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Psychological Gender Differences in Bariatric Surgery Candidates

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David Mahony at Northside Psychology PLLC
David Mahony
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Abstract

Over 177,000 bariatric surgeries were performed in 2006. Most patients are required to receive presurgical psychological clearance, although there are no empirically validated psycho-surgical risk factors. In an effort to establish normative data on suspected risk factors, the present study was conducted to determine if males and females differ on psycho-surgical risk factors. Subjects consisted of 361 consecutive bariatric surgery candidates undergoing a psychological evaluation in a private practice setting. They were administered the PsyBari, a test that detects and measures psycho-surgical risk factors, and the Beck Depression Inventory (BDI-2). The results indicate that males have significantly higher BMIs than females (p=0.035). Females have tried significantly more diets than males (p<0.000). Females are significantly more likely to report a history of depression than males (p<0.000). Females received significantly higher scores on the PsyBari Depression Index than males (p<0.000.). Females received significantly higher BDI-2 scores than males (p<0.001). Females are significantly more likely to report a history of anxiety than males (p=0.004). Females received significantly higher scores on the PsyBari Social Anxiety Index than males (p=0.038). The results indicate that males and females differ significantly on suspected psycho-surgical risk factors. Assessments of bariatric surgery candidates should recognize that males and females have different baselines for psycho-surgical risk factors. Further research on bariatric surgery candidates should report results separated by gender.
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UNCORRECTED PROOF
3RESEARCH ARTICLE
4Psychological Gender Differences in Bariatric
5Surgery Candidates
6David Mahony
7Received: 22 May 2007 / Accepted: 29 June 2007
8#Springer Science + Business Media B.V. 2007
11 Abstract
12 Background Over 177,000 bariatric surgeries were per-
13 formed in 2006. Most patients are required to receive
14 presurgical psychological clearance, although there are no
15 empirically validated psycho-surgical risk factors. In an
16 effort to establish normative data on suspected risk factors,
17 the present study was conducted to determine if males and
18 females differ on psycho-surgical risk factors.
19 Methods Subjects consisted of 361 consecutive bariatric
20 surgery candidates undergoing a psychological evaluation
21 in a private practice setting. They were administered the
22 PsyBari, a test that detects and measures psycho-surgical
23 risk factors, and the Beck Depression Inventory (BDI-2).
24 Results The results indicate that males have significantly
25 higher BMIs than females ( p= 0.035). Females have tried
26 significantly more diets than males ( p< 0.000). Females are
27 significantly more likely to report a history of depression
28 than males ( p<0.000). Females received significantly
29 higher scores on the PsyBari Depression Index than males
30 (p<0.000.). Females received significantly higher BDI-2
31 scores than males ( p< 0.001). Females are significantly
32 more likely to report a history of anxiety than males ( p=
33 0.004). Females received significantly higher scores on the
34 PsyBari Social Anxiety Index than males ( p= 0.038).
35 Conclusion The results indicate that males and females
36 differ significantly on suspected psycho-surgical risk
37 factors. Assessments of bariatric surgery candidates should
38 recognize that males and females have different baselines
39 for psycho-surgical risk factors. Further research on
40bariatric surgery candidates should report results separated
41by gender.
42Keywords Psychological test .Bariatric surgery .
43Depression .Anxiety
44Introduction
45Over the past decade, bariatric surgery has become a
46popular treatment for morbidly obese patients. In 2006
47alone, an estimated 177,000 patients received this treatment
48[1]. The procedure requires patients to complete a battery of
49presurgical exams, and most surgeons require a psycholog-
50ical evaluation. Formal referral questions for the psycho-
51logical evaluation are provided to psychologists by surgical
52organizations in an effort to help them identify patients who
53are considered at risk for postsurgical psychological or
54behavioral problems (PSPBPs) [1]. These standard referral
55questions are not based on any empirical evidence and may
56or may not be effective in determining which patients are at
57risk for PSPBPs.
58Since the requirement for psychological evaluations on
59bariatric surgery candidates (BSC) has been established, a
60great deal of research has been conducted in an effort to
61identify psychosocial risk factors [2,3]. These efforts have
62begun to tease apart suspected risk factors, although initial
63findings suggest that factors previously considered to place
64a patient at risk are not necessarily problematic.
