postoperative weight loss outcomes by examining weight loss up to 5 years postbariatric surgery, and by stratifying findings according to the type of surgery undergone. SETTING: University Hospital. METHODS: Participants were recruited during presurgical bariatric surgery clinic visits at a bariatric and metabolic weight loss center. As part of standard of care all participants were required to participate in monthly medically supervised weight management visits before surgery. Participants who completed bariatric surgical procedures participated in postsurgical follow-up at 3 weeks, 3 months, 6 months, and then annually for 5 years. Weight outcomes measured were percentage of total weight lost. RESULTS: The results do not indicate a significant association between number of group visits attended and percent total weight loss at 1 month, 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, or 5 years postbariatric surgery. CONCLUSIONS: These data do not suggest a relationship between engagement in a medically supervised weight loss program prior to bariatric surgery and weight loss after surgery in either the short- or the long-term.

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Several psychosocial factors can impact surgical outcomes and overall patient wellbeing following surgery. Although advances in surgical interventions and pain management protocols can reduce surgical trauma and enhance recovery from surgery, additional intervention is warranted to optimize surgical outcomes and patient quality of life (QoL) in the short- and long-term. Research on mindfulness techniques suggests that mindfulness-based interventions (MBI) effectively promote health behaviors, reduce pain, and improve psychological wellbeing and QoL. Thus, there has been an increase in research evaluating the use of MBIs to improve postoperative outcomes and wellbeing in surgical patients. The authors provide a brief overview of psychosocial outcomes of surgery and MBIs and review the literature on the impact of MBIs on postoperative outcomes. The extant literature indicates that MBIs are feasible and acceptable for use in surgical patient populations and provides preliminary evidence of the benefits of mindfulness across a range of surgical patient populations. However, more research is needed to assess the long-term efficacy of MBIs delivered online and in-person across the perioperative continuum.

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BACKGROUND: Sleep disturbance is well established in individuals with obesity, and the relationship between poor sleep and obesity is supported by population, longitudinal, experimental, and intervention studies. However, the prevalence and characteristics of poor sleep in individuals seeking bariatric surgery have thus far been poorly examined. OBJECTIVES: We sought to characterize self-reported sleep parameters in individuals seeking bariatric surgery and to compare these data with controls. SETTING: Two Academic Medical Centers, United States, and an online survey of healthy controls. METHOD: Individuals seeking bariatric surgery (n = 427) completed presurgical psychological evaluations at 2 comprehensive bariatric surgery programs. Data on medical co-morbidities and from self-report questionnaires on sleep quality, insomnia, anxiety, and depression were abstracted from charts. Data from controls (n = 180) were collected using an online survey tool and compared with bariatric cases. RESULTS: Across study sites, 40.4% of bariatric cases took at least 30 minutes to fall asleep, 46.7% had insufficient total sleep time (<6.5 hr), 65.1% reported general poor sleep quality, and 30.8% reported clinically significant insomnia symptoms. Approximately 20% of the variance in poor sleep quality and insomnia was explained by body mass index, obstructive sleep apnea, anxiety, and depression. Cases and controls were similar, although bariatric cases reported significantly poorer sleep efficiency. CONCLUSIONS: Our results suggest that similar to a control population, the majority of patients seeking bariatric surgery are experiencing sleep difficulties. Presurgical assessment and treatment of sleep problems may be beneficial to patients and may help improve weight loss treatment outcomes. Optimally, assessment would include 1 of the 2 self-report questionnaires used herein, and treatment would involve Cognitive Behavioral Therapy for Insomnia. Future research assessing sleep patterns with objective measurement tools and evaluating the impact of sleep on postsurgical outcomes is warranted.

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The extant literature indicates negative self-perceptions are a risk factor for disordered eating (DE) and DE is a risk factor for overweight and obesity. While childhood emotional abuse (EA) is often linked to DE and obesity, it is typically not included in comprehensive models of these health problems. Further investigation of interactions among EA, self-perception, and DE is needed to refine treatments for overweight, obesity, and DE. This study evaluated a model of DE and weight difficulties in which negative self-perception mediate the relationship between EA and DE, and DE predicts body mass index (BMI) in a population of emerging adults. Further, this study investigated the utility of history of EA for prediction of DE and classification of individuals with and without DE. Self-report questionnaires on childhood trauma, psychopathology, and eating behaviors were administered to 598 undergraduate students. Latent variable analysis confirmed the hypothesized model. Recursive partitioning determined that individuals reporting a high level of EA likely meet criteria for night eating syndrome (NES) or binge eating disorder (BED), and history of EA has a moderate to high level of specificity as a predictor of BED and NES. These findings confirm the necessity of evaluating EA and DE in emerging adults with weight difficulties, and the importance of assessing self-perception and DE in individuals with a history of EA. Future studies should investigate the utility of addressing EA and self-perception in interventions for DE and obesity and to determine whether these findings can be generalized to a clinical population.

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Risk for suicidality (current or past suicidal ideation or attempt) increases after bariatric surgery; however, there is a paucity of research investigating suicidality predictors in this population. This study involved a retrospective chart review of individuals seeking psychological clearance for bariatric surgery. In total, 32 participants (15.8%) were classified as reporting suicidality. These participants endorsed greater depressive symptomatology and hopelessness, and hopelessness and mood disorder diagnosis each uniquely predicted whether or not a patient was classified as reporting suicidality. The findings within suggest that increased attention to the relationship among these variables may improve methods for identification of high-risk patients. Implications for clinical practiced are discussed.

