肥胖症手术候选人的抑郁亚型、暴食和体重减轻。
Depression subtypes, binge eating, and weight loss in bariatric surgery candidates.
机构信息
Department of Psychology, Oklahoma State University, Stillwater, Oklahoma.
Department of Psychology, Oklahoma State University, Stillwater, Oklahoma.
出版信息
Surg Obes Relat Dis. 2020 May;16(5):690-697. doi: 10.1016/j.soard.2019.12.017. Epub 2019 Dec 24.
BACKGROUND
Depression and binge eating disorder (BED) are prevalent among bariatric surgery candidates. Depression subtypes may be differentially related to obesity, such that the atypical subtype predicts poorer outcomes. However, no research has examined depression subtypes, BED, and weight loss in bariatric candidates.
OBJECTIVE
To examine whether presurgical atypical depressive symptoms, compared with no depressive and melancholic depressive symptoms, were associated with higher rates of presurgical BED, binge eating severity, and poorer postsurgical weight loss trajectories among bariatric candidates.
SETTING
An outpatient Midwest bariatric clinic.
METHODS
Participants were 345 adults (aged 46.27 ± 12.78 yr, 76% female; body mass index = 49.84 ± 8.51 kg/m) who received a presurgical evaluation. Depression subtypes (melancholic, atypical, and no depressive symptoms) were categorized using the Beck Depression Inventory-II. BED diagnosis and severity were evaluated using the Eating Disorder Diagnostic Scale and Binge Eating Scale, respectively. Weight loss trajectories were calculated as percent total weight loss postsurgery.
RESULTS
Using no depression as the referent, participants reporting melancholic symptoms (odds ratio = 7.60, P < .001 confidence interval [2.59-22.28]) and atypical symptoms (odds ratio = 10.11, P < .01 confidence interval [2.69-37.94]) were more likely to meet criteria for BED. Patients with atypical depressive symptoms exhibited the highest binge eating severity scores (mean = 23.03). Depression subtypes did not predict percent total weight loss trajectories within 18-months postbariatric surgery.
CONCLUSIONS
Patients reporting preoperative atypical depressive symptoms were more likely to meet criteria for co-morbid BED diagnosis and have greater binge eating severity but did not have poorer weight loss within 18 months postsurgery. Future studies with longer-term follow-up and corresponding measures of postsurgical depression and binge eating pathology are warranted.
背景
抑郁和暴食障碍（BED）在接受减重手术的患者中较为普遍。抑郁亚型可能与肥胖有不同的关联，例如非典型抑郁亚型预示着更差的结果。然而，目前还没有研究探讨抑郁亚型、BED 和减重手术候选者的体重减轻。
目的
研究与无抑郁和忧郁性抑郁症状相比，术前非典型抑郁症状是否与术前 BED 发生率较高、暴食严重程度较高以及减重手术后体重减轻轨迹较差有关。
地点
中西部一家门诊减重诊所。
方法
参与者为 345 名成年人（年龄 46.27 ± 12.78 岁，76%为女性；体重指数=49.84 ± 8.51 kg/m），他们接受了术前评估。使用贝克抑郁量表二型（BDI-II）对抑郁亚型（忧郁型、非典型型和无抑郁症状）进行分类。使用饮食障碍诊断量表（EDD）和暴食量表分别评估 BED 诊断和严重程度。术后体重减轻轨迹计算为术后总体重减轻的百分比。
结果
以无抑郁为参照，报告有忧郁症状（比值比=7.60，P<.001置信区间[2.59-22.28]）和非典型症状（比值比=10.11，P<.01置信区间[2.69-37.94]）的患者更有可能符合 BED 的诊断标准。有非典型抑郁症状的患者表现出最高的暴食严重程度评分（均值=23.03）。抑郁亚型并未预测减重手术后 18 个月内的总体重减轻轨迹。
结论
报告术前非典型抑郁症状的患者更有可能符合共病 BED 的诊断标准，且暴食严重程度更高，但在术后 18 个月内体重减轻情况并无差异。需要进一步进行具有更长期随访和相应的术后抑郁和暴食病理测量的研究。
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