65For example, it was initially thought that BSCs who
66scored high on depression scales would be at risk for
67PSPBPs because symptoms of depression would interfere
68with postsurgical compliance, motivation, and coping
69skills. Studies have found that, although a large percentage
70of BSCs experience presurgical depression, these symptoms
OBES SURG
DOI 10.1007/s11695-007-9245-5
D. Mahony (*)
Department of Psychiatry, Lutheran Medical Center,
150 55 St. Suite 2-45, Brooklyn,
New York, NY 11220, USA
e-mail: dmahony@lmcmc.com
Q1
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UNCORRECTED PROOF
71 usually improve postsurgically without any PSPBPs [4,5].
72 In fact, a study done by Averbukh et al. [6] found a
73 negative correlation between presurgical depression scores
74 and postsurgical weight loss. Instead of depression inter-
75 fering with postsurgical functioning, there may be a
76 rebound effect where higher levels of presurgical depres-
77 sion predict better postsurgical functioning.
78 Similarly, a history of sexual abuse was considered to be
79 a risk factor, especially for female patients. The belief was
80 that these patients want to avoid sexual attention because it
81 reminds them of past sexual trauma. So, they use their
82 weight as a means to protect themselves from sexual
83 attention. Once they lose weight, they will receive more
84 sexual attention and experience increased anxiety due to the
85 reminder of the past sexual trauma. In spite of these
86 assumptions, studies have found no increased anxiety or
87 PSPBPs for this population [7,8].
88 These findings, and others, leave the psychological
89 examiner in the position of having to grant or deny surgical
90 clearance without having much empirical criteria as to which
91 patients will experience PSPBPs. In fact, the assessment
92 practices of mental health professionals vary widely for
93 bariatric surgery, with no established standards [9,10].
94 In an effort to address this problem and standardize the
95 bariatric surgery psychological evaluation, the PsyBari was
96 created [11]. The PsyBari is a psychological test that
97 measures variables considered to be important in identify-
98 ing patients at risk for PSPBPs. It is a 217-item paper-and-
99 pencil test that scores BSCs on multiple indices related to
100 psychological and behavioral variables considered to be
101 important in bariatric surgery psychological evaluations.
102 This includes a depression and social anxiety index. Using
103 the PsyBari, a wide range of potential psychosocial risk
104 factors can be assessed rapidly. The examiner can review
105 individual items and standardized T scores on each index.
106 As part of the initial standardization process, presurgical
107 norms have to be established for the PsyBari. This includes
108 determining in what ways BSCs are a heterogeneous
109 population. Previous research on the psychosocial variables
110 considered to be important in bariatric surgery often group
111 the patients together into one homogenous group [5,13].
112 This is in contrast to a wealth of research that exists on
113 psychosocial variables involved in nonsurgical obese pa-
114 tients, i.e., obese patients who are not considering bariatric
115 surgery. These researchers have shown that nonsurgical
116 obese patients are a heterogeneous population, with one of
117 the most frequently cited differences being gender. In fact,
118 the data differentiating nonsurgical obese males and
119 females is so extensive that researchers usually present
120 and discuss these populations separately [14,15]. For
121 example, researchers have consistently found that nonsur-
122 gical obese females report higher levels of depression and
123 social anxiety than nonsurgical obese males [14,16].
124It would be meaningful to know if BSCs also differ on
125variables such as gender. This would allow examiners to
126evaluate patients’psychosocial variables more accurately.
127Put another way, it is important to know what role gender
128plays in presurgical psychological evaluations. We cannot
129simply extrapolate findings of nonsurgical obese popula-
130tions onto BSCs because these two populations differ in
131important ways. For example, BSCs have to have a BMI of
13235 or above to be eligible for bariatric surgery, whereas
133subjects in nonsurgical obesity research may have lower
134BMIs.
135The present study is focused on determining if gender
136subgroups exist within the BSC population as they do with
137nonsurgical obese populations. Differentiating BSCs on
138psychological and behavioral variables is important because
139it may indicate that they have different norms and different
140risk factors for bariatric surgery.
