By CHRISTINE PEAT
Published: December 10, 2013
Obesity Week, the first annual combined meeting of The Obesity Society (TOS) and the American Society of Metabolic and Bariatric Surgery (ASMBS), was held November 11-16th, 2013 in Atlanta, Georgia. This meeting was the first of its kind as these two organizations joined forces to provide a week’s worth of programming centered around the etiology and treatment of obesity and its associated morbidities. As a psychologist with a distinct interest in the intersection of obesity, bariatric surgery, and eating pathology, this particular conference provided focused knowledge on the science of bariatric medicine and the clinical management of bariatric patients. In fact, two days of pre-conference programming were devoted to psychological and behavioral issues in bariatric surgery patients in ASMBS’ “Master’s Course in Behavioral Health” which focused on issues ranging from pre-surgical interventions to improve physical activity; food cravings in bariatric patients; and binge eating outcomes. In his presentation during the Master’s Course, Dr. James Mitchell suggested that estimates of psychopathology in individuals being considered for bariatric surgery vary widely and that part of this discrepancy might lie in the differences between using structured interviews and more routine assessments. He and his colleagues found very low inter-rater agreement (κ = 0.184) between these two methods in assessing mood disorders and even greater disagreement on assessments of anxiety disorders (κ = -0.017) and eating disorders (κ = -0.048). If you are unfamiliar with this statistic, perfect agreement between methods would be a κ of 1.0! Such findings certainly underscore the importance of thinking carefully about what assessment methods are used to screen candidates for bariatric surgery as well as the necessity of taking into account such findings when summarizing the estimates of psychopathology in this population. Additionally, Krista Castleberry, LCSW reported on the positive effects of weight loss associated with bariatric surgery on quality of life domains such as physical health, mobility, daily activities, and work functioning, and Dr. Graham Thomas presented his innovative research on using mobile technology to teach behavioral weight loss skills specifically to individuals who have undergone bariatric surgery. While the literature on bariatric surgery still has several obstacles to overcome, presentations at this year’s Obesity Week shed light on the direction in which the field is moving and highlighted critical gaps in our current knowledge.
One particularly fascinating talk was the keynote address by Dr. John Gunstad, which focused on the potential deleterious effects of obesity on cognitive ability. His research is built upon growing knowledge that obesity is associated with accelerated cognitive decline (with both independent and interactive effects with obesity-related morbidities) and with disease states that significantly impact cognitive functioning such as stroke, Alzheimer’s disease, and vascular dementia. Dr. Gunstad posited that if obesity is associated with these negative outcomes, it might be possible for weight loss to improve cognitive function. While behavioral weight loss interventions have been shown to demonstrate some positive effects in terms of improving cognitive function, those associated with bariatric surgery were far superior. Dr. Gunstad analyzed results from the national Longitudinal Assessment of Bariatric Surgery (LABS), which collects data at baseline (pre-surgery) and at various time points after surgery. At baseline, 25% of bariatric candidates demonstrated cognitive impairment at a clinical (diagnostically significant) level and up to 40% showed more subtle deficits. However, as early as 12 weeks after surgery, patients who were clinically impaired at baseline demonstrated statistically significant improvements in cognition. It is important to note here that patients did not simply demonstrate a tapering off or stabilizing of their cognitive impairments – they actually improved functioning suggesting that the brain might be healing itself. Dr. Gunstad was quick to note that as a clinical neuropsychologist, there are few interventions (if any) available to not only stop but reverse cognitive decline, thus these findings are particularly compelling. In fact, at 12 months after surgery, patients who were clinically impaired at baseline demonstrated memory performance that was within normal limits! Dr. Gunstad’s work has important implications for the potential benefits of bariatric surgery not only on weight but also on cognition, and his results help spark critical discussions about how best to screen bariatric candidates and manage their care after surgery.
In sum, the 2013 Obesity Week conference provided highlights of leading-edge research and clinical practice and helped shed light on areas on which the field needs to focus to continue to provide quality care to patients. Though the work presented was certainly not exhaustive and not without its share of controversy, the dialogue among researchers, clinicians, and patients was necessary and timely. It will be interesting to see how Obesity Week programming continues to develop in coming years to deliver the newest insights in obesity research and treatment.