Abstract: Purpose The aim of this study was to examine the psychometric properties of the Spanish version of the Experience of Caregiving Inventory (ECI-S), which is designed to assess the caregiver’s appraisal of the impact of caring for a relative with a serious mental illness. Methods A cross-sectional study was conducted among 320 caregivers of a relative with an eating disorder to examine: (a) descriptive statistics; (b) internal consistency reliability; (c) the fit of the original ten-factor structure of the ECI through exploratory factor analysis, using a semi-confirmatory approach, for each subscale individually, and (d) concurrent validity. A total of 307 caregivers completed the scale. Results Reliability of the ECI subscales scores was acceptable (α = 0.63–0.89). Results replicated the original ten-factor structure of the instrument. The concurrent validity was supported by correlations of the ECI-negative subscale with psychological distress (GHQ-12, 0.43), and with depression and anxiety (HADS, 0.48 and 0.49, respectively). Conclusions The Spanish version of the ECI (ECI-S) demonstrated good psychometric properties in terms of validity and reliability that were similar to the original version. It is an acceptable and valid instrument for assessing the impact on family members of caring for a relative with an eating disorder and can be recommended for use in clinical settings in Spain. Level of evidence Level V, cross-sectional descriptive study. PubDate: 2020-04-01
Abstract: Purpose Research has demonstrated impaired executive functioning among Binge Eating Disorder (BED) patients that could be influenced by age and weight. We aim to compare decision-making, set-shifting and central coherence between BED-obese patients (BED-Ob), non-BED-obese patients (non-BED-Ob), and normal-weight healthy controls (NW-HC) without the influence of these variables. Methods Overall, 35 BED-Ob, 32 non-BED-Ob and 26 NW-HC participants completed the Iowa Gambling Task, the Trail Making Test and the Rey-Osterrieth Complex Figure Test. Results BED-Ob patients showed higher cognitive impairment compared to NW-HC on decision-making, set-shifting, visual attention and memory. Conclusions BED-Ob patients have an impaired cognitive profile on decision-making, set-shifting, visual attention and memory but not impaired central coherence. As all groups were aged-matched and no significant differences between BED-Ob and non-BED-Ob participants were evident, our results demonstrate that this impairment is independent from weight/age, pointing out that it is BED itself to account for inefficiencies in cognitive functioning. Level of evidence Level III, case-control study. PubDate: 2020-04-01
Abstract: Objective With the rise in electronic cigarette (ENDS) use among US young adults, more research is needed on expectations for use and perceptions related to body image, weight control, and stress relief. Methods College students (N = 230; modal age 21 years; 68% female) completed an online survey assessing cigarette smoking and ENDS, dieting and body image, perceptions about flavors, stress, weight gain prevention, and appetite regulation. Sample characteristics Dual use (cigarette and ENDS) was reported by n = 69 (30.0%). Exclusive cigarette smoking was endorsed by n = 53 (23%) with exclusive ENDS use reported by n = 15 (6.5%). Ninety-three participants (40.5%) reported not using either product. Results Among those using ENDS, < 33% reported using as a stress management tool, < 15% reported using ENDS to control appetite, and > 70% reported using cartridges that tasked like sweets. There was a positive correlation between dieting behaviors and body concern, suggesting those who reported higher use of ENDS for weight and appetite regulation also had higher pathological eating scores and concern over body shape and size. Conclusion Prevention and education related to weight, body image, and tobacco are needed to address misperceptions of tobacco products. Level of evidence Level V, cross-sectional descriptive study. PubDate: 2020-04-01
Abstract: Purpose Excessive gestational weight gain is associated with detrimental outcomes to both the mother and baby. Currently, the best approach to prevent excessive gestational weight gain in overweight and obese women is undetermined. The present study aimed to evaluate the effectiveness of a group-based outpatient dietary intervention in pregnancy to reduce excessive gestational weight gain. Methods In this retrospective study, overweight and obese pregnant women who attended a single 90-min group education session were compared to women who received standard care alone. Total gestational weight gain, maternal and neonatal outcomes were compared between the intervention and control groups. Data were analysed using Student t, Mann–Whitney and Chi-squared tests as appropriate. A 24-h dietary recall was analysed and compared to the Australian National Nutrition Survey. Results A significant reduction in gestational weight gain was observed with this intervention (P = 0.010), as well as in the rate of small for gestational age births (P = 0.043). Those who attended the intervention had saturated fat and sodium intake levels that exceeded recommendations. Intake of pregnancy-specific micronutrients including folate, calcium and iron were poor from diet alone. Conclusions A low-intensity antenatal dietary intervention may be effective in reducing excessive gestational weight gain, although multi-disciplinary interventions yield the best success. Further research is required to identify the optimal modality and frequency to limit excessive gestational weight gain. Dietary interventions tailored to ethnicity should also be explored. Level of evidence Level II, controlled trial without randomization. PubDate: 2020-04-01
