| 1. |
- Karlsson, Jan, 1950, et al.
(författare)
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Psychometric properties and factor structure of the Three-Factor Eating Questionnaire (TFEQ) in obese men and women. Results from the Swedish Obese Subjects (SOS) study.
- 2000
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Ingår i: International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. - 0307-0565. ; 24:12, s. 1715-25
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the construct validity of the Three-Factor Eating Questionnaire (TFEQ) in obese men and women. SUBJECTS: A total of 4377 middle-aged, obese subjects in the Swedish Obese Subjects (SOS) study. METHODS: The total sample was randomly split into two data subsets and psychometric testing was performed separately in each sample. Multitrait/multi-item analysis was conducted to test scaling assumptions and factor analysis was used to test the factor structure. Measures of mental well-being (MACL, HAD) were used for testing criterion-based validity. RESULTS: The Cognitive Restraint factor was consistently reproduced and scaling analysis demonstrated strong item-scale discriminant validity, while the item-scale convergent validity was unsatisfactory. The internal structure of the Disinhibition scale was weak. Most Disinhibition and Hunger items grouped in one global factor labeled Uncontrolled Eating. A third cluster containing items on Emotional Eating was also identified. The obtained three-factor structure was cross-validated and replicated across subgroups by gender, age and BMI. CONCLUSION: The original TFEQ factor structure was not replicated. A short, revised 18-item instrument was constructed, representing the derived factors of Cognitive Restraint, Uncontrolled Eating and Emotional Eating. The most efficient items were used to boost both the convergent and discriminant validity of the scales.
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| 2. |
- Karlsson, Jan, 1950, et al.
(författare)
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Psychosocial functioning in the obese before and after weight reduction: construct validity and responsiveness of the Obesity-related Problems scale.
- 2003
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Ingår i: International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. - : Springer Science and Business Media LLC. - 0307-0565. ; 27:5, s. 617-30
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The Obesity-related Problems scale (OP) is a self-assessment module developed to measure the impacts of obesity on psychosocial functioning. Our principal aim was to evaluate the construct validity and responsiveness of the OP scale. Our specific aims were to test: (1). the psychometric performance of OP; (2). if OP scores differed by gender and weight category; (3). if OP scores are inversely related to mental well-being; (4). if weight reduction in the obese is accompanied by improvements in psychosocial functioning (OP). SUBJECTS: Four samples were used: 6863 subjects in the SOS cross-sectional study; 2128 in the SOS intervention study; 1017 nonobese in the SOS reference study; and 3305 obese subjects in the XENDOS study. MEASUREMENTS: Psychosocial functioning was measured by OP. Overall mood was measured by MACL. Anxiety and depression symptoms were measured by HAD. RESULTS: Psychometric testing provided strong support for the construct validity of OP. Factor analysis confirmed the homogeneity of the construct and multitrait/multi-item scaling analysis demonstrated strong item-convergent/discriminant validity. Reliability coefficients were high and floor and ceiling effects were small. Psychometric results were cross-validated and replicated in subgroups by gender, age and body mass index (BMI). As expected, large differences in OP were observed between obese and nonobese (P<0.0001). Obese women reported more weight-related psychosocial problems than obese men (P<0.0001). Psychosocial disturbances (OP) among the obese were significantly related to poor mood (MACL; P<0.0001) and anxiety and depression symptoms (HAD; P<0.0001). Change in OP over time was strongly correlated with weight loss (P<0.0001). A distinct dose-response effect between weight reduction and improvements in OP was demonstrated. Scores on psychosocial functioning (OP) and mental well-being (MACL, HAD) in nonobese (BMI<30) surgical patients at 4-y follow-up were equal to scores observed in nonobese reference subjects (NS). CONCLUSION: OP is a psychometrically valid obesity-specific measure suitable for evaluating HRQL effects of obesity interventions. The negative impact of obesity on psychosocial functioning is considerable and disturbances are connected with poor mental well-being. Weight reduction in the obese is followed by improvements in both psychosocial functioning and mental well-being.
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| 3. |
- Karlsson, Jan, 1950, et al.
(författare)
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Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study.