141In specific, the present study hypothesizes that, consis-
142tent with the findings in nonsurgical obesity research,
143female BSCs will report higher levels of depression and
144social anxiety than male BSCs. This is predicted to be
145independent of BMI, and it is hypothesized that male BSCs
146will report higher BMIs than female BSCs. The study limits
147the number of PsyBari indices to those that have been
148found to show gender differences in nonsurgical obese
149populations in an effort to limit the likelihood of a type I
150error. The present study also hypothesizes that female BSCs
151will have more experience dieting and more experience
152with psychological and psychiatric treatment. These varia-
153bles were included because their importance is in assessing
154dieting experience and willingness to acknowledge and
155address psychological problems.
156Materials and Methods
157A power analysis was calculated using an effect size of 0.5,
158alpha level set at 0.05, and power set at 0.95, resulting in a
159sample size of 176 subjects [17]. A total of 361 records
160were available from subjects who underwent psychological
161evaluations for bariatric surgery in a private practice setting
162from August 2002 to September 2006. This included 244
163(67.6%) females and 117 (32.4%) males. Ages ranged from
16419 to 70, with a mean age of 41.7 (SD = 10.8). Subjects
165identified their ethnic group as Caucasian (64.6%), African-
166American (13.2%), Hispanic (9.9%), Asian (1.1%), Native-
167American (0.5%), and other (4.7%).
168Subjects were referred from two local bariatric surgery
169programs. They were administered the PsyBari, a test that
170measures weight-related psychological and behavioral
171variables considered to be relevant in predicting postsurgi-
172cal performance, and the Beck Depression Inventory 2
173(BDI-2) [18]. Subjects then completed a 1-h semistructured
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UNCORRECTED PROOF
174 interview. The results of the PsyBari and BDI-2, along with
175 the interview results, determined whether or not the subject
176 received psychological clearance.
177 The data were analyzed for normality using the Shapiro–
178 Wilk test [19]. Most of the data were positively skewed and
179 did not meet criteria for normal distribution. This is
180 consistent with BSCs’tendency to minimize psychological
181 symptoms. Due to these results, nonparametric tests, the
182 Mann–Whitney and Chi Square, were used. The alpha rate
183 was set at 0.05.
184 Results
185 Regarding weight and eating habits, men reported signifi-
186 cantly higher BMIs (M=49.20, SD= 7.84) than women
187 (M=47.23, SD= 7.32), U= 10,927.00, p= 0.035 (two-tailed).
188 Women have tried significantly more diets (M=7.75,
189 SD=4.08) than men (M=5.48, SD 3.18), U=8,483.00,
190 p<0.000 (two-tailed).
191 For reported levels of depression, women were signifi-
192 cantly more likely to report a history of depression than men
193 (45.7% for women vs. 17.4% for men), X
2
(4, N=347)=
194 26.624, p<0.000. On the PsyBari Depression Index,
195 women received significantly higher scores (M= 10.91,
196 SD=5.15) than men (M=8.01, SD = 5.10), U=4,447.500,
197 p<0.000 (two tailed). On the BDI-2, women also received
198 significantly higher scores (M=13.73, SD=9.94) than men
199 (M=9.74, SD= 7.72), U= 8,211.000, p<0.001 (two tailed).
200 For reported levels of anxiety, women were more likely
201 to acknowledge a history of anxiety than men (23.2% of
202 women vs. 10.4% of men), X
2
(4, N=348)= 8.133, p=
203 0.004. On the PsyBari Social Anxiety Index, women scored
204 significantly higher (M=6.77, SD=4.52) than men (M=
205 5.58, SD=4.39), U= 5,959.000, p= 0.038.
206 In regards to mental health treatment, women were
207 significantly more likely to acknowledge a history of
208 psychotherapy than men (36.5% of women vs. 15.9% of
209 men) X
2
(4, N=346)=15.373, p<0.000. Women were
210 significantly more like to acknowledge taking psychiatric
211 medicine in the past than men (33% of women vs. 14.2% of
212 men) X
2
(4, N=346)= 13.813, p< 0.000.
213 Discussion
214 The results show that, similar to nonsurgical obese popu-
215 lations, BSCs should not be considered a homogenous
216 population. BSCs differ significantly, based on gender, on
217 many psychosocial variables routinely measured in psycho-
218 logical assessments. Specifically, female BSCs were signif-
219 icantly more likely to acknowledge a history of depression
220 and social anxiety. Female BSCs received significantly
221higher scores on the PsyBari depression and social anxiety
222indices. Female BSCs also received significantly higher
223BDI-2 scores. Female BSCs admitted to receiving psycho-
224logical and psychiatric treatment more than men. Female
225BSCs also had significantly more diet history than male
226BSCs. These differences are independent of weight because
227it was found that male BSCs have significantly higher BMIs
228than female BSCs.