Abstract: Background and purpose Recent research demonstrates a significant relationship between weight status and impaired reaction time in young, adult, and elderly individuals. However, most such studies were performed on small samples, used only body mass index as the body obesity index, used simple reaction time, and oftentimes did not consider some potential confounders such as age, socioeconomic status, or physical activity in their studies. The present study explored the relationship between various reaction time tasks and various obesity indices in a sample of youth. Methods Two hundred and thirty-four young males (19–24 years) underwent standard anthropometry, various information processing tasks (e.g., clinical reaction time, simple audio and visual reaction time, and choice reaction time), as well as an inhibitory control task (congruent and incongruent Simon reaction time). Results Results revealed no significant relationship between any of the information processing tests and body mass index, nor for fat percentage, waist circumference, and waist-to-height ratio after adjustment for potential confounders. A weak positive association was observed only between congruent Simon reaction time (but not incongruent Simon reaction time) and waist circumference in participants (t value = 0.199; Std error = 0.0014; p = 0.047; Cohen’s f2 = 0.09). Conclusion Inhibitory control, but not information processing speed, was associated only with waist circumference in apparently healthy young men. Level of evidence Level I, experimental study. PubDate: 2020-04-01
Abstract: Purpose Interpersonal and intrapersonal factors contributing to body appreciation in emerging adult women remain poorly explored. Thus, the present study aimed to test the impact of early memories of warmth and safeness with peers, self-compassion, and social safeness, in body appreciation and in disordered eating attitudes and behaviours. Methods A total of 387 women aged between 18 and 25 completed a set of self-report questionnaires. Data were analysed through descriptive and correlation statistics, and the suitability of a theoretical model was explored via path analysis. Self-report instruments assessed participants’ weight and height, early memories of warmth and safeness with peers, self-compassion, social safeness, body appreciation, as well as disordered eating. Results Early memories of warmth and safeness with peers associated with higher self-compassion and feelings of social safeness, which were both positively linked to body appreciation. Body appreciation associated with a lower display of disordered eating. Conclusion It seems that childhood and adolescent experiences may have an important influence on the development of self-to-self and self-to-others secure relationships, with consequences on the way women behave and relate with their unique body characteristics. The pertinence of developing self-compassion and affiliative skills to promote positive body image among females is suggested, as well as of applying compassion-based strategies when clinically approaching symptoms of eating disorders. Level of evidence Cross-sectional descriptive study, Level V. PubDate: 2020-04-01
Abstract: Introduction The psychological profile of obese people deciding to start obesity treatment may be different from those not choosing to seek the therapy. Previous studies have shown a higher incidence of depression in obese than in normal weight people. However, data are lacking concerning the occurrence of depressive symptoms and their severity in obese subjects who do or do not decide to start treatment for obesity. Therefore, the aim of this study was to evaluate the prevalence and severity of depressive symptoms among obese people starting treatment and not seeking treatment for obesity. Materials and methods Enrolled subjects were 331 adults (241 women, 90 men), including 193 obese subjects starting treatment for obesity (46.8 ± 13.2 years, BMI 37.6 ± 5.5 kg/m2) and 138 obese volunteers never seeking treatment for obesity (44.3 ± 12.5 years, BMI 34.7 ± 4.3 kg/m2). Depression levels were determined using the Beck Depression Inventory (BDI). Results The level of depression was significantly higher among those starting treatment for obesity than those never seeking treatment for obesity (13.2 ± 9.2 vs. 9.5 ± 7.9 points; p < 0.001). This difference was statistically significant in women (14.4 ± 9.2 and 11.0 ± 8.2 points, respectively; p < 0.01), but not in men (7.2 ± 6.4 and 7.3 ± 7.1 points, respectively; p = 0.95). There were more women with moderate/severe depressive symptoms in the group starting treatment than in the group not seeking treatment for obesity (44.7 and 24.4%, respectively). No such difference was observed in men. Conclusions Obese subjects, especially women, with depressive symptoms are more likely to start treatment for obesity. Level of evidence Level III, case-control analytic study. PubDate: 2020-04-01