- 2007
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Ingår i: International journal of obesity (2007). - : Springer Science and Business Media LLC. - 0307-0565 .- 1476-5497. ; 31:8, s. 1248-61
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To examine trends and effects of weight loss treatment on health-related quality of life (HRQL) in the severely obese over 10 years. DESIGN: Swedish obese subjects (SOS) intervention study is a controlled, longitudinal trial of the health effects of weight loss in the severely obese. Subjects: A total of 655 of 851 surgically treated and 621 of 852 conventionally treated obese men (body mass index, BMI>or=34) and women (BMI>or=38) who completed 10 years of the study. MEASUREMENTS: HRQL was assessed before treatment and after 0.5, 1, 2, 3, 4, 6, 8 and 10 years. RESULTS: HRQL change during the 10-year observation period largely followed phases of weight loss, weight regain and weight stability. Improvements and deteriorations in HRQL were associated with the magnitude of weight loss or regain, except regarding anxiety. Peak improvements in the surgical group were observed during the first year of weight loss, whereas the weight regain phase (mainly between 1- and 6-year follow-up) was accompanied by a gradual decline in HRQL. The period from 6- to 10-year follow-up was characterized by relatively stable observations in both weight and HRQL. At 10 years, net gains were noted in all HRQL domains compared to baseline. Comparisons of treatment effects on HRQL in the surgical vs conventional group after 10 years showed significantly better outcome in the surgical group on current health perceptions, social interaction, psychosocial functioning and depression, whereas no significant differences were found for overall mood and anxiety. Long-term results of the study suggest that a maintained weight loss of about 10% is sufficient for positive long-term effects on HRQL, a limit that was reached in about two-thirds of the surgically treated patients who completed 10 years of the study. CONCLUSION: Long-lasting weight reduction in the severely obese has a general long-standing positive outcome on HRQL. Bariatric surgery is a favorable option for the treatment of severe obesity, resulting in long-term weight loss and HRQL improvements in a majority of patients. However, difficulties among some surgical patients to control and maintain weight loss over time should not be ignored. Future research should study if the long-term efficacy of bariatric surgery may be further enhanced by implementing lifestyle modification techniques in the postoperative management of patients.
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| 4. |
- Lindroos, Anna-Karin, 1958, et al.
(författare)
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Dietary intake in relation to restrained eating, disinhibition, and hunger in obese and nonobese Swedish women
- 1997
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Ingår i: Obesity Research. ; 5, s. 175-182
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Tidskriftsartikel (refereegranskat)abstract
- Department of Internal Medicine, Göteborg University, Sweden. The aims of this study were to: describe dietary intakes of obese and nonobese middle-aged women using a validated food frequency questionnaire; to assess dietary restraint, disinhibition, and hunger by the three factor eating questionnaire (TFEQ) in obese and nonobese samples and determine which of the factors are independently associated with obesity; and to examine correlations between selected nutritional variables and the TFEQ factors. Subjects studied included 179 obese Swedish women (BMI > 32) and 147 nonobese population-based controls (BMI < 28). Age-adjusted mean energy intake was significantly higher in obese women (2730 +/- 78 vs. 2025 +/- 85 kcal, p < 0.0001). In absolute and relative terms, fat intake was higher and alcohol intake was lower in the obese subjects. Disinhibition was the strongest TFEQ factor independently differentiating the obese and nonobese states, i.e., after adjustment for restraint and hunger. Within the obese sample, strong associations were seen between energy intake and disinhibition (p = 0.0005) and hunger (p = 0.0004). The association between energy intake and restrained eating was negative and weaker (p = 0.04). No such associations were seen in nonobese women. Thus, using a dietary instrument that is valid and unbiased with respect to obesity, strong psychological correlates, possibly causal, of variability in energy intake were detected in middle-aged women with obesity. Disinhibition is associated with both obesity and high-energy intakes and is therefore an important factor to consider in the treatment of women with obesity. PMID: 9192390 [PubMed - indexed for MEDLINE]
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| 5. |
- Rydén, Anna, 1957, et al.
(författare)
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Obesity-related coping and distress and relationship to treatment preference.
- 2001
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Ingår i: The British journal of clinical psychology / the British Psychological Society. - 0144-6657. ; 40:2, s. 177-88
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The primary purpose was to define obesity-related strategies for coping with psychological problems connected with obesity. We also wanted to identify obesity-related distress and explore the effect of coping on distress. Thirdly, we wanted to investigate differences in coping and distress related to choice of surgery or conventional treatment. DESIGN: Cross-sectional data from patients in the Swedish Obese Subjects (SOS) intervention study. METHODS: An obesity-related questionnaire concerning coping and distress was created and evaluated in 2510 patients from the SOS study, using multitrait, exploratory and confirmatory factor analysis procedures. RESULTS: Three coping factors were defined. Social Trust and Fighting Spirit were problem-focused, whereas Wishful Thinking was emotion-focused. Surgical candidates displayed lower levels of problem-focused and higher levels of emotion-focused coping. We also identified two distress factors: Intrusion and Helplessness. Wishful Thinking was positively related to distress, and Social Trust and Fighting Spirit were inversely related, thus explaining the higher levels of distress reported by the surgical candidates. CONCLUSIONS: In our sample, emotion-focused coping proved maladaptive and was associated with increased distress. Problem-focused coping, however, was adaptive and associated with reduced distress. These findings partly explain psychological morbidity and should be taken into consideration in the treatment of obese people.
