Im Rahmen des metabolischen Syndroms bei morbider Adipositas kommt es unter anderem zu Imbalancen im autonomen Nervensystem (ANS): ein Missverhältnis von Sympathikus und Parasympathikus (PS) führt zu einer Dysregulation von orexigenen und anorexigenen Hormonen und konsekutiv zu einer weiteren Gewichtszunahme. Diese Arbeit untersucht die Auswirkung von bariatrischen Operationen auf das abdominale ANS anhand des parasympathisch regulierten PPP drei Monate nach Intervention. Die Veränderungen der Imbalance wurden mit Hilfe eines modifizierten Sham Feedings (MSF) ermittelt, bei dem nur die kephale Phase der Nahrungsaufnahme durchlaufen und die Mahlzeiten nicht geschluckt wird. Die PPP-Spiegel im Verlauf des MSF sind daher ausschließlich eine Darstellung des PS. Zusätzlich wurden die Verläufe der Insulin- und Glukosewerte bestimmt. Die PPP-Spiegel der normalgewichtigen Kontrollgruppe sind signifikant höher als die der adipösen Patienten prä- und postoperativ. Die Kurvenverläufe des PPP sind aber zwischen den Gruppen vergleichbar. Somit ist die akute Reaktion des PS auf die Nahrungsaufnahme bei morbider Adipositas zwar unverändert, es zeigt sich aber keine Verbesserung der ANS-Dysfunktion kurz nach Intervention. Die Aufteilung der Patienten in Jüngere und Ältere (verglichen mit dem Durchschnittsalter der Studie) ergibt postoperativ absolut und relativ eine Zunahme der PPP-Spiegel bei den Älteren, während es bei den Jüngeren zu einem Abfall kommt. Bei halbierter Gruppegröße ist die Aussagekraft der Signifikanz jedoch eingeschränkt. Auch ohne diabetische Stoffwechsellage gleichen sich die Insulin- und Glukosewerte der Patienten post-OP denen der Kontrollen an. Eine mögliche Ursache hierfür ist aber nicht nur eine primäre ANS-Verbesserung, denn vor allem in der ersten postoperativen Phase scheint die starke Nahrungsmittelrestriktion mehr Auswirkungen zu haben. Eine spätere Besserung der ANS-Imbalance durch z.B. Gewichtsverlust ist jedoch nicht ausgeschlossen. / The metabolic syndrome in morbid obesity induces, among other things, imbalances in the autonomic nervous system (ANS): a mismatch of the sympathetic and parasympathetic nervous system (PS) leads to a dysregulation of orexigenic and anorexigenic hormones and consecutively to further weight gain. This paper aims to investigate the effect of bariatric surgery on the abdominal ANS determined by parasympathetically regulated pancreatic polypeptide (PPP) three months after the intervention. Changes in imbalance were determined using a modified Sham Feeding (MSF) procedure. Here, the proband is only subjected to the cephalic phase of food intake and meals are not swallowed. The PPP levels over the course of the MSF are therefore a representation of PS-regulation only. Concentrations of insulin and glucose during MSF were also determined. The overall PPP levels of the normal-weight control group are significantly higher than those of the obese patients pre- and postoperatively. However, the PPP curve progressions are not significantly different. The acute PS response to food intake is unchanged in morbid obesity and there is no improvement in ANS dysfunction shortly after bariatric surgery. Dividing the patients into younger and older (compared to the mean age of the group) though results in a postoperative absolute and relative increase in PPP levels in the older, while there is a decrease in the younger. With only half the people per group, the significance of this comparison is limited. Even though the subjects of this study were non-diabetic, the insulin and glucose levels were significantly reduced after the surgery and similar to those of the normal-weight controls. But an improvement in ANS imbalance is not the most likely explanation. In this short time after the operation the restriction of food seems to have a more significant effect. An improvement of ANS imbalance due to e.g. weight loss later on cannot be excluded.

