Leslie Heinberg

Leslie Heinberg
Cleveland Clinic · Metabolic and Bariatric Institute

About

181
Publications
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Publications

Publications (181)
Article
Full-text available
Purpose of Review Social isolation and loneliness have long been identified as risk factors for poorer physical and mental health and increased mortality. These factors have also been shown to impact dietary behavior and physical activity which play a role in precipitating and maintaining obesity. Less is known about the impact of social isolation...
Article
Eating disorders are associated with significant medical morbidity and mortality and serious psychological impairment. Individuals seeking bariatric surgery represent a high-risk group for evidencing disordered eating and eating disorders, with some patients experiencing the persistence or onset of disordered eating postsurgery. This review synthes...
Article
Patients presenting for bariatric surgery have been shown to have high rates of psychiatric disorders. These studies have utilized structured interviews using older versions of the DSM. This study examined whether similar lifetime frequencies would be similar using the recent DSM-5. Participants (N = 131) were evaluated as part of a longitudinal st...
Article
Full-text available
Purpose: A considerable number of post-bariatric surgery patients report problematic eating behaviors (PEBs) and/or eating disorders (EDs). Examining psychosocial variables associated with ED symptoms may identify targets for postoperative interventions to reduce these behaviors and improve surgical outcomes. Methods: A total of 161 participants...
Article
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Introduction: Mental health professionals routinely assess psychosocial risk factors prior to bariatric surgery to help identify factors that may impede surgical outcomes. Data regarding longer-term psychosocial functioning postoperatively are needed. Purpose: Assess the psychosocial functioning of patients who obtained bariatric surgery approxim...
Article
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Purpose of Review Marijuana use presents a unique challenge to bariatric surgery programs. We review the recent evidence examining marijuana use on outcomes following bariatric surgery. Recent Findings Recent studies have not demonstrated an increased risk of short-term surgical complications or differences in up to 2-year weight loss following su...
Article
Background Research identifying preoperative psychosocial predictors of bariatric surgery outcomes has yielded inconsistent results with minimal examination of longer-term outcomes. Utilizing a broadband measure of personality and psychopathology during the preoperative evaluation helps to identify preoperative risk factors for suboptimal bariatric...
Article
Full-text available
Bariatric surgery induces significant shifts in the gut microbiota which could potentially contribute to weight loss and metabolic benefits. The aim of this study was to characterize a microbial signature following Roux-en-Y Gastric bypass (RYGB) surgery using novel and existing gut microbiota sequence data. We generated 16S rRNA gene and metagenom...
Article
Eating pathology is common pre-operatively and continues to be prevalent following bariatric surgery. A new version of the Minnesota Multiphasic Personality Inventory (MMPI), the MMPI-3, contains a new scale called Eating Concerns (EAT) that aims to assess problematic eating behaviors. The current investigation seeks to establish preliminary conver...
Preprint
Full-text available
Background Bariatric surgery induces significant shifts in the gut microbiota which could potentially contribute to weight loss and metabolic benefits. The aim of this study was to characterize a microbial signature following Roux-en-Y Gastric bypass (RYGB) surgery using novel and existing gut microbiota sequence data. Results We generated 16S rRN...
Article
Psychological symptoms are frequently reported in patients with Postural Orthostatic Tachycardia Syndrome (POTS); however, the nature of these symptoms is not well understood. The current study described baseline psychological symptoms in patients with POTS, and examined associations between psychological and self-report autonomic symptoms. Partici...
Article
Bariatric surgery is currently the most efficacious and durable intervention for severe obesity. The most commonly performed procedures in the U.S. are the Roux-en-Y Gastric Bypass (RYGB) and the Sleeve Gastrectomy (SG), which involve significant anatomical and physiological alterations that lead to changes in behavior and biology. Unfortunately, m...
Article
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With the outbreak of COVID-19, patients and providers were forced to isolate and become innovative in ways to continue exceptional patient care. The Cleveland Clinic went from mostly in-person medical appointments to all virtual/telemedicine care in about 2 weeks’ time. In this piece, we show specifically the thought process and our conversion of t...
Article
Background: Obstructive sleep apnea (OSA) is prevalent among bariatric surgery candidates and is associated with numerous adverse health conditions, both pre- and postoperatively. Continuous positive airway pressure therapy (CPAP) is the first-line treatment for OSA, but it requires significant behavioral changes. As such, CPAP adherence is a sign...