229The results show that gender is an important variable
230when assessing BSCs. Males and females have different
231baselines on psychosocial variables, and individual BSCs
232should be compared to gender-based norms. Future research
233can determine if these gender differences persist after
234bariatric surgery and weight loss. Males and females may
235have different PSPBPs; different eating habits; different
236social adjustments; and, overall, different reactions to the
237surgery. In other words, males may have different risk factors
238than females. These differences need to be taken into account
239during presurgical psychological evaluations.
240As more information is obtained on BSCs, future research
241will be needed to determine if separate norms should be
242established for other psychosocial variables such as SES,
243race/ethnicity, and age. Establishment of these norms will
244assist future attempts at determining and measuring variables
245that place BSCs at high risk for PSPBPs.
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... Moreover, the participants in this study are either considering MBS or have already completed MBS. Thus, this finding is consistent with another study that has shown that among those who pursue MBS completion, women are more likely to have anxiety or both depression and anxiety [48,49]. However, unlike previous research, this current study did not observe sex differences for history of depression only [48]. ...
... Thus, this finding is consistent with another study that has shown that among those who pursue MBS completion, women are more likely to have anxiety or both depression and anxiety [48,49]. However, unlike previous research, this current study did not observe sex differences for history of depression only [48]. Yet, depression and anxiety have also been reported as factors that contribute to MBS hesitancy [49]. ...
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  • OBES SURG
Background Mental health conditions including depression and anxiety are often prevalent among metabolic and bariatric surgery (MBS) patients, but it is not known if these conditions predict the decision to complete the procedure and if this varies by race and ethnicity. This study aimed to determine if depression and anxiety are associated with MBS completion among a race/ethnically diverse sample of patients. Methods This prospective cohort study included participants who were referred to an obesity program or two MBS practices between August 2019 and October 2022. Participants completed the Mini International Neuropsychiatric Interview (MINI) instrument to determine history of anxiety and/or depression, as well as MBS completion status (Y/N). Multivariable logistic regression models determined the odds of MBS completion by depression and anxiety status adjusting for age, sex, body mass index, and race/ethnicity. Results The sample consisted of 413 study participants (87 % women, 40% non-Hispanic White, 39% non-Hispanic Black, and 18% Hispanic). Participants with a history of anxiety were less likely to complete MBS (aOR = 0.52, 95% CI = 0.30–0.90, p = 0.020). Women had increased odds of a history of anxiety (aOR = 5.65, 95% CI = 1.64–19.49, p = 0.006) and of concurrent anxiety and depression (aOR = 3.07, 95% CI = 1.39–6.79, p = 0.005) compared to men. Conclusions Results showed that participants with anxiety were 48% less likely to complete MBS compared to those without anxiety. Additionally, women were more likely to report a history of anxiety with and without depression versus men. These findings can inform pre-MBS programs about risk factors for non-completion. Graphical abstract
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... 6 It has been reported that female patients, in particular, were diagnosed with depression and anxiety disorder more often, resorted to psychiatric treatments more frequently, received more recommendations with regards to dietary treatments, and had lower BMI values. 41 In future studies, sex-specific evaluations should be performed, sex-specific risk factors and associated conditions should be determined, whether sex-based differences persist after BS should be identified, and whether the responses to surgery differ by sex should be investigated. ...
... Although the original validity-reliability study did not include an analysis on age groups, the presence of sexrelated differences suggested that this might also be required. 41,42 In addition, there are studies in the literature indicating an increase in suicide rates after BS among women under 24 years of age. 43,44 Given that there will be different psychiatric disorders and physical illnesses among different age groups, the importance of evaluating age-related differences before surgery is warranted. ...
