Doctor of Philosophy, The Ohio State University, 2022, Human Ecology: Human Development and Family Science

According to the American Society of Metabolic and Bariatric Surgery (ASMBS) clinical practice guidelines, all patients seeking bariatric surgery are required to have a preoperative psychological evaluation. The purpose of the psychological evaluation is to assess current and untreated mental health diagnoses, disordered eating, substance use and psychosocial history prior to surgery (Mechanick et al., 2020). However, there is no clear guidance on how these areas should be assessed within the evaluation. These guidelines also do not provide guidance on how providers should assess family/relational contexts that may also influence the patients' ability to modify and maintain health behaviors. This is critical information that is needed to establish consistency of the preoperative psychological evaluation process between centers to ensure equity for bariatric patients in the evaluation process between centers. This current dissertation presents the results of three studies which investigated associations between psychological evaluation pass/delay rates, demographics, current diagnoses (mental health, disordered eating, substance use), postoperative outcomes, impairment/no impairment on that piloted relational screener, and whether a patient completed the behavioral health consultation once screening as impaired. It also explored the preliminary feasibility of piloting a brief relational screener alongside the standard psychological evaluation and referral pathways. The first study provides evidence about which mental health, disordered eating, and substance use diagnoses associate with patient pass and delay rates from the bariatric surgery preoperative psychological evaluation. It also investigated reasons, recommendations, and referrals for delay and denial after the postoperative psychological evaluation. Significant associations between pass/delay rates and demographics, current mental health treatment, and having a current mental health, disordered (open full item for complete abstract)

Committee: Keeley Pratt (Advisor); Natasha Slesnick (Committee Member); Ashleigh Pona (Committee Member); Brian Focht (Committee Member); Lorraine Wallace (Committee Member) Subjects: Health Sciences; Psychotherapy; Social Psychology

Doctor of Philosophy, The Ohio State University, 2020, Biomedical Sciences

With over one-third of US adults considered obese and an even larger proportion of adults and children being classified as overweight, the prevention and management of obesity has never been more crucial. The burden associated with obesity and its related comorbidities (ORC), including type 2 diabetes (T2DM), cardiovascular disease (CVD), hypertension (HTN), and obstructive sleep apnea (OSA), is tremendous, both in terms of direct costs to the healthcare system and indirect costs associated with decreased productivity. Despite this burden, there are relatively few treatments available for obesity. Currently, bariatric surgery (BS) is the most effective treatment modality for obesity and ORC with laparoscopic Roux-en Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) being the two most commonly performed procedures. Numerous studies support the clinical superiority of BS over intensive medical weight loss, with many patients experiencing upwards of 60% excess body weight loss (EBWL) and complete remission of T2DM and HTN within two years of BS. For these reasons, along with the decreasing morbidity and mortality, the number of BS has exponentially increased during this time to meet the demand for this important, life-saving procedure. Contiguous with the rise of surgical weight loss, our understanding of the pathophysiology of obesity and adipose tissue physiology has significantly expanded. The Hsueh laboratory has been instrumental in delineating the interconnection between the adipocyte and adipose tissue inflammation in obesity. Pivotal studies in murine models demonstrated that visceral adipose tissue is significantly more inflamed following high fat diet and is characterized by reductions in immunosuppressive regulatory T cells (Tregs) and increased pro-inflammatory M1-like macrophages, T helper Type 1 cells (Th1s), and neutrophils as compared to chow fed controls. Furthermore, murine adipocytes become pro-inflammatory immune antigen-pre (open full item for complete abstract)

Committee: Willa Hsueh MD (Advisor); Ginny Bumgardner MD PhD (Committee Member); Earl Harrison PhD (Committee Member); Wael Jarjour MD (Committee Member); Sabrena Noria MD PhD (Committee Member) Subjects: Biomedical Research; Health Care; Immunology; Medicine; Nutrition; Surgery