Article
Full-text available
Previous studies suggest the importance of understanding what factors increase risk of lack of physical activity (PA) prior to bariatric surgery, which may increase risk of suboptimal postoperative outcomes. Therefore, the current study sought to explore which Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scales were a...
Article
Research using a categorical-polythetic classification system for mental illness has raised concern regarding the validity of categorical classification systems. Recent efforts suggest psychopathology is better understood from a dimensional framework, though there has been varying evidence of a somatization factor. The current investigation seeks t...
Article
Background: The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2- RF) has empirically-validated utility in pre-surgical psychological evaluations of bariatric surgery patients. However, clinicians may prefer shorter, symptom-focused measures. Objectives: The purpose of the current study is to evaluate the feasibility and pot...
Article
Researchers have observed variation in levels of body image disturbance and eating pathology among women from different Western countries. Examination of cross-cultural differences in the established risk factors (i.e., thin-ideal internalization, muscular-ideal internalization, and appearance pressures from family, peers, and media) for negative o...
Article
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Background: Bariatric surgery has been shown to be a safe and effective intervention for patients with comorbid obesity and multiple sclerosis (MS); however, this sub-population may be at heightened risk for pre- and postoperative depressive symptoms. Objective: This current exploratory study aims to describe the prevalence and nature of depress...
Article
Background Many bariatric surgery candidates report body image concerns prior to surgery. Research has reported post-surgical improvements in body satisfaction, which may be associated with weight loss. However, research has failed to comprehensively examine changes in affective, behavioral, and cognitive body image. Objectives This research exami...
Article
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Purpose: Identify psychological factors associated with body image dissatisfaction (BID) before, 3 months, and 6+ months after bariatric surgery. Methods: Bariatric patients (n=444) completed a preoperative interview, 3 and/or 6+ month postoperative psychology appointment, and Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMP...
Article
Background: The current investigation aims to predict 3-year postoperative percent total weight loss among a sample of bariatric surgery patients with super-super obesity. Objective: Previous research implies that persons with presurgical super-super obesity (body mass index [BMI] ≥60 kg/m(2)) tend to have poorer loss outcomes compared with thos...
Article
Full-text available
Objectives Inadequate sleep increases the risk for age-related cognitive decline and recent work suggests a possible role of the gut microbiota in this phenomenon. Partial sleep deprivation alters the human gut microbiome, and its composition is associated with cognitive flexibility in animal models. Given these findings, we examined the possible r...
Article
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Objectives: Dysbiosis of the gut microbiome is implicated in numerous human health conditions. Animal studies have linked microbiome disruption to changes in cognitive functioning, although no study has examined this possibility in neurologically healthy older adults. Methods: Participants were 43 community-dwelling older adults (50-85 years) th...
Article
In June 2013, the American Medical Association (AMA) released the controversial decision to designate obesity a disease. Proponents predicted the decision would lead to reduced weight-related stigma, whereas opponents predicted designating a third of the population as “diseased” would exacerbate stigma. To determine the effects of defining obesity...
Article
Obesity and diabetes are associated with deficits in multiple neurocognitive domains and increased risk for dementia. Over the last two decades, there has been a significant increase in bariatric and metabolic surgery worldwide, driven by rising intertwined pandemics of obesity and diabetes, along with improvement in surgical techniques. Patients u...
Article
Background: 30-day readmissions occur in 5% or more of bariatric surgery patients. Some readmissions relate directly to surgical risks whereas others relate to more non-specific complaints or non-adherence and may reflect risks outside of the surgical procedure. Objective: To investigate whether pre-surgical psychosocial factors are related to re...
Article
Background One of the ultimate goals of bariatric and metabolic surgery is to decrease cardiovascular morbidity and mortality. Obese individuals who smoke tobacco are at an increased risk of cardiovascular events and may benefit the most by positive effects of bariatric surgery on cardiometabolic risk factors. The safety profile of sleeve gastrecto...
Article
Background: Psychosocial factors contribute to poorer weight loss outcomes following bariatric surgery; however, findings on associations between preoperative psychiatric diagnoses, psychological testing, and weight loss are inconsistent. Objectives: Examine associations between pre-surgical psychiatric diagnoses derived from a semi-structured cli...
Article
Background and aims: Gastroparesis (GP) patients suffer from recurrent symptoms of nausea, vomiting, early satiety, and abdominal pain. The impact of GP on quality of life (QoL), health care utilization and daily activities is not well understood. Materials and methods: Part 1: 398 adult patients (≥18 y) with documented GP (symptoms >6 mo) were...