Validity and Reliability of the Turkish Version of Mahony Psychological Assessment for Bariatric Surgery
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Background The aim of this study was to determine the validity and reliability of the Turkish version of Mahony Psychological Assessment for Bariatric Surgery which can be easily administered and used as a guide by health professionals who will be included in the treatment of patients who are potential candidates for bariatric surgery. Methods A total of 310 patients who were admitted to health institutions for bariatric surgery in 3 different provinces of Turkey answered these questions in the Turkish translation of Mahony Psychological Assessment for Bariatric Surgery. Eating disorder examination questionnaire was also administered to the patients in addition to Mahony Psychological Assessment for Bariatric Surgery. Results Early life problems due to weight scores of women were significantly higher than men (P = .001). Among the age groups, both the early life problems due to weight scores (P = .008) and dysphoric feelings about weight scores (P < .001) of the 18-44 age group were significantly higher than the participants who are over the age of 45. There is a weak-to-medium and positive correlation between the total Mahony Psychological Assessment for Bariatric Surgery total scores and all the subscale and total scores of the Eating Disorder Examination Questionnaire (P < .05 for all). These correlation results support the co-validity of Mahony Psychological Assessment for Bariatric Surgery and Eating Disorder Examination Questionnaire. Internal consistency of the Mahony Psychological Assessment for Bariatric Surgery was at a high level except for the subscale of positive treatment attitude and supportive environment. Cronbach’s ɑ values were calculated to be 0.902 for the subscale of emotional and binge eating, 0.820 for the early life problems due to weight, 0.856 for the dysphoric feelings about weight, 0.539 for the positive treatment attitude and supportive environment, and 0.919 for the whole scale. Conclusion The analyses have shown that the Turkish version of Mahony Psychological Assessment for Bariatric Surgery may be used in clinical interviews and psychiatric evaluation of bariatric surgery patients in Turkey.
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... Usually, females were more likely to report a history of depression and/or anxiety, and scored significantly higher than men on depression and social anxiety measurements [6]. ...
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Aspectos Socioeconômicos, Comorbidades e Intolerâncias Alimentares em Pacientes Submetidos à derivação gástrica em Y de Roux: Um Estudo Comparativo entre Gêneros: Pós-Bariátrico: estudo comparativo de gênero
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Preoperative psychiatric evaluation for bariatric surgery
Chapter
  • May 2010
Psychosomatic medicine or consultation-liaison psychiatry is the branch of psychiatry that focuses on the mental health issues which accompany, or develop as a result of, other medical disorders. This subdiscipline forms an important part of training in psychiatry. This book provides an ideal first exposure to the inseparable nature of physical and psychological health and illness, and a comprehensive introduction to the broad range of disorders seen on the psychiatric consult service. Organized into a series of bitesized chapters, each focusing on a typical consult question, this handbook provides a practical and portable reference which should set both strategy and tactics for the next generation of consulting psychiatrists. Essential reading for medical students, psychiatry residents and psychosomatic fellows, this manual will provide immediate, in-the-field guidance on the evaluation and management of common consultation requests.
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Exploring gender, psychiatric symptoms, and eating behaviors as predictors of attrition to bariatric surgery
Article
  • May 2022
  • AM J SURG
Background Only a small proportion of eligible individuals undergo bariatric surgery. The purpose was to examine attrition to surgery and whether psychiatric symptoms and eating behaviors differentially predicted attrition among men and women. Method Data was collected from a retrospective chart review of 313 patients who underwent a pre-surgical psychosocial evaluation. Results The overall attrition rate was 33.5%; 42.6% of men and 31.7% of women experienced attrition. In the multivariate analysis of the entire sample, White patients (OR = 2.33, CI: 1.33, 4.08) and those without a history of binge eating (OR = 2.71, CI: 1.23, 5.97) were more likely to undergo surgery. In a multivariate analysis of women only, race and binge eating independently predicted attrition; however, no factors significantly predicted attrition among men. Conclusions Factors identified at the pre-surgical psychosocial evaluation can identify patients at risk for attrition, and these factors may differ for men and women.
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GPOWER: a general power analysis program
Article
Full-text available
  • Mar 1996
GPOWER is a completely interactive, menu-driven program for IBM-compatible and Apple Macintosh personal computers. It performs high-precision statistical power analyses for the most common statistical tests in behavioral research, that is,t tests,F tests, andχ 2 tests. GPOWER computes (1) power values for given sample sizes, effect sizes andα levels (post hoc power analyses); (2) sample sizes for given effect sizes,α levels, and power values (a priori power analyses); and (3)α andβ values for given sample sizes, effect sizes, andβ/α ratios (compromise power analyses). The program may be used to display graphically the relation between any two of the relevant variables, and it offers the opportunity to compute the effect size measures from basic parameters defining the alternative hypothesis. This article delineates reasons for the development of GPOWER and describes the program’s capabilities and handling.
