ASMBS 2011 - Day 1

So here I am... ASMBS!!! I have wanted to attend the ASMBS conference for three years now! I remember learning that anyone who was anyone in the Bariatric Community goes to ASMBS and I wanted to go too!

I didn't sleep last night because we all know I am a procrastinator. I was awake packing and had to make a run tot he office to put the finishing touches on a presentation for a perspective employer :-) I got to the airport at 4:15 in the am. JFK, terminal 5, Jetblue! The ONLY way to fly! On the plane by 5:45am and passed out before the plane even took off. I woke up about 20 minutes before we landed. Thank goodness for those two hours of sleep. Landed in Sunny beautiful Orlando, FL at 8:45am, picked up my rental car and headed for the hotel.

I was hunting for a Starbucks but there was no one to be found... Orlando, for a touristy town is definitely lacking in the Starbucks department! Made it to the hotel, changed and ran out to take the 30 minute drive tot he Gaylord Palms Conference center in Kissimmee, FL. This place is HUGE!!!! It's also gorgeous!!! I parked my rent-a-compact and headed in to find the registration booth.

I had an hour before my first class so I grabbed some ASMBS sponsored lunch! Dear ASMBS, thank you so very much for ensuring that I eat at least one meal a day because the cost of your conference has me wiped!

Onto my first class... Masters in Behavioral Health Part One... The Pre-op Eval. I totally thought this was going to be like a psych or social work class I took in school. Boy was I wrong. 3 Abstracts... All talking about using various psychological scales during the pre-op eval.

Abstract 1.
Construct Validity and Clinical Utility of the MMPI-2-RF Among Bariatric Surgery Candidates.
By: Anthony Tarescavage
While I was able to follow this abstract, Anthony spoke very fast and zipped through his slides. Once he started talking about Standard Deviation I have to admit my mind kinda zoned out. I tried to be there I really did but I am not a fan of research. I don't mind gathering data but once it comes time to analyze it... That's just not my strength. The basic jist of the talk (at least what I got from it, is that the MMPI-2-RF is a restructured clinical scale which encompasses 51 different scales in 338 questions. Each of these 338 items are taking from the original MMPI 2 which is initially over 500 questions. I think he was trying to say that the data showed a positive correlation between certain items and either a positive or negative outcome post-operatively. To be honest, I personally didn't feel that the data presented was conclusive enough to show positive correlation between the MMPI 2 RF and post-op outcomes. But then again perhaps I was just too zoned out to get it.

Abstract 2.
Differences in Psychological Profiles of Sugar Cravers.
By: Kerry B. Ferguson
The basic premise here was that many patients pre-op, self reported during their psych eval that they were Sugar Cravers. Such scales were used as the Carb Addiction Scale and the BDI (depression scale) and the results showed that 75% of sleeve and bypass patients self reported that after surgery their cravings for sugar disappeared. There was also a positive correlation between Depression and Sugar Cravings. I personally don't think enough research was done here. The presenter neglected to provide a clear and universal definition of what a Sugar Craver is, so therefore there is really no baseline from which to measure. I think there is much more to be discovered here.

Abstract 3.
SCL-90R Profiles and Weight Loss Outcomes Among Bariatric Surgery Candidates.
By: Kathleen Ashton
Yet another talk on the benefits of using certain psychological scales to predict outcome of a bariatric surgery candidate. The findings here stated that Patients with a positive clinical profile lost 9% less than their negative clinical profiled peers. This was prob one of the most well thought out and interesting of the abstracts with regard to the psychological scales being used as a predictor for post-operative weight loss outcome.