PHD, Kent State University, 2009, College of Nursing

Bariatric surgery, such as gastric bypass surgery (GBS) and laparoscopic gastric banding (Lap-band), has emerged in response to the epidemic of obesity which is now the leading cause of preventable death in the United States (U.S.),second only to smoking. Although the majority of bariatric surgical patients experience successful outcomes, the overall failure rate (those who fail to lose weight or regain more than 50% of their excess body weight lost (Deitel, 2001; Halverson,1981)) of bariatric surgeries is approximately 20% (Benotti & Forse, 1995; Rusch & Andris, 2007). Research has been done which studied the physiological issues related to this surgery; however, little is known about possible psychological and sociological factors that influence weight loss and maintenance in post-operative bariatric patients. While there is research that has identified self-efficacy as influencing weight loss maintenance in medical weight loss programs, to date there is no published research linking the construct of self-efficacy to weight loss maintenance in bariatric patients. Therefore, the purpose of this study was to examine the role of self-efficacy on weight loss maintenance in post-operative bariatric surgical patients. This study was guided by social cognitive theory of which self-efficacy is an important construct and incorporated a descriptive, correlational design. A study questionnaire was administered to 91 bariatric patients from two bariatric surgical centers in Northeast Ohio. Descriptive statistics, correlation, and multiple regression were used to answer the research questions. Findings revealed that of all study variables only self-efficacy was found to be associated with weight loss maintenance in multivariate regression (p > 0.001) and explained 41% of the variance in the regression model. This study represents the first research done in nursing to find a significant relationship between level of self-efficacy and a bariatric patient's ability to mai (open full item for complete abstract)

Committee: Ruth Ludwick PhD (Committee Co-Chair); Carol Sedlak PhD (Committee Co-Chair); Cynthia Capers PhD (Committee Member); Cynthia Symons DEd (Committee Member); Timothy Chandler PhD (Committee Member) Subjects: Nursing

Doctor of Psychology (PsyD), Wright State University, 2016, School of Professional Psychology

According to the World Health Organization and National Institutes of Health, obesity is a global health problem. Worldwide, obesity is the fifth-leading cause of death. Weight loss surgeries such as gastric banding, sleeve gastrectomy, and gastric bypass surgery have become increasingly popular methods to manage intractable obesity in the United States. Such surgeries have inherent risks, both medical and psychosocial, and as a result, candidates for weight loss surgery routinely undergo pre-surgical evaluations to determine their suitability for weight loss procedures. The current study was done in partnership with Kettering Bariatrics in Kettering, Ohio, and is an analysis of the ability of their pre-surgical psychological evaluation to predict post-surgical success. In this study, success was defined as percentage of weight lost. Regression analyses examined the predictive ability of six psychological constructs and four demographic variables on weight loss at three post-surgical time points. Different predictor variables were demonstrated to predict weight loss at different post-surgical intervals. The results of this study were interpreted using Prochaska & DiClemente's Stages of Change as a theoretical framework. The clinical implications for mental health providers working with the weight loss surgery population are discussed, and suggestions for future research are made.

Committee: Julie Williams PsyD, ABPP-RP (Advisor); Jeffery Allen PhD, ABPP-CN (Committee Member); Larry James PhD, ABPP-HP (Committee Member) Subjects: Health; Medicine; Psychology

Master of Food and Nutrition (MFN), Bowling Green State University, 2014, Food and Nutrition

Background: As obesity rates rise, new methods to provide substantial weight loss have become crucial to the healthcare industry. Bariatric surgery has proven to be the most effective treatment for obesity, and the Roux-en-Y Gastric Bypass operation has not only enabled many to lose excess weight, but also has resulted in the resolution of comorbid conditions. To date, research on the effectiveness of the RYGB surgery in postmenopausal women is minimal. Objective: This study was completed to compare excess body weight lost and metabolic syndrome resolution in pre- and postmenopausal Roux-en-Y Gastric Bypass surgery patients, preoperatively to one year postoperatively. Methods: A retrospective chart review was completed for 42 premenopausal and 36 postmenopausal RYGB surgery patients at Wood County Hospital in Bowling Green, Ohio. Surgeries took place between September 2008 and May 2012. Weight data was collected preoperatively, and at 2 week, 2 month, 6 month, and 1 year follow up appointments. To determine diagnosis of metabolic syndrome, preoperative, 6 month, and 1 year data was utilized. Results: At 1 year, percent excess body weight lost was 68.79% for the premenopausal group and 59.44% for the postmenopausal group, which was significant, t(73)= 2.61, p=0.011. To compare the effect time on percent excess body weight lost for those with data at all follow up appointments, a repeated measures analysis of variation was done, which showed a difference between groups as time elapsed, with significance at 1 year F(3,195)=4.71, p=0.0182. Excess percent body weight lost was greater than 50% in 64 of 78 individuals at 1 year. Significance between pre- and postmenopausal groups was also found for preoperative (X2 (1, n=76) p=0.0307) and midway glucose (X2 (1, n=76) p=0.0047), as well as midway (X2 (1, n=69) p=0.0024) and 1 year blood pressure (X2 (1, n=74) p=0.0089). Preoperatively, metabolic syndrome diagnosis was 54 of 78 (22 premenopausal and 32 postmenopa (open full item for complete abstract)