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Quality of life assessment of morbidly obese patients: Effect of weight- reducing surgery
Article
Full-text available
  • Mar 1998
The effect of surgically induced weight loss on the quality of life of morbidly obese patients was investigated in a controlled cross-sectional study. A postoperative group of 62 patients was compared with a control group of 20 preoperative patients. The Nottingham Health Profile part I (NHP-I) and part II (NHP-II) and a visual analogue scale were used for quality of life assessment. Significant differences were found on the NHP-II (P < 0.0001), the visual analogue scale (P < 0.001), and on the domains of mobility (P < 0.0001), energy (P < 0.001), and emotional reaction (P < 0.001) on the NHP-I in favor of the postoperative group. Better quality of life outcome was related to larger weight loss and shorter length of postoperative follow-up. No correlation was found between quality of life outcome and the type of surgical procedure or surgical complications. The unemployment rate was 53% for the overall postoperative group and 64% for the female postoperative group compared with 80% (P < 0.05) and 84% (NS) in the overall and female control groups, respectively. Overweight as the reason for unemployment was more frequent in the control group. The results of this study show that quality of life is better after surgically induced weight loss and is not related to the type of surgical procedure nor to surgical complications. Postoperative quality of life tends to decrease with time.
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Binge Eating in Gastric Bypass Patients Before Surgery
Article
  • Mar 1999
Binge eating in the obese, specifically those undergoing bariatric surgery, has only recently been investigated. This study is a continuation of a long-term effort to determine the impact of eating disorders on the outcome of bariatric surgery. Self-report questionnaires (Binge Eating Scale, Beck Depression Inventory, Questionnaire on Weight and Eating Patterns) were completed by 125 patients preparing to undergo gastric bypass surgery. Binge eating was clearly a problem in this population, with 33.3% showing severe binge eating problems on the Binge Eating Scale. Over half of patients engaged in bingeing or grazing, most reporting a frequency of two or more times per week. A high level of depression was associated with binge eating. Because postsurgical long-term weight loss maintenance is contingent on modifying eating behavior, the identification and treatment of such disorders may be critical to successful long-term outcome in these patients.
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Psychosocial aspects of obesity and obesity surgery
Article
  • Nov 2001
  • SURG CLIN N AM
There is a growing consensus that bariatric surgery is the treatment of choice for extremely obese individuals who have failed to reduce their weight satisfactorily using behavioral or pharmacologic interventions. The gastric bypass in particular is associated with excellent long-term weight loss. Although most extremely obese individuals will have essentially normal psychological functioning, a significant minority suffer from depression, binge eating, trauma, or other emotional complications that may require treatment before or after bariatric surgery. A structured behavioral assessment, conducted by a mental-health professional and a registered dietitian, can readily identify those who are most likely to require adjunct counseling.
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The Role of Psychological Functioning in Morbid Obesity and Its Treatment with Gastroplasty
Article
  • Jan 2002
The authors evaluated the psychological characteristics of the morbidly obese. The condition-specific and quality-of-life characteristics of a large sample of vertical banded gastroplasty (VBG) patients were evaluated. The role that these psychological characteristics play in moderating the success of gastroplasty surgery, as well as the impact of surgery on quality of life, was examined. This is a cross-sectional evaluative study of a clinical samples, with longitudinal follow-up and with non-surgical comparison groups. 89 morbidly obese individuals were assessed before VBG (but after having been accepted for surgery) and again 1.27 years after surgery. This group represents 98% of the patients who received VBG (i.e., a 2% dropout rate). We used established psychological measures (quality of life, adjustment to obesity, functional impairment, and eating attitudes), including a scale developed by our group specifically for morbid obesity, to identify distinct psychological profiles of the morbidly obese before surgery. The three profile groups differed significantly in psychological characteristics, ranging from high functioning (little emotional distress, functional impairment or dysfunctional eating) to poor functioning (high emotional distress, functional impairment and dysfunctional eating). The subgroups did not differ on pre-surgical weight, and did not differ from morbidly obese groups not seeking surgery. For the surgery group, regardless of pre-surgery psychological profile, VBG produced significant weight loss, maintained at 1 year after surgery. As well, surgery resulted in significant improvements in quality of life and psychological adjustment, especially in the profile group initially presenting with psychological disturbance. There was no evidence to suggest that those with pre-surgical psychological difficulties did more poorly with VBG. These data call into question screening out individuals with psychological problems from gastroplasty surgery. Furthermore, psychological difficulties, if they exist, appear more related to the nature of morbid obesity than to the character of the individual. Psychological difficulties pre-surgery were normalized following surgery.