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| 6. |
- Sjöström, Lars, et al.
(författare)
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Effects of bariatric surgery on mortality in Swedish obese subjects.
- 2007
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Ingår i: The New England journal of medicine. - 1533-4406. ; 357:8, s. 741-52
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality. METHODS: The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%). RESULTS: The average weight change in control subjects was less than +/-2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastroplasty, 25%; and banding, 20%. After 10 years, the weight losses from baseline were stabilized at 25%, 16%, and 14%, respectively. There were 129 deaths in the control group and 101 deaths in the surgery group. The unadjusted overall hazard ratio was 0.76 in the surgery group (P=0.04), as compared with the control group, and the hazard ratio adjusted for sex, age, and risk factors was 0.71 (P=0.01). The most common causes of death were myocardial infarction (control group, 25 subjects; surgery group, 13 subjects) and cancer (control group, 47; surgery group, 29). CONCLUSIONS: Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.
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| 7. |
- Sjöström, Lars, et al.
(författare)
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Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery.
- 2004
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Ingår i: The New England journal of medicine. - 1533-4406. ; 351:26, s. 2683-93
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk, but whether these benefits persist over time is unknown. METHODS: The prospective, controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects. We now report follow-up data for subjects (mean age, 48 years; mean body-mass index, 41) who had been enrolled for at least 2 years (4047 subjects) or 10 years (1703 subjects) before the analysis (January 1, 2004). The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years. RESULTS: After two years, the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group (P<0.001). After 10 years, the weight had increased by 1.6 percent and decreased by 16.1 percent, respectively (P<0.001). Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period. Two- and 10-year rates of recovery from diabetes, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, hypertension, and hyperuricemia were more favorable in the surgery group than in the control group, whereas recovery from hypercholesterolemia did not differ between the groups. The surgery group had lower 2- and 10-year incidence rates of diabetes, hypertriglyceridemia, and hyperuricemia than the control group; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable. CONCLUSIONS: As compared with conventional therapy, bariatric surgery appears to be a viable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolemia, amelioration in risk factors that were elevated at baseline.
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| 8. |
- Sjöström, Lars, et al.
(författare)
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Swedish obese subjects (SOS). Recruitment for an intervention study and a selected description of the obese state
- 1992
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Ingår i: International Journal of Obesity. ; 19, s. 465-479
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Tidskriftsartikel (refereegranskat)abstract
- Department of Medicine, Sahlgren's Hospital, University of Göteborg, Sweden. SOS (Swedish obese subjects) is an on-going intervention trial designed to determine whether the mortality and morbidity rates among obese individuals who lose weight by surgical means (gastric banding, vertical banded gastroplasty and gastric by-pass) differ from the rates associated with conventional treatment. For this purpose, the study is recruiting a sample of obese men and women who constitute a registry of potential subjects from which the participants are drawn. Eligibility criteria for participation in the registry were: age at application 37-57 years and BMI greater than or equal to 34 kg/m2 for men and greater than or equal to 38 kg/m2 for women. Before receiving a health examination, all patients complete extensive questionnaires on current and past health status, utilization of medical care and medications, socio-economic status, psychological profiles, dietary habits, physical activity, weight history, and familial disposition to obesity. Each surgical case is matched to its optimal control in the registry, to ensure that the two groups do not differ systematically with respect to any of 18 matching variables that may affect prognosis. The first 1006 subjects included in the registry have been studied with respect to morbidity and compared with on-going population studies of men and women in Göteborg, Sweden. The relative risks of prevalent disease and symptoms associated with obesity in 50-year-old males and females respectively were 4.3 and 4.7 (dyspnoea), 14.7 and 11.8 (angina), 6.3 (myocardial infarction, males only), 2.1 and 4.5 (hypertension), 5.2 and 6.6 (diabetes), 4.6 and 26.1 (claudication) and 1.7 and 1.8 (gall bladder disease). Correspondingly, obese males and females display elevations of systolic and diastolic blood pressure, fasting glucose, insulin, triglyceride, and uric acid levels. However, total cholesterol was not increased in obese males and was in fact significantly lower in obese compared with reference women. HDL-cholesterol was lower in obese than reference men (data were not available in reference women). The rate of taking sick pensions was over twice as high in SOS obese patients than in population controls. Finally, comparison of measurements with self-reported prevalence estimates revealed a considerable amount of previously undiagnosed hypertension and diabetes in the obese subjects. These data suggest that the excess health risks associated with obesity may not be fully appreciated. PMID: 1322873 [PubMed - indexed for MEDLINE]
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