Committee: Julian Williford Jr., PhD (Advisor); Mary Jon Ludy PhD, RD (Committee Member); Mark Earley PhD (Committee Member) Subjects: Food Science; Nutrition; Surgery

Doctor of Philosophy, University of Toledo, 2010, Psychology

Obesity has become an epidemic in the United States, especially in the past 30 years, with the rate of obesity more than doubling. Bariatric surgery has become a more common method to deal with obesity and its associated sequelae. Before being approved for surgery, one must engage in a psychological evaluation to determine whether one has the psychological and emotional resources necessary to proceed with gastric bypass surgery. The objective of the current study was to determine whether specific psychological variables obtained during the psychological evaluation for gastric bypass surgery, specifically, the validity and clinical scales of the MMPI-2 and the SCL-90-R, and psychological variables obtained during the clinical interview, could be used to predict success post-surgery in terms of percent excess weight lost (%EWL). It was expected that clinical elevations on these scales would predict lower weight loss. Results indicated that the only significant predictor of outcome, in terms of a higher %EWL, was a lower score on subscale Pd2 (Psychopathic Deviate: Authority Problems) of the MMPI-2 at six months post-surgery. However, higher scores on scale 2 (Depression) and F (Infrequency), as well as a greater number of Axis I diagnoses, approached significance as predictors of %EWL at 6 months post-surgery. In addition, a greater number of self-reported coping mechanisms and a higher score on scale 1 (Hypochondriasis) of the MMPI-2 also demonstrated a trend towards significance for being considered significant predictors at 1 and 2 years post-surgery, respectively. None of the hypothesized predictor variables were found to be significant predictors of %EWL at 3 months, 1 year, or 2 years post-surgery, or for maintenance of weight loss from 1 to 2 years post-surgery. Limitations, strategies to overcome these limitations, and directions for future research are discussed.

Committee: Jeanne Brockmyer PhD (Committee Co-Chair); Janis G. Woodworth PhD (Committee Co-Chair); Wesley Bullock PhD (Committee Member); Mojisola Tiamiyu PhD (Committee Member); John D. Jasper PhD (Committee Member) Subjects: Clinical Psychology

Master of Science, The Ohio State University, 2010, Allied Medicine

There are many factors thought to contribute to childhood overweight, such as poor diet and lifestyle choices. Eating behaviors of children have been found to mimic the eating behaviors of their parents. Following weight loss surgery (WLS), patients are expected to follow a diet consisting of small portions, low fat foods, and fruits and vegetables and also to perform at least 30 minutes of physical activity daily. Therefore, if a parent is compliant with post-surgical recommendations, a child may theoretically mimic the positive behaviors of the parent. This study explores the impact of these new parental behaviors on a child after parental weight loss surgery. Forty-five obese children whose parents had undergone WLS were used as the experimental group and 90 age- and gender-matched controls. All subjects were selected from a weight loss program housed within a large children's hospital. A review of medical assessment forms was conducted to collect data on lifestyle behaviors and food frequency. Few significant differences were found between groups, however the experimental group was more likely to eat two or more helpings of food at each sitting (p=0.015) and less likely to play outdoors for more than an hour each day (p=0.013). There were few remarkable differences in food frequency. Based on these results, parental WLS does not seem to improve the eating and lifestyle behaviors of children when compared to obese control subjects. It may be possible to alter conventional peri-surgical education to benefit the entire family instead of just the individual. Much more research is needed in this area.