Abstract: Purpose Celiac disease (CD) is a chronic immune-mediated systemic disease characterized by inflammation and villous atrophy of the small intestine. A strict, lifelong gluten-free diet (GFD) is the only treatment for CD. Disordered eating behaviors (DEBs) prevail in adolescence and young adulthood, and confer a risk of developing into full-blown eating disorders. The aims of the current study were to assess the incidence and risk factors for DEBs among individuals with CD, and to examine an association between adherence to GFD and DEBs. Methods A cohort of 136 individuals with CD responded to a web-mediated survey that assessed DEBs and adherence to a GFD. The survey included demographic data (gender, age, weight, disease duration) and two self-rating questionnaires: the Eating Attitudes Test-26 and the gluten-free diet questionnaire. Results DEBs were found in 19% of female and 7% of male responders. These individuals were characterized by being overweight (p = 0.02), of an older age (p = 0.04) and female sex (p = 0.06). Strict adherence to a GFD was reported by 32% of the responders and was not correlated with age, disease duration, age at diagnosis of CD and with being overweight. Conclusions Caregivers should be aware of the increased occurrence of DEBs in adolescents with CD, especially those who are overweight, older and of a female gender. Level of evidence Level V, cross-sectional descriptive study. PubDate: 2020-04-01
Abstract: Purpose The central role of caregiver eating messages has been recognized on later individual’s eating behaviour, body image and weight status. Additionally, shame is a painful emotion also associated with the development and maintenance of body image and eating-related difficulties. The main aim of the present study was to explore the moderator effect of the recall of caregiver eating messages on the associations between external shame, body weight and shape-related concerns, and the adoption of inflexible eating rules. Methods The sample comprised 479 women from the general population, aged from 18 to 60 years, who completed self-report measures. Results Results of the correlation analyses showed that early caregiver restrictive/critical eating messages were positively associated with external shame, inflexible eating and overvaluation of body weight and shape. Path analysis results demonstrated a moderator effect of early caregiver critical eating messages on the relationship between external shame and both weight and shape-related concerns and inflexible eating. These results revealed that caregiver restrictive/critical eating messages exacerbated the impact of shame on these psychopathological indices, with the tested model accounting for 19% and 38% of the variance of inflexible eating rules and body weight and shape concerns, respectively. Conclusions These findings seem to suggest important research and clinical implications, contributing to the understanding of disordered eating patterns, and appear to represent a new avenue for the development of prevention and intervention programs. Particularly, these findings support the relevance of targeting caregiver eating-related attitudes and messages in prevention interventions for eating psychopathology. Level of evidence Level V, cross-sectional descriptive study. PubDate: 2020-04-01
Abstract: Purpose Accumulating evidence suggests weight suppression (WS) is related to disordered eating and eating disorder (ED) risk in non-clinical samples; however, research to-date has not examined the intentionality of, or motivations for, WS. The purpose of this study was to: (1) qualitatively assess WS motivation in undergraduates, and (2) explore differences in body image and eating behaviors across motivation categories. Methods In the first study, responses from 192 undergraduates were evaluated using inductive content analysis; four primary motivation categories emerged: appearance, functional, sports/military, and unintentional. In a second study, 1033 undergraduates indicated their primary WS motivation, if applicable, and completed body image and eating behavior measures. Separate analyses were run by gender; covariates included current body mass index (BMI) and WS. Results Differences in body image and eating behaviors emerged across motivation categories for both men (p < 0.001) and women (p < 0.001). Appearance-motivated WS in men, and appearance and sports/military-motivated WS in women, were related to greater body dissatisfaction, restraint, thin-ideal internalization, and ED risk. Undergraduates with intentional WS demonstrated higher body dissatisfaction and eating pathology than undergraduates with unintentional or no WS (all ps < 0.05). Conclusions Assessing weight history and WS motivations could be a brief, low-cost intervention to improve identification of undergraduates at greatest risk for EDs. This information could be integrated into campus marketing campaigns promoting wellness. Level of evidence Cross-sectional descriptive study, Level V. PubDate: 2020-04-01