Article
Background: The reasons why some patients who begin the pre-surgical process for bariatric surgery fail to complete the procedure are understudied. Previous research implies that psychological factors play a role. Objectives: To examine whether scores from baseline psychological testing incrementally predict failure to proceed with bariatric surge...
Article
Objective: The Sociocultural Attitudes Toward Appearance Questionnaire-4 (SATAQ-4) is a measure of internalization of appearance ideals (i.e., personal acceptance of societal ideals) and appearance pressures (i.e., pressures to achieve the societal ideal). The current study sought to address limitations of the scale in order to increase precision...
Article
Bariatric surgery is the most effective treatment for morbid obesity; however, a subset of patients who undergo this procedure regain weight or achieve suboptimal weight loss results. A large number of studies have examined whether psychological variables play a role in weight-loss surgery outcome. Although pre-surgical psychopathology has been fou...
Article
Background: Graze eating is defined as repetitive, unplanned eating of small amounts of food throughout the day. Little consensuses exists regarding whether graze eating, like Binge Eating Disorder (BED), is characterized by feelings of loss of control (LOC). Further, little is known about how patients who graze eat with and without LOC differ psyc...
Article
Full-text available
Background: Although studies have associated postoperative weight loss with improvement in body image dissatisfaction, some individuals continue to report body image concerns after bariatric surgery. These concerns are linked to increased depressive symptoms and decreased self-esteem in bariatric populations. Objective: This study sought to expl...
Article
Bariatric surgery is a viable treatment option for patients with extreme obesity and associated medical comorbidities; however, optimal surgical outcomes are not universal. Surgical societies, such as the American Society for Metabolic and Bariatric Surgery (ASMBS), recommend that patients undergo a pre-surgical psychological evaluation that includ...
Article
Objectives: Body concealment is a component of social avoidance among people with visible differences from disfiguring conditions, including systemic sclerosis (SSc). The study objective was to develop a measure of body concealment related to avoidance behaviors in SSc. Methods: Initial items for the Body Concealment Scale for Scleroderma (BCSS)...
Article
Full-text available
Background: Implementation of a multidisciplinary conference (MC) attended by medical, surgical, nutrition, bioethics, and psychology specialists may help identify treatment plans for bariatric surgery candidates with a high-risk psychiatric profile. Methods: Data were assessed for all bariatric candidates evaluated by the MC in an academic center...
Article
Objective Obesity is a well-established risk factor for poor neurological outcomes, and bariatric surgery has been shown to improve many aspects of cognitive function. Factors underlying improved cognition following surgery are not yet fully established. A recent study of bariatric surgery patients demonstrated lower preoperative alkaline phosphata...
Article
Previous studies suggest that presurgical psychopathology accounts for some of the variance in suboptimal weight loss outcomes among Roux-en-Y gastric bypass (RYGB) patients, but research has been equivocal. The present study seeks to extend the past literature by examining associations between presurgical scale scores on the broadband Minnesota Mu...
Article
Full-text available
The Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3) and its earlier versions are measures designed to assess societal and interpersonal aspects of appearance ideals. Correlational, structural equation modeling, and prospective studies of the SATAQ-3 have shown consistent and significant associations with measures of body image...
Article
Obesity is prevalent in patients with cognitive impairment, but the risks and benefits in this complex group are unknown. The aim of this study was to assess outcomes in a small cohort of patients with lifelong cognitive impairment who underwent bariatric surgery and to introduce important concepts when considering surgery in this complex group. Ac...
Article
The current chapter aims to review the literature on behavioral health and psychosocial correlates within bariatric surgery. Psychosocial evaluation is an established component of the presurgical clearance process for bariatric surgery patients, and behavioral health providers play an essential role in screening and preparing patients for surgery....
Article
Background Presurgical Psychological Screening (PPS) is used to identify factors that may impact postoperative adherence and surgical outcomes in bariatric surgery candidates. Minnesota Multiphasic Personality Inventory – 2 Restructured Form (MMPI-2-RF) findings have demonstrated utility for this task. Objectives To explore whether there are clini...
Article
Background: The Binge Eating Scale (BES) is a widely-used self-report measure of binge eating severity. Hood et al. reported a 2-factor structure for the BES in a sample of bariatric surgery candidates, with factors labeled feelings/cognitions and behavioral manifestations. The present study aims to replicate and extend the factor structure obtain...