These three abstracts led to a very interesting discussion about the place of mental health professionals and the pre-op psych eval in pre-op patient care. There seems to be an unspoken yet widely accepted belief that Mental Health professionals are supposed to be able to predict, based on the evaluation, and tell the surgeon, if a particular patient is "good candidate" for bariatric surgery. The unspoken agreement is that a good candidate is one who will comply with the rules, and lose and maintain a certain percentage of their excess weight. Not for nothing, I can't tell you that! No one can. We can give our best guess but really it's a 50/50 shot. Either the patient will or wont. I think the mental health professionals in this field along with the ASMBS need to change the way the pre-op psych eval is viewed. Instead of it being a predictive factor, perhaps we can view it as more of an intake in which we use psychological scales to best gauge a post-op treatment plan for each individual patient. I think we need to require as part of a patients complete treatment of obesity, that patients have 6 sessions of therapy after bariatric surgery and more if needed. As one surgeon got up and said during this discussion, his patients who have severe and persistent mental illnesses like schizophrenia, who engage in regular weekly therapy and medication management are some of his most successful and compliant patients. GO FIGURE! What do you think? Do you think we should try to predict outcomes or help patients attain the outcomes they desire? What changes would you make?

The discussion turned to billing codes for all of these psych evals and I left. I cannot and do not accept insurance and listening to the fees some of these folks charge makes me feel like I am selling myself short.

So I went to hang out at the OAC booth with my good friend Jeff Haaga! Have you all joined the Obesity Action Coalition yet? They are having a half price membership sale here at ASMBS and raffling off 3 Apple TVs! I personally hold 2 memberships to the OAC. a regular membership and a professional one. I spoke to Jeff about more ways I could get involved. After his release from booth duty and we sold a few memberships, I joined him for dinner to discuss some new possibilities for me. I have been invited to join a committee within the OAC. I have a few choices to consider. Once I know more I will fill you all in :-)

After dinner, I headed over to Beth and Andrea's hotel to say a quick hello and girlie banter a bit. On the way back to my hotel, I finally found me a Starbucks!!! Woohoo! Got my iced latte and headed back tot he hotel. Long day... but well worth it! I am looking forward to sharing tomorrows sessions with you and all of the extra curricular invite only parties and cocktail hours! Tomorrow night is the OAC's member only party. I look forward to meeting the board members and those that make the OAC tick.

'til tomorrow friends,
xoxo
Sleeve Pixie

Is Food an Addiction?

The Diagnostics and Statistical Manual (DSM IV-tr) lists a few levels of what we have come to know as addiction. Substance ABUSE and DEPENDENCY…  

The criteria for substance abuse as listed in the DSM IV-tr is... 

A maladaptive pattern of abuse leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:

1. Recurrent use resulting in failure to fulfill major role obligations at work, school, or home.
2. Recurrent use in situations in which it is physically hazardous. 
3. Recurrent related legal problems.
4. Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
5. These symptoms must never have met the criteria for substance dependence.

Ok so I can easily stretch food to fit into the above description of substance abuse… I say STRETCH because realistically, most of these wont happen to a foodie. Perhaps we may meet the criteria in Number 4 but I am willing to bet that most if not ALL of us can cancel out Food ABUSE because we meet the Criteria for dependence. 

The criterion for Substance DEPENDENCE however, I don’t need to stretch at all to fit. The criteria for substance dependence as listed in the DSM IV-tr is...

A maladaptive pattern of use, leading to clinically significant impairment or distress, as manifested by three or more of the following seven criteria, occurring at any time in the same 12-month period:

