Psychosocial Predictors of Weight Loss after Bariatric Surgery

ArticleinObesity Surgery 16(12):1609-14 · January 2007with25 Reads
DOI: 10.1381/096089206779319301 · Source: PubMed
Abstract
The authors investigated the predictive value of various parameters such as age, preoperative weight, eating behavior, psychiatric disorders, adverse childhood experiences and self-efficacy with regard to weight loss after gastric restrictive surgery. After a minimum follow-up of 30 months (median follow-up 50 months; range 30-84 months), a questionnaire concerning extent of, satisfaction with, and consequences of weight loss was mailed to 220 morbidly obese female patients following laparoscopic Swedish adjustable gastric banding (SAGB). Questionnaires were completed and returned by 140 patients (63%). Average BMI loss was 14.6 kg/m(2). Most patients (85%) were happy with the extent of weight loss. Satisfaction with weight loss showed a significant correlation with extent of weight loss. BMI loss was greatest in the obese with an atypical eating disorder (20.0 kg/m(2)), and BMI loss was least in the obese with no eating-disordered behavior before surgery (13.4 kg/m(2)). Obese patients with two or more psychiatric disorders showed significantly less weight loss than did obese patients with one or no psychiatric disorder (BMI units 10.8 vs 14.0 vs 16.1; P=.047). The findings indicate a less successful outcome for obese patients with psychiatric disorders (particularly adjustment disorders, depression and/or personality disorders), compared to patients not mentally ill. An eating disorder preceding surgery, however, was not a negative predictor of success following bariatric surgery. To improve outcome of bariatric surgery in obese patients with psychiatric disorders, more individual psychosocial intervention strategies are necessary.
    • "For instance, some individuals with major depression are able to function adequately in their daily lives, while others are greatly impaired by their symptoms. There is evidence that the severity of psychiatric symptoms, rather than their mere presence, plays a more influential role in determining surgery outcome [51,113,[118][119][120]. Therefore, the relevant focus of the presurgical evaluation should be the impact that such symptoms or diagnoses have on postsurgical adherence and self-care. "
    [Show abstract] [Hide abstract] ABSTRACT: Psychosocial factors have significant potential to affect long-term outcomes of bariatric surgery, including emotional adjustment, adherence to the recommended postoperative lifestyle regimen, weight loss outcomes, and comorbidity improvement/resolution. Thus, it is recommended that bariatric behavioral health clinicians with specialized knowledge and experience be involved in the evaluation and care of patients both before and after surgery. The evaluating clinician plays a number of important roles in the multidisciplinary treatment of the bariatric patient. Central among these is the role of identifying factors that may pose challenges to optimal surgical outcome and providing recommendations to the patient and bariataric team on how to address these issues. This document outlines recommendations for the psychosocial evaluation of bariatric surgery patients, appropriate qualifications of those conducting these evaluations, communication of evaluation results and suggested treatment plan, and the extension of behavioral health care of the bariatric patient to the entire span of the surgical and post-surgical process.
    Article · Feb 2016
    • "In this regard, Lier et al. (2011) found that patients without postoperative psychiatric disorders achieved a HRQOL comparable to the general population one year after bariatric surgery; whereas patients with postoperative psychiatric disorders showed impaired HRQOL compared to the population norm. Moreover, 2 studies (Kinzl et al., 2006, Rutledge et al., 2011) showed that patients with two or more psychiatric disorders after surgery (such as adjustment disorders and/or personality disorders) experienced less weight loss than patients with one or no psychiatric disorder. "
    [Show abstract] [Hide abstract] ABSTRACT: Obesity has become one of the major health problems in current industrialized societies. The negative impact of morbid obesity (defined as having a Body Mass Index>40 kg/m2) in the health-related quality of life of patients is significant. Bariatric surgery is currently considered an effective treatment to achieve sustained weight loss in patients with severe obesity, after failure of non-invasive treatments. The role of physical activity for optimizing bariatric surgery outcomes is receiving growing attention. In this sense, the aim of this article was to review the scientific literature concerning the psychosocial effects of surgery and physical activity in bariatric patients. The search was performed using Medline and Scopus databases. From a total of 58 articles, 37 articles were included in the review after the application of exclusion and inclusion criteria. In view of the evidence collected in this review, this article finishes with several conclusions and recommendations linking current knowledge with future research and future health-care interventions with this population.