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Binge eating disorder, weight control self-efficacy, and depression in overweight men and women
Article
  • Apr 2004
To examine binge eating, depression, weight self-efficacy, and weight control success among obese individuals seeking treatment in a managed care organization. Gender-stratified analyses of associations between binge eating, depression, weight self-efficacy, and weight change, using data from a randomized clinical trial that compared low-cost telephone-based, mail-based, and usual care interventions for weight loss. A total of 1632 overweight individuals (460 men, 1172 women; mean age: 50.7 y; mean body mass index: 34.2 kg/m(2)) were recruited from a large Midwestern US managed care organization. Height and weight were measured by study personnel at baseline, and self-reported weight was assessed at 6 and 12 months; self-reported depression status, binge eating, and self-efficacy for weight control were assessed at baseline. Lifetime prevalence rates for depression and probable binge eating disorder were high. Weight self-efficacy was inversely related to weight in both men and women. For women, depression was associated with lower weight self-efficacy and higher body weight. Women reporting depression or lower weight self-efficacy at baseline had less weight loss success at 6 and 12 months. Depression, binge eating disorder, and weight self-efficacy were not significantly associated with weight loss success in men. Negative emotional states are highly prevalent and predict poor treatment outcomes, particularly for obese women. As obese women with clinical depression typically are excluded from intervention studies, further research on how to address the intersection of obesity intervention and mood management may be warranted.
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Depression Score Predicts Weight Loss following Roux-en-Y Gastric Bypass
Article
  • Jan 2004
The prevalence of obesity is increasing in the United States. Bariatric surgery is the only intervention that can reliably induce and maintain significant weight loss in obese patients. The association between pre-surgical severity of depression and success at weight loss following Roux-en-Y gastric bypass (RYGBP) has not yet been fully elucidated. 145 charts of patients who underwent RYGBP for morbid obesity were reviewed. 47 patients who filled out the Beck Depression Inventory (BDI) before surgery and completed 1 year of follow-up were studied. The relationship between pre-surgical severity of depression and success at weight loss was examined through multivariate regression analysis using percent excess weight loss (%EWL) as a dependent variable and BDI score as one of the predictors. Weight loss at 1 year was significantly related to the BDI score before surgery (P =0.014). BDI score was also found to be a significant predictor of the amount of weight lost (kg) 1 year after surgery (P =0.027). Age (P =0.03) and initial body mass index (BMI) (P =0.011) were the only other variables with significant independent relations to %EWL. Our data show a positive correlation between pre-surgical severity of depression as measured by BDI score and the 1-year success at weight loss after RYGBP as measured by %EWL. More depressed individuals tend to lose greater amounts of weight compared with less depressed individuals. Future prospective studies should examine possible mechanisms and effects of depression and other psychiatric disturbances on long-term weight loss after RYGBP.
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Childhood Sexual Abuse is not Associated with a Poor Outcome after Gastric Banding for Severe Obesity
Article
  • May 2005
The aim of this study was to examine whether a history of childhood sexual abuse is associated with weight, health, and depression after Laparoscopic Adjustable Gastric Banding for severe obesity. 157 patients (144 female, 13 male) filled out questionnaires on average 34 months after surgery (range 8-68 months). 23% of the participants, all women, reported a history of childhood sexual abuse. There were no differences between patients with and without a history of childhood sexual abuse on weight and physical health, but the group with a history of childhood sexual abuse showed a higher level of depression. A reported history of childhood sexual abuse does not appear to impact on weight outcome after bariatric surgery, but some patients may need additional psychological treatment for their mental health problems.
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