Objective: Weight bias internalization (WBI) is associated with eating disorder psychopathology and non-normative eating behaviors among individuals with overweight and obesity, but has rarely been investigated in prebariatric patients. Based on findings demonstrating a relationship between emotion dysregulation and eating behavior, this study sought to investigate the association between WBI and eating disorder psychopathology as well as non-normative eating behaviors (i.e., food addiction, emotional eating, and eating in the absence of hunger), mediated by emotion dysregulation. Method: Within a consecutive multicenter study, 240 prebariatric patients were assessed using self-report questionnaires. The mediating role of emotion dysregulation was examined using structural equation modeling. Results: The analyses yielded no mediational effect of emotion dysregulation on the association between WBI and eating disorder psychopathology. However, emotion dysregulation fully mediated the associations between WBI and emotional eating as well as eating in the absence of hunger. Further, emotion dysregulation partially mediated the relationship between WBI and food addiction symptoms. Discussion: Prebariatric patients with high levels of WBI are at risk for non-normative eating behaviors, especially if they experience emotion regulation difficulties. These findings highlight the importance of interventions targeting WBI and improving emotion regulation skills for the normalization of eating behavior in prebariatric patients.

Objective: As long-term results of conservative treatment for obesity are discouraging, bariatric surgery is becoming a treatment option for extremely obese adolescents. However, mental and behavioral problems need to be respected when treating this vulnerable target group. Methods: A detailed systematic literature review on pre- and post-operative depressive, anxiety and eating disorder symptoms of adolescent patients was performed in PsychINFO, PubMed and Medline electronic databases. Results: Twelve studies met the inclusion criteria. Although strength of evidence was limited, results suggested that pre-operatively a third of adolescents suffered from moderate to severe depressive disorder symptoms and a quarter from anxiety disorder symptoms, while a substantial number showed eating disorder symptoms. Post-operatively, levels of depressive disorder symptoms significantly improved. Original articles on outcomes of eating and anxiety disorder symptoms after weight loss surgery were not found. Conclusions: Further attention is needed on consistent clinical assessment of mental health disturbances and their consecutive treatment in adolescents. Future research should also focus on psychological and psychosocial predictors of weight loss after bariatric surgery.

Bei der Identifikation von Risikofaktoren für die Entstehung und Aufrechterhaltung von Adipositas wurde in den letzten Jahren zunehmend der Forschungsfokus auf die Persönlichkeitsaspekte des Individuums gerückt. Insbesondere das Zusammenspiel von Impulsivität, defizitärer Emotionsregulation und Reaktivität für Nahrungsreize im Sinne von nahrungsspezifischen Aufmerksamkeitsverzerrungen wurde mit unkontrolliertem Essverhalten in Zusammenhang gebracht, das langfristig zu Gewichtszunahme, Adipositas und Misserfolgen in der Gewichtsreduktionsbehandlung führt. Die Adipositaschirurgie (AC) stellt derzeit die effektivste Behandlung bei schwerer Adipositas dar. Dennoch gibt es Patient*innen, die langfristig einen unzureichenden Behandlungserfolg bezüglich Gewichtsverlust und Reduktion von physischen und psychischen Komorbiditäten nach AC aufweisen. Ziel der vorliegenden Dissertation war es, Patient*innen erstmalig vor und nach AC bezüglich ihrer Impulsivität, Emotionsregulation und nahrungsspezifischen Reaktivität zu subtypisieren und zu prüfen, ob bestimmte Persönlichkeitsprofile mit einer erhöhten allgemeinen und essstörungsspezifischen Psychopathologie assoziiert sind und einen prädiktiven Wert für mittelfristig erfasste gewichts- und gesundheitsbezogene Erfolgsparameter der AC haben. Die jetzigen Studienergebnisse stützen die Annahme, dass insbesondere postoperativ vorhandene Impulsivität und Emotionsdysregulation beim Individuum mittelfristig pathologisches Essverhalten begünstigen, das mit unzureichenden Gesundheits-Outcomes nach AC assoziiert ist. Hingegen konnten Aufmerksamkeitsverzerrungen für visuelle Nahrungsreize nicht in Verbindung mit dem 1-Jahres-Outcome der AC gebracht werden. Vielmehr scheinen Menschen mit schwerer Adipositas und Gewichtsreduktionswunsch visuelle Nahrungsreize in kontrollierten Aufmerksamkeitsprozessen bewusst zu vermeiden.