Abstract: Purpose Cognitive-behavioral theories posit that body checking decreases negative emotions, but increases levels of arousal. However, few studies have investigated the effects of body checking on the course of emotional states. Therefore, the current study examined how normal-weight females with higher and lower eating, weight, and shape concerns feel during a checking episode of their most-liked and least-liked body parts. Methods In an online design, levels of negative emotions and arousal were retrospectively assessed before, during, immediately after, and 15 min after an individually remembered body-checking episode. Participants (N = 355) also rated their subjective satisfaction with specific body parts. Results Levels of negative emotions were lower 15 min after the checking episode of most-liked and least-liked body parts than before the episode. However, negative emotions increased during the checking episode of least-liked body parts, but subsided thereafter. The levels of arousal increased during the checking episodes of most-liked and least-liked body parts and decreased afterwards, and females with higher concerns reported greater levels of arousal than females with lower concerns. Furthermore, females with higher concerns reported more body checking than those with lower concerns. Conclusions The results support the assumptions of the cognitive-behavioral theories, as body checking led to a decrease in negative emotions in the longer term, and levels of arousal increased during the checking episode. The greater levels of arousal in females with higher concerns, and their pronounced body-checking behavior, might enhance their existing concerns and increase the risk of disordered eating. Level of evidence Level V, descriptive study. PubDate: 2020-04-01
Abstract: Purpose The study aimed to assess the prevalence of underweight and overweight or obesity and their sociodemographic, lifestyle, and health factors in a national adult population in Lao People’s Democratic Republic (PDR) (Laos). Methods A national cross-sectional study based on a stratified cluster random sampling was conducted in 2013. The total sample included 2531 individuals 18–64 years, (females = 59.3%; mean age 38.7 years, SD = 12.8) from Laos. Questionnaire interview, blood pressure and anthropometric measurements, and biochemistry tests were conducted. Multinomial logistic regression was utilized to determine the association between sociodemographic, lifestyle and health status factors, and underweight and overweight or obesity relative to normal weight. Results Using Asian criteria for body mass index (BMI) classification, 9.7% of the population was underweight (BMI < 18.5, kg/m2), 47.5% had normal weight (BMI 18.5–22.9 kg/m2), 17.5% overweight (23.0–24.9 kg/m2), 19.6% class I obesity (BMI 25.0–29.9 kg/m2), and 5.6% class II obesity (BMI ≥ 30.0 kg/m2) (or 42.8% overweight, class I or class II obesity). In adjusted multinomial logistic regression, female sex (adjusted relative risk ratio-ARRR 0.67, confidence interval-CI 0.45, 0.99), current tobacco use (ARRR 1.57, CI 1.02, 2.41), and having no hypertension (ARRR 0.50, CI 0.26, 0.97) were associated with underweight, and middle and older age (ARRR 1.79, CI 1.41, 2.25), being Lao-Tai (ARRR 1.37, CI 1.06, 1.76), urban residence (ARRR 1.62, CI 1.20, 2.17), having meals outside home (ARRR 1.36, CI 1.04, 1.77), no current tobacco use (ARRR 0.57, CI 0.34, 0.59), low physical activity (ARRR 1.39, CI 1.01, 1.92), having hypertension (ARRR 2.52, CI 1.94, 3.26), and dyslipidaemia (ARRR 1.56, CI 1.21, 2.00) were associated with overweight or obesity. Conclusion A dual burden of both adult underweight and overweight or obesity was found in Laos. Sociodemographic, lifestyle, and health status risk factors were identified for underweight and overweight or obesity, which can help in guiding public health programmes to address both these conditions. Level of evidence Level V, descriptive cross-sectional survey. PubDate: 2020-04-01
Abstract: Purpose To determine the association between breakfast consumption habit and overweight and obesity in a sample of Iranian university students. Methods A sample of 78,905 university students, aged 18 years or older, was recruited from 28 provinces in Iran to assess breakfast consumption pattern. Breakfast consumption habit was evaluated using a pre-tested questionnaire. Weight and height were measured using standard protocol and then body mass index (BMI) was calculated. Overweight (obesity included) and obesity were defined as BMI ≥ 25 and BMI ≥ 30 kg/m2, respectively. Results Mean age of participants was 21.50 ± 4.01. After controlling for potential confounders, participants who ate breakfast > 4 days/week had 15% lower risk of overweight compared with those who ate < 1 day/week (OR: 0.85, 95% CI 0.78–0.92). Such significant association was also seen in female students (OR: 0.82, 95% CI 0.72–0.93); however, it was marginally significant in male ones (OR: 0.89, 95% CI 0.79–1.00). In addition, a significant inverse association was found between breakfast consumption and obesity (OR: 0.74, 95% CI 0.64–0.85) such that after adjusting for potential confounders, students who consumed breakfast > 4 days/week were 33% less likely to be obese compared with those who consumed it < 1 day/week (OR: 0.67, 95% CI 0.57–0.78). Such significant inverse association was also seen in either gender. Conclusions Breakfast consumption was inversely associated with odds of overweight and obesity in university students. Level of evidence Level V, cross-sectional descriptive studies. PubDate: 2020-04-01