1. Tolerance, as defined by either of the following:
1. A need for markedly increased amounts to achieve intoxication or desired effect. (check)
2. Markedly diminished effect with continued use of the same amount of substance. (When I was little I ate a cookie, pre-op I ate a whole damn box!)
2. Withdrawal, as defined by either of the following:
1. The characteristic withdrawal syndrome… Substance is taken to relieve or avoid withdrawal symptoms. (Check: I know I am a bitch when carb detoxing and even worse when sugar detoxing)
3. Substance is often taken in larger amounts or over a longer period than was intended. (Check)
4. There is a persistent desire or there are unsuccessful efforts to cut down or control substance use. (CHECK!! Every failed diet in the last 15 yrs!)
5. A great deal of time is spent in activities necessary to obtain substance, use substance or recover from its effects. (Check! How many of us have spent countless hours thinking about whats for lunch, where we are going to go out to eat, what we will eat when we get there and how we will burn off the meal afterwards)
6. Important social, occupational, or recreational activities are given up or reduced because of substance use. (Check: I know I didn't want to be seen at certain social functions at 391lbs. The clothing selection was limited, what would people think, would I be able to walk there from the car etc... etc…)
7. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (Check! So many of us continue our negative eating patterns knowing we may die from our high cholesterol, high blood pressure, diabetes etc etc)

Ok so just saying, to qualify as substance dependence, you need 3!!! I got ALL 7!!!! How many did you get??

**The criteria above was taken word for word as the criterion for Alcohol.

So are you convinced yet that food is an addiction? No of course you aren't! You want the SCIENTIFIC PROOF! Ok Ok. As always I come prepared! I am sure you have heard me rant about this before. Research shows that carbohydrates and sugar react with the same neuron receptors as OPIATES! Opiates are drugs like:

• Opium
• Morphine
• Codeine
• Heroin

Don't believe me... read it for yourself HERE and HERE. And here are a few quotes from a a few studies I have used in the past. I cannot link to because I got it through my Adelphi Library. But you can find the study if you would like to pay for it. 

Research done by Bruinsma and Taren (1999), shows that, chocolate may evoke similar psychopharmacologic and behavioral reactions in susceptible persons as opiates. A review of the literature on chocolate cravings indicates that the hedonic appeal of chocolate (fat, sugar, texture, and aroma) is likely to be a predominant factor in such cravings. Other characteristics of chocolate, however, may be equally as important contributors to the phenomena of chocolate cravings. Chocolate may be used by some as a form of self-medication for dietary deficiencies (eg, magnesium) or to balance low levels of neurotransmitters involved in the regulation of mood, food intake, and compulsive behaviors (eg, serotonin and dopamine). Chocolate cravings are often episodic and fluctuate with hormonal changes just before and during the menses, which suggests a hormonal link and confirms the assumed gender-specific nature of chocolate cravings. (p. 1249) Another interesting finding on Chocolate suggests that addiction for chocolate may stem from the same receptors in the brain as opiates. Naloxone, found in chocolate attaches to opiate receptors in the brain. “Endogenous opiates, are involved in drug addictions and are responsible for the body's response to pleasure, stress, and pain. A study investigating this hypothesis found that infusions into rats of the opiate antagonist naloxone diminished taste preferences for high-fat and sweet foods and selectively suppressed consumption of these foods; in contrast, rats infused with morphine, an opiate agonist, increased their fat intake.”

** Bruinsma, K., & Taren, D. L. (1999). Chocolate: Food or Drug? Journal of the American Dietetic Association, 9

Avena, Rada, and Hoebe (2008), shows that intermittent sugar access also acts by way of opioids in the brain. There are changes in opioid systems such as decreased enkephalin mRNA expression in the accumbens. Signs of withdrawal seem to be largely due to the opioid modifications since withdrawal can be obtained with the opioid antagonist naloxone.(p.887)

**Avena, N. M., Rada, P., & Hoebel, B. G. (2008). Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neurosci Biobehav Rev, 32(1), 20-39.

Withdrawal symptoms of opiates include:

• Agitation
• Anxiety
• Muscle aches
• Increased tearing
• Insomnia
• Runny nose
• Sweating
• Abdominal cramping
• Diarrhea
• Dilated pupils
• Goose bumps
• Nausea
• Vomiting

Which ones do you get? I get Anxiety and Agitation big time. But I have also had the Muscle Aches and Diarrhea. We are not created equal. 

So how about now... I have given you solid evidence and research to back my claim that food IS an addiction... What are your thoughts?

xoxo

Sleeve Pixie