Research documented the effectiveness of obesity surgery (OS) for long-term weight loss and improvements in medical and psychosocial sequelae, and general cognitive functioning. However, there is only preliminary evidence for changes in attentional processing of food cues after OS. This study longitudinally investigated visual attention towards food cues from pre- to 1-year post-surgery. Using eye tracking (ET) and a Visual Search Task (VST), attentional processing of food versus non-food cues was assessed in n = 32 patients with OS and n = 31 matched controls without weight-loss treatment at baseline and 1-year follow-up. Associations with experimentally assessed impulsivity and eating disorder psychopathology and the predictive value of changes in visual attention towards food cues for weight loss and eating behaviors were determined. During ET, both groups showed significant gaze duration biases to non-food cues without differences and changes over time. No attentional biases over group and time were found by the VST. Correlations between attentional data and clinical variables were sparse and not robust over time. Changes in visual attention did not predict weight loss and eating disorder psychopathology after OS. The present study provides support for a top-down regulation of visual attention to non-food cues in individuals with severe obesity. No changes in attentional processing of food cues were detected 1-year post-surgery. Further studies are needed with comparable methodology and longer follow-ups to clarify the role of biased visual attention towards food cues for long-term weight outcomes and eating behaviors after OS.

Zur Behandlung von Adipositas Grad III wird die chirurgische Therapie als einzig wirksame Strategie angesehen. Randomisierte Studien zum Vergleich von Adipositaschirurgie mit strukturierten konservativen Therapien liegen bisher nicht vor. Wir verglichen die Wirksamkeit beider Ansätze und randomisierten 64 adipöse Patienten (34 konservativ, 30 chirurgisch). Die chirurgische Therapie beinhaltete eine Magenband-Implantation, die konservative Therapie Ernährungsumstellung (-600 kcal/Tag; 25% Fettkalorien), Bewegungstherapie (2x45 Minuten Aqua-Gymnastik /Woche), verhaltenspsychologische Sitzungen und medikamentöse Therapie (Sibutramin 10 mg/Tag). Auswertbare Daten lagen von 20 konservativ und 10 chirurgisch behandelten Patienten vor. Die Körpergewichtsreduktion nach 1 Jahr betrug 13±9% in der konservativen und 15±3% in der chirurgischen Gruppe (p=ns). 90% des Gewichtsverlustes der konservativen Gruppe erfolgte in den ersten 4 Monaten. In beiden Gruppen besserten sich NBZ, HbA1c, Glucose-/Insulinfläche (AUC) des oGTT ähnlich. Wobei AUCIns der operativen Gruppe zunächst anstieg, während in der konservativen Gruppe eine deutliche signifikante Reduktion um 21%; (Wechselwirkung: p=0,01) resultierte. Die chirurgisch versorgten Patienten zeigten eine ausgeprägtere Reduktion der Nüchtern-Insulinresistenz (konservativ -26±33%, -38±16% chirurgisch); (p=ns). Die gemittelte Insulinsensitivität verbesserte sich mehr in der konservativen Gruppe. In beiden Gruppen konnte die antihypertensive und antidiabetische Therapie reduziert werden. Eine intensive konservative Therapie bewirkt bei Patienten mit Adipositas Grad III nach 1 Jahr eine ähnliche Gewichtsreduktion wie die Implantation eines Magenbandes. Beide Behandlungsstrategien verbessern den Glukosestoffwechsel, tendenziell größere Verbesserung postprandial in der konservativen Gruppe. Somit sollte auch bei Patienten mit hochgradiger Adipositas initial ein konservativer Behandlungsversuch unternommen werden. / Surgical treatment has been advocated as the only effective means to treat obesity stage III. However, randomized studies comparing surgical methods with structured conservative treatment approaches have not been conducted. We compared the efficacy of both strategies in 64 obese patients and randomized 34 patients in conservative therapy, 30 patients in surgical therapy. Surgical therapy included implantation of an adjustable gastric band. Conservative therapy incorporated dietary adjustment (-600 kcal/day; 25% fat calories), physical exercise (2x45 minutes exercise in water/week), psychological behavioral counseling and pharmacological therapy (sibutramine 10 mg/day). The full data set was obtained in 20 conservative and in 10 surgical treated patients. After one year, body weight had decreased 13±9% in the conservative and 15±3% in the surgical group (p=ns). In contrast to gastric banded patients 90% of weight loss in conservative group was happened in the fist 4 month. Fasting blood glucose, HbA1c, area under the curveGlucose/Insulin improved similarly in both groups. Whereas for the time of beginning in gastric banded group AUCIns increased, in conservative group decreased (-21%; interaction: p=0.01). Surgically treated patients exhibited a slightly greater reduction in fasting insulin resistance (conservative -26±33%, -38±16% surgical; p=ns). In contrast, averaged insulin sensitivity tended to improve slightly more in the conservative group. Antihypertensive and antidiabetic therapy could be reduced in both groups. Intense conservative therapy in patients with obesity stage III is over one year as effective as surgical therapy with an adjustable gastric band in reducing body weight. Both strategies improve glucose metabolism with a greater tendency in postprandial glucose metabolism in conservative group. Thus, severely obese patients should at least initially be submitted to a treatment trial with intense conservative therapy.