Abstract: Objective This study aimed to compare dietary patterns (timing and frequency of binge episodes, caloric intake and macronutrient composition) of patients with binge eating disorders (BE) with and without night eating syndrome (NES). Design The study includes 59 women (18–60) who sought treatment for Eating Disorders (EDs) and were diagnosed with BED or BN (BE) with or without NES. They were divided into two groups: NES–BE and BE-only. The participants kept 7-day, 24-h food diaries and completed demographic and depression questionnaires. Results NES–BE reported significantly a higher frequency of binge days and binge episodes during the week, and more energy and fat consumption than BE-only. Conclusions Individuals with NES–BE exhibit higher levels of eating pathology than individuals with BE-only. Thus, NES–BE may not be simply a variant of BED or BN but rather a separate entity that may lead to a more severe disorder and require early assessment and more intensive and suitable treatment. Level of evidence Level V, cross-sectional descriptive study. PubDate: 2020-04-01
Abstract: Purpose The concept for the contemplation group intervention was derived from motivational interviewing (MI) to support people suffering from an eating disorder who are reluctant to engage with treatment. This evaluation focuses on the contemplation group run by the eating disorder services in the Cardiff and Vale area between 2012 and 2016 to investigate the outcomes for participants and implications for working with people suffering from an eating disorder who are ambivalent about change. Method Quantitative measures were used to assess eating disorder symptomatology, motivation to change and location within the stages of change model. A brief qualitative evaluation of client experiences was also included. Results While dropout was high, a number of patients displayed increased readiness for treatment at the end of the group or even started to engage in change-focussed therapy. Participants who completed the group described it as challenging but helpful. Conclusions This evaluation shows that explorative contemplation of their ambivalence towards their eating disorder and treatment was helpful for the participants of the group and supported them in achieving more clarity and decisiveness regarding whether to engage in treatment or not. Further research is needed to evaluate long-term outcomes for patients who feel ambivalent towards treatment, and to explore what interventions can be used to help them. Evidence level Level IV: Evidence obtained from multiple time series with or without the intervention. PubDate: 2020-04-01
Abstract: Purpose This study explores whether mindful parenting dimensions and children’s body mass index (BMI) z-scores are associated with mothers’ concern about child weight and child-feeding practices (i.e., responsibility for child feeding, pressure to eat, restriction, food reward, and monitoring). Methods The sample included 576 mothers of children/adolescents (7–18 years old) with normal weight (BMI = 3–85th percentiles) and 490 mothers of children/adolescents with overweight/obesity (BMI ≥ 85th percentile; 59% undergoing nutritional treatment). Mothers completed the Portuguese versions of the Interpersonal Mindfulness on Parenting Scale and the Child Feeding Questionnaire. Results Mothers of children with overweight/obesity undergoing nutritional treatment presented lower levels of emotional awareness of the child, nonjudgmental acceptance of parental functioning, and pressure to eat and higher levels of concern about child weight, restriction and monitoring than the other groups presented. Almost all mindful parenting dimensions and children’s zBMI were significantly associated with mothers’ concern and child-feeding practices. Conclusions Mindful parenting dimensions and children’s weight seem to be important predictors of mothers’ child-feeding practices and of their concern about child weight, which suggests that a mindful approach in parenting might help mothers adopt more adaptive and weight-adapted child-feeding practices. Level of Evidence Level III, case-control analytic study. PubDate: 2020-04-01
Abstract: Background Day treatment programs for individuals with eating disorders (ED) have been the subject of research and are promoted as an alternative to inpatient treatment due to their therapeutic and economic advantages, but have not regularly been implemented in regular care. Purpose We investigated the long-term effectiveness of a transdiagnostic combined eating disorder treatment program which consisted of an 8-week day treatment phase followed by an average of 19 sessions of outpatient treatment over an average of 39 weeks in a naturalistic setting. Methods We accepted 148 patients with different diagnoses of eating disorders into our combined treatment program. We assessed weight, behavioral eating disorder symptoms and eating disorder related cognitions and attitudes at the beginning and the end of the day treatment phase and after 6, 12 and 26 months. Results Over the course of the 8-week day treatment phase, patients with initial binge eating, purging and/or fasting behavior reduced these symptoms by 91%, 90% and, 86%. Patients who were underweight at baseline gained on average 1.05 BMI points (d = 0.76). In addition, eating disorder related cognitions and attitudes of all patients significantly improved with large effect sizes (d = 1.12). On average, all improvements remained stable during the follow-up period. Conclusions Our findings add to the existing studies on day treatment and support previously found encouraging effects of treatment programs that combine day treatment and consecutive outpatient treatment for eating disorders. Level of evidence Level III, longitudinal cohort study. PubDate: 2020-04-01