Committee: Chris Taylor PhD (Advisor); Jill Clutter PhD (Committee Member); Ihuoma Eneli MD, MS (Committee Member) Subjects: Nutrition

Master of Science, The Ohio State University, 2009, Allied Medicine

In 2006, the American Society of Metabolic and Bariatric Surgery (ASMBS) reported an estimated 177,600 people in the U.S. had bariatric surgery.1 This is a descriptive study regarding pre- and post-bariatric surgery patients' self-efficacy toward successful adherence to recommendations of bariatric surgery. A questionnaire was completed by a group of bariatric surgery patients to measure self-efficacy pre- (n=20) and post-surgery (n=9). The results indicate weight loss and each domain show a statistical significance with overall success. This indicates that individuals with a higher pre-surgery self-efficacy toward successful adherence to the recommendations of bariatric surgery will experience greater weight loss. More specifically, it demonstrates that they were more confident towards the statements that they could lose weight after surgery, achieve their goal weight and change their diet for life.

Committee: Kay Wolf Dr. (Advisor); Shirley Kindrick Dr. (Committee Member); Jill Clutter Dr. (Committee Member) Subjects: Cognitive Therapy; Health; Health Care; Health Education; Nutrition; Surgery

PhD, University of Cincinnati, 2024, Pharmacy: Pharmaceutical Sciences

Background: Bariatric surgery, as a pivotal intervention to treat obesity, has seen dynamic utilization trends over recent years, and the subsequent pharmacological implications, particularly concerning statin discontinuation, hold significance. With the world grappling with the cardiovascular epidemic and its associated mortality, there's an imperative need to understand the cardiovascular outcomes post-bariatric surgery, especially when linked with discontinuation of critical medications like statins. Aims: This dissertation aimed to delineate the trends in bariatric surgery utilization and the corresponding shifts in surgical techniques in the U.S. Furthermore, it sought to understand the patterns and repercussions of statin discontinuation post-surgery, with an emphasis on discerning the risks associated with discontinuing statin therapy, particularly among patients with a history of Atherosclerotic Cardiovascular Disease (ASCVD). Methods: Comprehensive retrospective analyses were conducted utilizing the TriNetX electronic medical records network, spanning the years 2012 to 2021. The trends in bariatric surgeries were examined alongside their procedural variations. In parallel, patients on statin therapy undergoing bariatric surgery were identified, with their subsequent statin discontinuation patterns being analyzed. The consequences of such discontinuations, especially regarding ASCVD events, were also explored, taking into consideration both primary and secondary prevention cohorts. Results: There was a steady upswing in bariatric surgeries until 2018, which saw a decline during 2020 and 2021, coinciding with the COVID-19 pandemic. The surgical landscape depicted a decline in the Roux-en-Y (RYGB) procedure, substituted by an uptake in the sleeve gastrectomy (SG) procedure. Among statin therapy users, 48% of primary prevention and 34.5% of secondary prevention patients discontinued statin therapy within six months post-bariatric surgery. Alarmingly, w (open full item for complete abstract)

Committee: Ana Hincapie Ph.D. (Committee Chair); Jianfei (Jeff) Guo Ph.D. (Committee Member); Patricia Wigle Pharm.D. (Committee Member); Marepalli Rao Ph.D. (Committee Member); Alex Lin Ph.D. (Committee Member) Subjects: Pharmacy Sciences

Master of Science, The Ohio State University, 2023, Human Ecology: Human Development and Family Science

Objective: This study explored adolescents' mental health and relationship with parents pre-bariatric surgery. Background: Bariatric surgery has been established as the most successful and cost-effective treatment for adult patients with severe obesity. Currently, there is little research around adolescent bariatric surgery and mental health (depression, anxiety, etc.), especially with racial/ethnic minority adolescents. Method: Adolescents' responses to specific items on the BDI-II (sadness, suicidal thoughts, feelings of worthlessness, and changes in appetite) and BASC-3 (anxiety, depression, and self-esteem) were analyzed for associations with their body mass index (BMI) and with parental responses to the BASC-3 for adolescents' interpersonal skills and relationship with parent. Demographic differences on the BDI-II and BASC-3 were also noted. These patients range from ages 12-21 and underwent bariatric surgery from June 2020 to November 2022. Pearson's correlations, independent t-tests, and ANOVA were used. Results: The results of the study reported that parents who had higher t-scores for relationship with their adolescents had adolescents who had lower depression t-scores, lower anxiety t-scores, and higher self-esteem t-scores. Parents who had higher t-scores for their adolescents interpersonal relations had adolescents who had lower depression t-scores, lower anxiety t-scores, and higher self-esteem t-scores. White adolescents had higher depression t-scores than Black and Hispanic adolescents. Black and Hispanic adolescent had higher self-esteem t-scores compared to White adolescents. Conclusions: This study focuses on adolescents' reports of their preoperative depression, anxiety, and self-esteem in association with their presenting BMI. Further research is warranted to assess the longitudinal outcomes of adolescent's mental health and BMI, particularly those of minority populations.