Article
Full-text available
Weight loss prior to bariatric surgery is often recommended, but success with weight loss varies. The current study piloted the efficacy of a structured, low-glycemic portion-controlled diet (PCD) intervention compared to usual dietary care (UDC). The study randomized 73 subjects in a 12-week, controlled, randomized design. Participants' height, we...
Article
Binge eating disorder (BED) was recently included in the DSM-5. The prevalence rate for BED using the DSM-IV-TR research criteria tends to be higher in bariatric surgery candidates than the normative population; however, no studies have examined how many more bariatric surgery candidates will meet the new, less conservative criteria of DSM-5. We ex...
Article
Research has demonstrated negative effects of both alcohol and tobacco use after bariatric surgery. However, no research to date has examined effects of cannabis use after bariatric surgery, even though cannabis is the most commonly used illicit drug in the USA. Literature review reveals that many practitioners generalize from data regarding alcoho...
Article
Binge Eating Disorder (BED) is among the most common psychiatric disorders in bariatric surgery candidates. The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) is a broadband, psychological test that includes measures of emotional and behavioral dysfunction, which have been associated with BED behaviors in bariatric surg...
Article
African-Americans have been shown to have poorer weight loss outcomes after bariatric surgery, and many reasons for such outcomes have been postulated, including metabolic and genetic differences, socioeconomic factors, and differences in culture. African-Americans have also been noted to have differences from the majority population in other psych...
Article
Full-text available
Presurgical psychological screening of bariatric surgery candidates includes some form of standardized psychological assessment. However, associations between presurgical psychological screening and postoperative outcome have not been extensively studied. Here, we explore associations between presurgical Minnesota Multiphasic Personality Inventory-...
Article
Background: Psychological comorbidity is common in bariatric surgery candidates. Many multidisciplinary teams incorporate psychometric testing to screen for psychological factors that, if left unattended, may negatively impact surgical results. Here, we report descriptive findings and empirical correlates of Minnesota Multiphasic Personality Inven...
Article
Although bariatric surgery is the most effective intervention for severe obesity, a significant minority of participants fail to achieve or maintain optimal weight loss at extended follow-up. Accumulating evidence suggests that adherence to prescribed postoperative recommendations, including attendance at follow-up appointments and dietary and phys...
Article
Bariatric surgery patients are at increased risk for suicide and lifetime substance abuse problems, and these risks are surgical contraindications. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has scales to screen for these risks factors, among others. We seek to evaluate the classification accuracy of the MMPI-2-...
Article
Bariatric surgery patients are at increased risk for suicide and lifetime substance abuse problems, and these risks are surgical contraindications. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has scales to screen for these risks factors, among others. We seek to evaluate the classification accuracy of the MMPI-2-...
Article
Full-text available
Bariatric surgery is increasingly recognized as a highly effective treatment for individuals who are severely obese. Amount of weight loss and resolution of comorbidities surpass those of nonsurgical approaches; however, suboptimal weight loss and weight regain are not uncommon. These outcomes, though not fully understood, are likely at least parti...
Article
Impairment in cognitive function is found in a significant subset of individuals undergoing bariatric surgery, and recent work shows this impairment is associated with smaller postoperative weight loss. Reduced cognitive function could contribute to poorer adherence to postoperative guidelines, although this has not been previously examined. The pr...
Article
The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics i...
Conference Paper
1). Overview the psychology of bariatric surgery. 2). Review studies using the MMPI-2-RF as a pre-surgical psychological measure in this population. 3).Introduce Latent Construct Modeling. 4).Correlates between latent constructs and the MMPI-2-RF.
Article
Background: Concerns have been raised about an increased incidence of substance abuse after bariatric surgery. Alcohol use after surgery may be particularly problematic because of changes in pharmacokinetics leading to greater intoxication. The present study evaluated a substance abuse prevention group pilot intervention for at-risk bariatric surg...
Article
Objective: The present study investigated the effectiveness and feasibility of a cognitive-behavioral group intervention for the treatment of body image disturbance in women with eating disorders. Method: The study used a multiple-baseline design and enrolled 38 participants with a range of eating disorders. The intervention targeted attitudinal...
Article
Background: Obesity has been associated with abnormalities in reproductive functioning and fertility in women. A number of potential mechanisms have been identified, including neuroendocrine functioning and polycystic ovarian syndrome. Associations between infertility, depression, and anxiety have been found in nonobese populations; however, the r...