Background-Prior studies have reached contradictory conclusions concerning whether binge eating disorder (BED) is associated with greater psychopathology in extremely obese patients who seek bariatric surgery. This study used the Structured Clinical Interview for DSM-IV Diagnoses (SCID) to compare rates of Axis I psychopathology in surgery candidates who were determined to have BED or to be currently free of eating disorders. The relationship of BED to other psychosocial functioning and weight loss goals also was examined.

Previous studies have suggested that binge eating disorder (BED) impairs weight loss following bariatric surgery, leading some investigators to recommend that patients receive behavioral treatment for this condition before surgery. However, many of these investigations had significant methodological limitations. The present observational study used a modified intention‐to‐treat (ITT) population to compare 1‐year changes in weight in 59 surgically treated participants, determined preoperatively to be free of a current eating disorder, with changes in 36 individuals judged to have BED. Changes in weight and binge eating in the latter group were compared with those in 49 obese individuals with BED who sought lifestyle modification for weight loss. BED was assessed using criteria proposed for the Diagnostic and Statistical Manual (DSM) 5. At 1 year, surgically treated participants without BED lost 24.2% of initial weight, compared with 22.1% for those with BED (P > 0.309). Both groups achieved clinically significant improvements in several cardiovascular disease (CVD) risk factors. Participants with BED who received lifestyle modification lost 10.3% at 1 year, significantly (P < 0.001) less than surgically treated BED participants. The mean number of binge eating days (in the prior 28 days) fell sharply in both BED groups at 1 year. These two groups did not differ significantly in BED remission rates or in improvements in CVD risk factors. The present results, obtained in carefully studied participants, indicate that the preoperative presence of BED does not attenuate weight loss or improvements in CVD risk factors at 1 year in surgically treated patients. Longer follow‐up of participants is required.

BackgroundDepression and diminished health status are common in adults with diabetes, but few studies have investigated associations with socio-economic environment. The objective of this manuscript was to evaluate the relationship between neighborhood-level SES and health status and depression.MethodsIndividual-level data on 1010 participants at baseline in Look AHEAD (Action for Health in Diabetes), a trial of long-term weight loss among adults with type 2 diabetes, were linked to neighborhood-level SES (% living below poverty) from the 2000 US Census (tracts). Dependent variables included depression (Beck Inventory), and health status (Medical Outcomes Study (SF-36) scale). Multi-level regression models were used to account simultaneously for individual-level age, sex, race, education, personal yearly income and neighborhood-level SES.ResultsOverall, the % living in poverty in the participants' neighborhoods varied, mean = 11% (range 0-67%). Compared to their counterparts in the lowest tertile of neighborhood poverty (least poverty), those in the highest tertile (most poverty) had significantly lower scores on the role-limitations(physical), role limitations(emotional), physical functioning, social functioning, mental health, and vitality sub-scales of the SF-36 scale. When evaluating SF-36 composite scores, those living in neighborhoods with more poverty had significantly lower scores on the physical health (β-coefficient [β] = -1.90 units, 95% CI: -3.40,-0.039), mental health (β = -2.92 units, -4.31,-1.53) and global health (β = -2.77 units, -4.21,-1.33) composite scores.ConclusionIn this selected group of weight loss trial participants, lower neighborhood SES was significantly associated with poorer health status. Whether these associations might influence response to the Look AHEAD weight loss intervention requires further investigation.

Background Obese individuals with binge eating disorder (BED) frequently experience impairments in mood and quality of life which improve with surgical or behavioral weight loss interventions. It is unclear if these improvements are due to weight loss itself, or to additional aspects of treatment such as group support, or acquisition of cognitive-behavioral skills provided in behavioral interventions. Objectives To compare changes in weight, symptoms of depression, and quality of life, in extremely obese individuals with BED undergoing bariatric surgery or a lifestyle modification intervention. Setting University Hospital Methods Symptoms of depression and quality of life were assessed at baseline and 2, 6, and 12 months in participants undergoing bariatric surgery but no lifestyle intervention (n=36) and non-surgery participants receiving a comprehensive program of lifestyle modification (n=49). Results Surgery participants lost significantly more weight than lifestyle participants at 2, 6 and 12 months (p’s<0.001). Significant improvements in both mood (as measured by the Beck Depression Inventory-II) and quality of life (as measured by the Short Form-36) were observed in both groups across the year, but there were no differences between the groups at month 12 (even when controlling for reductions in binge eating). A positive correlation was observed between the magnitude of weight loss and change in BDI-II score when collapsing across groups. Moreover, weight loss at one time point predicted BDI-II score at the next time point, but BDI-II score did not predict subsequent weight loss. Conclusions We conclude that similar improvements in mood and quality of life can be expected from either bariatric surgery or lifestyle modification treatments for periods up to 1 year.

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After the article above was published, the following errors were subsequently identified. A total of 36 participants were described who had been diagnosed at baseline with binge eating disorder (BED), subsequently underwent bariatric surgery, and then provided at least one postoperative measurement of body weight (see page 1222, first paragraph of Results). In recently re-examining the data, we discovered that 3 of the 36 participants did not meet criteria for BED at baseline. One participant did not meet the frequency requirement of an average of at least one objective binge episode per week for the prior 3 months. (Such an episode is characterized by eating an objectively large amount of food in a discrete period of time and experiencing loss of control while eating.) Two participants met requirements for subjective binge episodes (i.e., experiencing loss of control but not eating an objectively large amount of food) but not for objective binge episodes. We removed observations for these three participants from the data set and reanalyzed the mean 12-month reduction in initial weight for the remaining 33 participants who had been diagnosed preoperatively with BED and provided at least one postoperative measurement of weight. These participants lost a mean of 21.5 6 2.2% of initial weight, as compared with the 22.1 6 1.7% loss for the 36 participants reported in the original publication (see page 1224, first paragraph, Surgery participants: effects of BED on weight loss). The 21.5 6 2.2% loss for the 33 participants with BED did not differ significantly (p50.23) from the 24.6 6 1.6% mean loss for the 59 participants who were determined at baseline to be free of an eating disorder, underwent surgery, and then provided at least one postoperative measurement of body weight. Deletion of observations for the three participants (determined not to have BED) resulted in small, insubstantial changes in values reported in Tables 1, 2, and 3 for the Surgery-BED group. Reanalysis of the data, with 33 rather than 36 Surgery-BED participants, confirmed the study's original conclusions that, "The present results, obtained in carefully studied participants, indicate that the preoperative presence of BED does not attenuate weight loss or improvements in CVD risk factors at 1 year in surgically treated patients."The above study included a comparison group of 49 individuals who were diagnosed with BED but elected to participate in a 1-year group lifestyle modification program rather than undergoing bariatric surgery. Participants in this group lost 10.3 6 1.5% of their initial weight at month 12, which was significantly (p<0.001) smaller than the 22.1 6 1.7% loss achieved by patients with BED who elected bariatric surgery (original N536). We reanalyzed the difference in weight loss between these two groups at month 12, excluding the three participants from the surgery group who did not meet criteria for BED (N533). As described in the original report, we used a linear mixed effects model, fitting quadratic and linear models. Surg...

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