Committee: Ashley Hicks (Committee Member); Keeley Pratt (Advisor) Subjects: Health Sciences; Mental Health; Minority and Ethnic Groups; Therapy

PHD, Kent State University, 2021, College of Arts and Sciences / Department of Psychological Sciences

The current study examined the utility of the MMPI-2-RF in predicting long-term bariatric surgery outcomes (i.e., postoperative weight regain, problematic eating behaviors, weight-related quality of life, and behavioral adherence), within the context of a biopsychosocial framework. Overall, facets of demoralization, dysfunctional negative emotions, antisocial behavior, and hypomanic activation were predictive of long-term bariatric surgery outcomes, above and beyond preoperative biological, demographic, and eating-related variables. The results provide support for utilizing a hierarchical and dimensional approach to personality and psychopathology to identify predictors of long-term bariatric surgery outcomes. Additionally, the results provide support for a biopsychosocial approach to preoperative bariatric surgery evaluations. Identification of these risk factors provides important targets for pre-and postoperative clinical interventions in order to maximize long-term surgical outcomes.

Committee: Yossef Ben-Porath PhD (Advisor); Mary Beth Spitznagel PhD (Committee Member); John Updegraff PhD (Committee Member); Leslie Heinberg PhD (Committee Member); Ryan Marek PhD (Committee Member); Roxburgh Susan PhD (Committee Member) Subjects: Clinical Psychology; Psychology

Doctor of Nursing Practice, Mount St. Joseph University , 2021, Department of Nursing

Constipation and other bowel related issues are a recurring problem following bariatric surgery procedures. It leads to an increase in emergency room visits and readmissions within the first three months following surgery. There are several studies that demonstrate that the use of clear, universal discharge instructions, also known as an enhanced recovery pathway, has shown positive correlation between it and better patient outcomes. This DNP project was based in a local hospital in Cincinnati, Ohio and implemented universal instructions for patients enrolled in the bariatric surgery program. The data collected was to determine if using these instructions would have a positive impact on patient outcomes, namely a decrease in emergency room visits and readmissions post-surgery.

Committee: Nancy Hinzman (Advisor) Subjects: Nursing; Surgery

PHD, Kent State University, 2019, College of Nursing

Despite what is known about risk factors, preventive treatment, and increased prevalence of fragility fractures in post-bariatric surgical patients, little is known about how patient views of osteoporosis inform their commitment to bone health. The purpose of this research was to examine the lived experience of osteoporosis risk in people who have had bariatric surgery. The specific aims were to understand: 1. What it means to live with the risk of osteoporosis after bariatric surgery 2. The perceptions of osteoporosis risks postoperatively. This study used interpretive phenomenology to explore osteoporosis from the perspective of bariatric surgery patients. Purposive and snowball sampling was used to recruit individuals at risk for osteoporosis and a history of bariatric surgery. Eligibility criteria required participants to be female, over the age of 18 and understand and speak English. The study consisted of in-depth semi-structured interviews with 14 participants. Using open-ended questions, the interviews were audio recorded and transcribed. Study aims were addressed using strategies outlined by Diekelmann, Allen, & Tanner (1989). Findings are described under the relational theme of Looking out for Self, and supported by three subthemes Understanding, Protecting, and Preventing. This research provided an understanding of the risk of osteoporosis from the constructed realities and experiences of those who had bariatric surgery. Osteoporosis risk after bariatric surgery was not well known by participants. Furthermore, participants did not understand that vitamin deficiency can lead to osteoporosis. Participants perceived little to no risk of osteoporosis. Patients need to be aware of the risks of bariatric surgery; without this understanding of awareness about osteoporosis and risk of fracture, uncertainty will remain as to how to enhance osteoporosis prevention efforts in this population.