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Weight-related teasing (WRT)/stigmatization may be distinct from teasing and general abuse and may differentially impact adult outcomes. As WRT increases in severity so do depression and disordered eating. Currently, there are no validated measures designed to assess abuse specific to weight. Thus, we developed the Weight-Related Abuse Questionnaire (WRAQ) and validated it in young adult and clinically obese populations. The WRAQ was administered to 3 samples of participants: 292 undergraduate students, 382 undergraduate students, and 59 individuals seeking bariatric surgery. Concurrent validity was assessed via measures of WRT and general childhood abuse. Convergent validity was assessed with measures of depression and disordered eating. Study 1 data were used to further develop the structure of the WRAQ. Study 2 indicated that the WRAQ had excellent psychometric properties (based on factor analyses and reliability/scale consistency analysis) and strong concurrent and convergent validity, supporting the validity of the questionnaire. 6-month test-retest reliability was also good. In Study 3 responses on the WRAQ converged well with interview responses, showed good psychometric properties, and showed moderate correlations with measures of childhood abuse and psychopathology. The WRAQ has strong psychometric properties and is strongly associated with measures of current psychopathology. Additionally, it fills a gap in the assessment literature and may be a beneficial tool for determining which individuals are at increased risk for psychopathology.

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The purpose of this article was to evaluate theories that (1) weight-related abuse (WRA) plays a unique role in the development of disordered eating, above and beyond general childhood verbal abuse and weight-related teasing, and (2) the perceived emotional impact of WRA mediates the relationship between WRA and current disordered eating. Self-report questionnaires on childhood trauma, weight-related teasing, WRA, and current eating behaviors were administered to a total of 383 undergraduate students. In initial regressions, WRA significantly predicted binge eating, emotional eating, night eating, and unhealthy weight control. WRA continued to significantly predict all 4 forms of disordered eating following the introduction of measures of weight-related teasing and childhood verbal abuse into the regression. Latent variable analysis confirmed that perceived emotional impact of WRA mediated the relationship between WRA and disordered eating, and tests for indirect effects yielded a significant indirect effect of WRA on disordered eating through perceived emotional impact. In sum, WRA is a unique construct and the content of childhood or adolescent maltreatment is important in determining eventual psychopathology outcomes. These findings support the necessity of incorporating information on developmental history and cognitive factors into assessment and treatment of individuals with disordered eating.

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The present study evaluated the importance of multimodal assessment of childhood verbal abuse (CVA) in pre-bariatric surgery psychological evaluations, and the role of CVA as a predictor of depression. Data from the psychological evaluations of 184 pre-bariatric surgery patients were retrospectively examined. Using two self-report measures and an interview-based screen, 52.2 % of participants reported experiencing some form of CVA; conversely, assessments of CVA based on only one measure yielded significantly lower prevalence rates. Endorsement of CVA on multiple measures was associated with more severe depressive symptomatology and greater likelihood of mood disorder diagnosis. Based on these data, a self-report measure and interview-based screen for CVA should be included in pre-bariatric psychological evaluations; either of these assessments may be conducted via a single-item screen. Lastly, patients who endorse CVA on multiple measures should be monitored closely for symptoms of depression post-surgery.

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This study sought to examine (a) a mediational model of childhood abuse, adult interpersonal abuse, and depressive symptoms and (b) the impact of weight-related teasing on rates and correlates of childhood abuse. Charts of 187 extremely obese individuals seeking psychological clearance for bariatric (weight-loss) surgery were retrospectively examined. Among the participants, 61% reported a history of childhood abuse, 30.5% reported adult interpersonal abuse, and 15% reported clinically significant depressive symptoms. Initially, the relationship between childhood abuse and current depressive symptoms was significant (p<.001). However, the introduction of adult interpersonal abuse as a mediator in the model reduced the magnitude of its significance (Sobel's test p=.01). The associations between childhood abuse and adult interpersonal abuse and between adult interpersonal abuse and depressive symptoms were significant (p<.001 and p=.002, respectively), and the model showed a good fit across multiple indices. Finally, weight-related teasing was a significant moderator in the relationship between childhood and adult interpersonal abuse. Bariatric surgery patients report elevated rates of childhood abuse that are comparable to rates in psychiatric populations (e.g., eating disorders, depression), and higher than those in community samples and other medical populations. The relationship between child abuse and depressive symptomatology may be partially explained by the presence of adult interpersonal abuse; additionally, the relationship between childhood and adult interpersonal abuse was stronger for those who did not endure weight-related teasing than for those who did.

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Bleomycin yields pulmonary injury characterized by inflammation that proceeds to fibrosis. The production of IL-10 by pulmonary macrophages is increased in the inflammation that accompanies bleomycin lung injury. In the present study, IL-10 deficient and wildtype mice received 0.075 units of bleomycin intratracheally at day 0 and were sacrificed at day 7 or day 14. At day 7, pulmonary inflammation was increased in IL-10-deficient mice as reflected by increased representation of CD3+ and CD4+ lymphocytes and GR-1+ pulmonary granulocytes in the bronchoalveolar lavage (BAL) fluid. Pulmonary interstitial CD80+ and CD86+ mononuclear cells were increased in situ. At day 14, mononuclear cell inflammation was comparable between groups but pulmonary eosinophils were increased in the wildtype. There was no difference in the degree of pulmonary fibrosis, as judged by histology or lung hydroxyproline content. Lung chemokine expression of MIP-1alpha/beta, MIP-2, and eotaxin was increased at days 7 and 14 with a trend towards increased MCP-1 expression at day 14. The findings suggest an immunomodulatory role for IL-10 in the inflammatory response but not in the pulmonary fibrosis yielded by bleomycin.

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