Objective: As long-term results of conservative treatment for obesity are discouraging, bariatric surgery is becoming a treatment option for extremely obese adolescents. However, mental and behavioral problems need to be respected when treating this vulnerable target group. Methods: A detailed systematic literature review on pre- and post-operative depressive, anxiety and eating disorder symptoms of adolescent patients was performed in PsychINFO, PubMed and Medline electronic databases. Results: Twelve studies met the inclusion criteria. Although strength of evidence was limited, results suggested that pre-operatively a third of adolescents suffered from moderate to severe depressive disorder symptoms and a quarter from anxiety disorder symptoms, while a substantial number showed eating disorder symptoms. Post-operatively, levels of depressive disorder symptoms significantly improved. Original articles on outcomes of eating and anxiety disorder symptoms after weight loss surgery were not found. Conclusions: Further attention is needed on consistent clinical assessment of mental health disturbances and their consecutive treatment in adolescents. Future research should also focus on psychological and psychosocial predictors of weight loss after bariatric surgery.

Objective: Weight bias internalization (WBI) is associated with eating disorder psychopathology and non-normative eating behaviors among individuals with overweight and obesity, but has rarely been investigated in prebariatric patients. Based on findings demonstrating a relationship between emotion dysregulation and eating behavior, this study sought to investigate the association between WBI and eating disorder psychopathology as well as non-normative eating behaviors (i.e., food addiction, emotional eating, and eating in the absence of hunger), mediated by emotion dysregulation. Method: Within a consecutive multicenter study, 240 prebariatric patients were assessed using self-report questionnaires. The mediating role of emotion dysregulation was examined using structural equation modeling. Results: The analyses yielded no mediational effect of emotion dysregulation on the association between WBI and eating disorder psychopathology. However, emotion dysregulation fully mediated the associations between WBI and emotional eating as well as eating in the absence of hunger. Further, emotion dysregulation partially mediated the relationship between WBI and food addiction symptoms. Discussion: Prebariatric patients with high levels of WBI are at risk for non-normative eating behaviors, especially if they experience emotion regulation difficulties. These findings highlight the importance of interventions targeting WBI and improving emotion regulation skills for the normalization of eating behavior in prebariatric patients.