Committee: Denice Sheehan Ph.D. (Committee Chair); Christine Graor Ph.D. (Committee Member); Amy Petrinec Ph.D (Committee Member); Stacy Clare Ph.D. (Committee Member) Subjects: Nursing

Doctor of Philosophy, The Ohio State University, 2019, Human Ecology: Human Development and Family Science

As the rates of obesity have increased over the past decades, bariatric surgery has emerged as the most effective treatment for obesity both in the short and long term. Even as patients experience significant weight loss, a portion of patients begin to regain weight starting around two years post-surgery. This U-shaped trend suggests that current care practices are not effective in staving off long term weight regain for bariatric surgery patients. One important area of patients' lives that has yet to be incorporated into the bariatric surgery process is their relationship with their romantic partners (referred to as partners herein). This is likely a missed opportunity, as patients and their partners are highly congruent in weight statuses and health behavior engagement. Thus, the incorporation of partners into the bariatric surgery process may provide essential support for patients' long-term weight loss. The purpose of this dissertation is to examine the feasibility, acceptability, and preliminary efficacy of partner attendance during bariatric surgery clinical appointments. In Chapter 1, a brief overview of the evidence for bariatric surgery in the United States is provided, as well as a review of important concepts and literature regarding bariatric surgery patients and their partners. Results of the dissertation are presented in Chapters 2, 3, and 4. The data presented in Chapters 2 through 4 was obtained from a four-arm randomized control trial that followed patients and their support figures (both partners and family members) from two months pre-surgery to two months post-surgery. Patients and their support figures were randomized to have their partners attend all appointments during the study period or continue as they normally would or “treatment as usual”. In Chapter 2, the feasibility and acceptability of partner attendance during bariatric surgery clinical appointments is assessed. Despite the small sample who consented to the study, and smaller subs (open full item for complete abstract)

Committee: Keeley Pratt (Advisor); Suzanne Haring (Committee Member); Lorraine Wallace (Committee Member); Brian Focht (Committee Member); Sabrena Noria (Committee Member) Subjects: Health; Personal Relationships; Social Psychology

Doctor of Philosophy, University of Akron, 2018, Sociology

How do bariatric patients make sense of the medical, aesthetic, and moral discourses related to fat, health, and illness? How are patients' identities shifted as their bodies change throughout the bariatric surgery process? To answer these questions, I interviewed 35 bariatric patients at various stages of their bariatric careers. I divide my findings into three chapters. First, I describe the bariatric process using Goffman's concept of the moral career and Foucault's ideas about discipline. The moral career of the bariatric patient proceeds through 4 stages: the pre-surgery process, recovery, the honeymoon stage, and the struggle stage. I argue that bariatric surgery utilizes two types of disciplinary technology: (1) a discursive process where patients are socialized into health behaviors and must prove themselves morally worthy of surgery; (2) an embodied process where patients' digestive tracts are modified to punish them for straying from “the program.” Next, I focus on the illness experience of bariatric patients. Before surgery, patients experience their bodies as chronically ill and lacking in freedom. They describe fitness and pain issues which limit their day-to-day mobility. They also count down their prescription medications as an important symbol of health and illness. After surgery, patients do not view the symptoms of bariatric surgery (such as vomiting, chest pain, diarrhea, constipation, hair loss, etc.) as illness but instead as worth it in the end, as something to adjust to, and as useful tools for weight loss. After that, I explore the relationship between health, appearance, and stigma, and how this relationship is impacted by intersecting identities of race, class, gender, and age. Bariatric patients describe their often-contradictory experience of the Western aesthetic of health; bariatric patients carry a highly visible fat stigma which is believed to convey their health status, yet they often view appearance as less important than health. Ev (open full item for complete abstract)

Committee: Clare Stacey (Committee Chair); Kathy Feltey (Committee Member); Susan Roxburgh (Committee Member); Manacy Pai (Committee Member); Isa Rodriguez-Soto (Committee Member); Mary Triece (Committee Member) Subjects: Sociology

