Psychological effects and outcome predictors of three bariatric surgery interventions: A 1-year follow-up study

Eating and weight disorders: EWD (Impact Factor: 0.79). 04/2014; 19(2). DOI: 10.1007/s40519-014-0123-6
Source: PubMed


Weight loss surgery efficacy has been demonstrated for morbid obesity. Different outcomes have been hypothesized, according to specific bariatric surgery interventions and psychological characteristics of obese patients. The present study compared three different surgery procedures, namely laparoscopic adjustable gastric band (LAGB), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD), in terms of weight loss efficacy and psychological outcomes.
Eighty-three subjects seeking bariatric surgery have been evaluated before and 12 months after surgery intervention, by means of a clinical interview and different self-reported questionnaires, including Eating Disorder Examination Questionnaire, Emotional Eating Scale, Binge Eating Scale, Beck Depression Inventory, Symptom Checklist and State-Trait Anxiety Inventory.
BPD group (26 subjects) showed the greatest weight loss, followed by RYGB (30 subjects), and LAGB group (27 subjects). All the treatments were associated with a significant improvement of anxiety, depression, and general psychopathology, and a similar pattern of reduction of binge eating symptomatology. BPD group reported a greater reduction of eating disorder psychopathology, compared to the other groups. Pre-treatment emotional eating severity was found to be a significant outcome modifier for the three treatment interventions.
These results suggest that all the three types of bariatric surgery significantly improved psychopathology and eating disordered behaviors. They also support the importance of a pre-treatment careful psychological assessment in order to supervise the post-surgical outcome.

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    • "These conditions often improve following bariatric surgery and may play an important role in the relationship between obesity and cognitive function. Similarly, psychological conditions such as depression and anxiety are also common among obese individuals and are related to cognitive deficits, but can improve postoperatively (Castellini et al., 2014). Another important mechanism likely involves improved glucose regulation. "
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    ABSTRACT: Obesity is associated with cognitive impairment, and bariatric surgery has been shown to improve cognitive functioning. Rapid improvements in glycemic control are common after bariatric surgery and likely contribute to these cognitive gains. We examined whether improvements in glucose regulation are associated with better cognitive function following bariatric surgery. A total of 85 adult bariatric surgery patients underwent computerized cognitive testing and fasting blood draw for glucose, insulin, and glycated hemoglobin (HbA1c) at baseline and 12 months postoperatively. Significant improvements in both cognitive function and glycemic control were observed among patients. After controlling for baseline factors, 12-month homeostatic model assessment of insulin resistance HOMA-IR predicted 12-month digits backward (β = -.253, p < .05), switching of attention-A (β = .156, p < .05), and switching of attention-B (β = -.181, p < .05). Specifically, as HOMA-IR decreased over time, working memory, psychomotor speed, and cognitive flexibility improved. Decreases in HbA1c were not associated with postoperative cognitive improvements. After controlling for baseline cognitive test performance, changes in body mass index (BMI) were also not associated with 12-month cognitive function. Small effects of improved glycemic control on improved aspects of attention and executive function were observed following bariatric surgery among severely obese individuals. Future research is needed to identify the underlying mechanisms for the neurocognitive benefits of these procedures.
    Journal of Clinical and Experimental Neuropsychology 04/2015; 37(4):1-12. DOI:10.1080/13803395.2015.1023264 · 2.08 Impact Factor
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    ABSTRACT: Obesity-associated cognitive impairments may be partially reversible through bariatric surgery. Depression, a prevalent comorbidity in bariatric surgery candidates, is linked with cognitive impairment and poorer surgical outcomes in other populations. No study has examined the effects of pre-operative depression on cognitive changes in bariatric surgery patients. Sixty-seven bariatric surgery patients completed a computerized cognitive test battery prior to surgery and 12 months post-operatively. The structured clinical interview for the DSM-IV Axis I disorders assessed major depressive disorder (MDD). Pre-surgery history of MDD was found in 47.8% of patients, but was not associated with greater baseline cognitive impairments. Repeated measures revealed improved cognitive abilities 12 months after surgery. Pre-surgery history of MDD did not influence post-operative cognitive function. Pre-operative history of MDD did not limit post-operative cognitive improvements. Larger studies with extended follow-ups are needed to clarify our findings and identify factors (e.g. older age) that may modify cognitive changes following surgery.
    Psychology Health and Medicine 09/2014; 20(7):1-12. DOI:10.1080/13548506.2014.959531 · 1.26 Impact Factor
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    ABSTRACT: Bariatric surgery has gained increasing relevance due to the dramatic rise in morbid obesity prevalence. A sound body of scientific literature demonstrates positive long-term outcome of bariatric surgery in decreasing mental and physical health morbidity. Still, there is a need for a manageable presurgical screening to assess major mental disorders. The aim of this study was to assess the frequency of common psychiatric syndromes in bariatric surgery candidates using a computerized version of the Patient Health Questionnaire (PHQ). In a prospective cohort study from August 2009 to July 2011 morbidly obese individuals seeking bariatric treatment were evaluated for mental health disorders using the PHQ (computerized German version). A total of 159 patients were included in this study. The median age of participants was 42 years, the median BMI was 49 kg/m(2). The PHQ revealed a prevalence of 84 % for mental health disorders, 50 % of the participants had three or more mental health disorders. A high somatic symptom burden (46 %), depressive syndromes (62 %) and anxiety disorders (29 %) were the most frequent psychiatric syndromes. The median number of psychiatric syndromes was 3 for women and 1 for men (p = 0.007). No correlation between BMI and a single syndrome or the sum of syndromes was observed. 84 % of the patients seeking bariatric treatment were screened positive for at least one mental health disorder. The computerized PHQ with automated reporting appears to be a useful instrument for presurgical assessment of bariatric patients in routine medical settings.
    Health and Quality of Life Outcomes 06/2015; 13(1):80. DOI:10.1186/s12955-015-0278-5 · 2.12 Impact Factor
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