Abstract: Abstract The relationship between self-compassion and well-being and health (e.g. a lower proneness for eating-related disturbances) is well stressed in the literature. However, the specific contribution of self-compassionate attributes, actions, and body compassion remains scarcely studied. The main aim of the present study was to examine whether the link between self-compassionate attributes and disordered eating attitudes and behaviours is mediated by self-compassionate actions and body compassion, in a sample of 299 Portuguese women from the general population. The tested model explained 44% of eating psychopathology’s variance and presented excellent fit indices. The most interesting contribution of this study was the suggestion that the ability to act in accordance with self-compassionate attributes is associated with higher levels of body compassion, that is, an attitude of appreciation, acceptance, warmth toward body-related thoughts, perceptions and feelings, which reflects in a lower susceptibility to adopt disordered eating attitudes and behaviours. These results seem to offer an important contribution for research and clinical practice by supporting the importance of including strategies to develop self-compassionate skills and body compassion competencies in prevention and treatment programs in the area of eating psychopathology. Level of evidence Level III, evidence obtained from a well-designed cohort. PubDate: 2020-04-01
Abstract: Purpose Ayahuasca is a traditional Amazonian medicine that is currently being researched for its potential in treating a variety of mental disorders. This article reports on exploratory qualitative research relating to participant experiences with ceremonial ayahuasca drinking and conventional treatment for eating disorders (EDs). It also explores the potential for ayahuasca as an adjunctive ED treatment. Methods Thirteen individuals previously diagnosed with an ED participated in a semi-structured interview contrasting their experiences with conventional ED treatment with experiences from ceremonial ayahuasca. The interviews were analyzed using thematic analysis. Results Participant reports were organized with key themes including that ayahuasca: led to rapid reductions in ED thoughts and symptoms; allowed for the healing of the perceived root of the ED; helped to process painful feelings and memories; supported the internalization of greater self-love and self-acceptance; and catalyzed spiritual elements of healing. Conclusions The results suggest that ayahuasca may have potential as a valuable therapeutic tool, and further research—including carefully controlled clinical trials—is warranted. Level of evidence Level V, qualitative descriptive study. PubDate: 2020-04-01
Abstract: Purpose When bariatric surgery is performed, a successful outcome is usually described as % total weight lost (EWL) or a change in BMI. These definitions fail to address the importance of post-operative psychosocial adjustment. Previous research has alluded to a ‘mind–body lag’ where the patient’s experienced body feels larger than their physically smaller post-operative body, perhaps as a result of amygdalae conditioning. The purpose of this study is to further investigate this psychological issue and assess its relationship to health locus of control, alexithymia, health quality of life and weight regain in bariatric surgery patients. Methods Forty female bariatric surgery patients between 18 and 30 months post-op completed demographic data, survey instruments and anthropometric testing. Their evolving self-view, health locus of control, tendency toward alexithymic thought, and health quality of life were measured to identify significant relationships. Hermans’ Dialogical Self Theory was used to understand the conflicted self-view of the participants. Results The majority of participants retained an obese view of self despite weight loss. Those who retained an ‘I-obese’ viewpoint were significantly more likely to see external situations and powerful others as controlling their weight, have difficulty identifying their feelings and score significantly lower in vitality, social functioning and mental health. Conclusion Despite losing weight, the majority of participants retained an obese view of self that was significantly associated with a lessened health quality of life. Use of the Evolving Self-View (ESV) exploratory tool may allow early identification of post-operative patients with a prolonged ‘I-obese’ self-view and provide an opportunity for intervention. Level of evidence Level III, cross-sectional case-control study. PubDate: 2020-04-01
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