MS, Kent State University, 2017, College of Education, Health and Human Services / School of Health Sciences

The purpose of this study was to investigate the existence of protocols available for perioperative nutritional care practice in accredited bariatric surgical centers, and determine current perioperative nutritional care practices for patients undergoing bariatric surgery. Descriptive study using an electronic survey of bariatric dietitians in accredited bariatric surgical centers. A total of 48 bariatric dietitians participated (response rate 52%). Descriptive statistics and content analysis were obtained. The majority (94.2%) felt that a standardized protocol addressing perioperative nutritional management of the bariatric population was either very important or extremely important. Respondents at 91.5% of institutions reported availability of protocols for preoperative nutrition care, and 91.5% of institutions had protocols for postoperative nutrition care. One-quarter (23.4%) reported availability of perioperative nutrition care protocols for patient-specific subpopulations. Respondents had divergent attitudes towards their institution's current perioperative nutrition management practices. The majority (91.4%) believed they had enough knowledge of different surgical procedures to provide safe and appropriate nutrition care to their patients. Practice variation was seen among respondents for perioperative nutrition risk screening. Standardization of perioperative nutritional care protocols was universally considered important. There were written protocols available for perioperative nutrition care in the majority of surveyed institutions; however, the content of these protocols was not standardized. Low awareness of perioperative nutrition care protocols for patient-specific subpopulations was found. The survey highlights divergences in respondents' attitudes toward their institution's current perioperative nutrition management practices. There are important discrepancies between surveyed respondents' practices relative to perioperative nutrition r (open full item for complete abstract)

Committee: Eun-Jeong Ha (Advisor); Natalie Caine-Bish (Committee Member); Karen Lowry Gordon (Committee Member) Subjects: Health Sciences; Nutrition; Surgery

PHD, Kent State University, 2017, College of Arts and Sciences / Department of Psychological Sciences

Although a number of studies have asserted that psychosocial factors contribute to suboptimal weight loss outcomes following bariatric surgery; research has been inconsistent regarding the associations between preoperative psychiatric diagnoses and psychological testing results and suboptimal weight loss. Research implies that psychopathology and personality are best capture by a hierarchical framework. The current investigation examined the utility of using the hierarchical model of psychopathology to predict 5-year Body Mass Index (BMI) outcomes. A total of 446 consecutively, locally residing consented patients who underwent a Roux-en-Y Gastric Bypass (RYGB) at least 5-years ago were included in the study. A majority were women (74.2%) and of Caucasian descent (66.2%). Patients' mean pre-surgical BMI was 49.14 kg/m2 [Standard Deviation (SD) = 9.50 kg/m2]. Psychiatric diagnoses were obtained from a pre-surgical, semi-structured clinical interview and all participants were administered the MMPI-2-RF at their pre-surgical evaluations. BMIs were collected at 4 post-operative time points across a 5-year trajectory. Age significantly predicted the nonlinear rate of BMI-reduction across time, such that older individuals evidenced a slower rate of change over time. Pre-surgical levels of Externalizing and Low Positive Activation/Emotionality predicted higher BMIs at the 5-year outcome. Pre-operative indicators of psychopathology are important in predicting post-operative outcomes, particularly when they are dimensional in nature and aligned with the hierarchical model of psychopathology. A closer follow-up with patients who evidence pre-surgical problems, both before and after surgery, may help improve outcomes.

Committee: Yossef Ben-Porath (Committee Chair); Manfred Dulmen (Committee Member); John Gunstad (Committee Member); Leslie Heinberg (Committee Member); Susan Roxburgh (Committee Member); Mary Anthony (Committee Member) Subjects: Psychological Tests; Psychology; Public Health

MA, Kent State University, 2017, College of Arts and Sciences / Department of Psychological Sciences

Severe obesity is associated with elevated risk for poor neurocognitive outcomes. The mechanisms underlying this association have not yet been fully elucidated, but cerebrovascular pathology resulting from obesity and its associated vascular risk factors has been identified as a likely contributor. The CHA2DS2-VASc is a clinical composite score used to assess risk for vascular events and has been used to estimate severity of cerebrovascular pathology. Past research shows associations between higher scores on the CHA2DS2-VASc and poorer cognitive function in persons with atrial fibrillation and advanced heart failure. However, no study has examined the predictive validity of CHA2DS2-VASc in persons with severe obesity. The current study examined the relationship between the CHA2DS2-VASc and cognitive function before and after bariatric surgery in a sample of individuals with severe obesity. Data from 87 bariatric surgery patients were extracted from a larger parent project. Cognitive function was assessed at baseline and 12 months following bariatric surgery. Self-report questionnaires were completed at the baseline visit to gain medical and demographic information. It was hypothesized that CHA2DS2-VASc scores would predict cognitive function in individuals with severe obesity prior to bariatric surgery, as well as improvements in cognitive function 12 months post-surgery. Additionally, the CHA2DS2-VASc was hypothesized to predict percent weight loss. Analyses revealed significant improvements in cognitive function from pre- to post-surgery in domains of memory, attention, and executive function. No significant associations were observed between the CHA2DS2-VASc and cognitive function at baseline and the stroke risk score did not predict the cognitive improvements seen in memory, executive function, or attention post-surgery. However, an association was found between CHA2DS2-VASc scores and percent weight loss 12 months post-surgery, such that higher C (open full item for complete abstract)

Committee: John Gunstad (Advisor) Subjects: Psychology

PhD, University of Cincinnati, 2015, Medicine: Biostatistics (Environmental Health)

Bariatric surgery has been shown to be an effective treatment option for severely obese individuals; however, there is no consensus regarding the best outcome measure to assess weight loss in these subjects. This study used patient's weight, body mass index (BMI), body fat percentage, waist circumference, and sagittal abdominal diameter to determine weight loss outcome measures involving: the loss from baseline of the metric, the percent loss from baseline of the metric, and the percent excess BMI loss. This analysis examined the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort which is a prospective observational study of adolescents undergoing bariatric surgery. The cohort consisted of adolescents (age 13-19 years) undergoing bariatric surgery at 5 US centers and involved standardized methods for collecting clinical and laboratory data. The subjects were assessed preoperatively, at 6 and 12 month's post-surgery, and annually thereafter.

Committee: Changchun Xie Ph.D. (Committee Chair); Charles Ralph Buncher Sc.D. (Committee Member); Todd Jenkins Ph.D. (Committee Member); Jane Khoury M.S. Ph.D. (Committee Member) Subjects: Biostatistics

Doctor of Philosophy, The Ohio State University, 2015, Kinesiology

The purpose of this dissertation was to identify the biopsychosocial-relational factors among obese and severely obese individuals seeking bariatric surgery at The Ohio State University Bariatric Surgery Center, specifically the variables of interest including sociodemographics, self-efficacy, social support, goal-setting, relationships, and physical activity (PA) and diet behaviors. Patients were recruited to participate in the one-time survey at pre-surgery information sessions held bi-monthly from September, 2014 to February, 2015. Patient data were analyzed using ANOVA via IBM SPSS+, Version 22 statistical software. Overall, participants were sedentary, engaging in very little to no physical activity (16.33 METs ± 17.90), with an average body mass index (BMI) of 51.44 (range: 31-82). The majority of participants felt that they were of fair to good health (78.0%) and that their daily activity was generally limited (59.7%). In addition, they reported moderate to low scores regarding cognitive restraint toward eating, uncontrolled eating, and emotional eating. Participants reported overall low self-efficacy, low social support from family and friends, and a low tendency to set and keep goals related to physical activity. Moderately low levels of attachment avoidance and anxiety toward participants' significant other and closest friend were observed. These results provide researchers and clinicians with an assessment of the bariatric surgery treatment-seeking population and will serve to better inform pre-surgery education programming. Previous research with bariatric patients demonstrated a significant relationship with the variables addressed in this study as well as associations with weight loss prior to surgery and continued weight loss post-surgery. These results provide researchers and clinicians with an assessment of the bariatric surgery treatment-seeking population. The findings from this study will be used to inform intervention-based research aimed at im (open full item for complete abstract)

Committee: Lorraine Wallace (Advisor); Keeley Pratt (Advisor); Bradley Needleman (Advisor) Subjects: Behavioral Sciences; Kinesiology