    Full-text · Article · Dec 2015 · Asia Pacific Journal of Clinical Nutrition
    • "Pre-operative weight has been found to be a short-term predictor of overall rate of weight loss. The is contradictory with the study done by Kinzl et al (2006), which shows that pre-operative weight has no significant association with weight loss 30 days after bariatric surgery. 24 Furthermore, current study reveals that subjects who are still working has lower rate of weight loss compared to the unemployed group. "
    File · Data · Dec 2015 · Asia Pacific Journal of Clinical Nutrition
    • "Nevertheless, some controversial findings have also been described. Some studies reported that binge ED patients have more difficulties adapting to restrictive eating behaviour after surgery and therefore are at greater risk of poor surgical outcome (Meany, Conceição, & Mitchell, 2014; Niego et al., 2007), while others found no association (Kinzl et al., 2006; Wadden et al., 2011). There are also studies suggesting that BS has a positive effect on abnormal eating behaviour, including uncontrolled and binge eating, at least in the short term (Wimmelmann et al., 2014). "
    [Show abstract] [Hide abstract] ABSTRACT: Bariatric surgery (BS) has proven to be the most effective treatment for weight loss and for improving comorbidities in severe obesity. A comprehensive psychological assessment prior to surgery is proposed to prepare patients for a successful post-surgical outcome. Therefore, the main aim of the present study was to assess psychological and personality predictors of BS outcome. The sample comprised 139 severely obese patients who underwent BS. Assessment measures included the Eating Disorders Inventory-2, the Symptom Checklist-Revised and the Temperament and Character Inventory-Revised. Our results show that favourable BS outcome, after 2 years follow up, was associated with younger age, less depression, moderate anxiety symptoms and high cooperativeness levels. Likewise, metabolic improvements were found to be linked to younger age and certain psychopathological factors. In conclusion, our findings suggest that age, baseline body mass index, psychopathological indexes and personality traits predict successful BS outcome. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
    Article · Sep 2015
    • "Pre-operative weight has been found to be a short-term predictor of overall rate of weight loss. The is contradictory with the study done by Kinzl et al (2006), which shows that pre-operative weight has no significant association with weight loss30 days after bariatric surgery. 24 "
    [Show abstract] [Hide abstract] ABSTRACT: This was a cross-sectional study that investigated the relationship between nutrient intake and psychosocial factors with the overall rate of weight loss after bariatric surgery among patients who had undergone sleeve gastrectomy in University Kebangsaan Malaysia Medical Centre (UKMMC). Forty-three subjects (15 men and 28 women) were recruited for this study. Subjects completed assessment questionnaires including the Binge Eating Scale (BES), Beck Depression Inventory (BECK), Family Support Questionnaires, and the Index of Peer Relation (IPR). Results showed that the median overall rate of weight loss was 4.3±5.5 kg/month, which was lower when compared to the rate of weight loss at three months which was 5.0±5.6 kg/month. Pre-operative weight was the predictor of overall rate of weight loss (p<0.05, R²=0.52). Binge eating disorder (BED) and depression were also closely associated with each other after bariatric surgery (p<0.001, R²=0.46). Subjects with good compliance to dietary advice had lower scores on the binge eating scale. The mean caloric and protein intake was very low, being only 562.2±310.4 kcal/day and 29.6±16.1 g/day. The intake of vitamin A, B1, B2, B3, B12, C, folate, and iron met the Malaysian Recommended Nutrient Intake (RNI). However, the RNI for calcium, zinc, selenium, vitamin D, and vitamin E was not met. In conclusion, although bariatric surgery had many health benefits, several factors hindered weight loss after bariatric surgery. Health care professionals should closely monitor patients after bariatric surgery.
    Full-text · Article · Sep 2015
    • "Depression or other similar psychological problems can also result in poor outcome. [19,20] Most suitable candidates for such surgery are those who have active lifestyle changes regarding both improved eating patterns and physical activity. [1] Surgeons have concerns about the unknown long-term effects of such surgery as more and more young patients with longer life expectancy are opting for such operations. "
    [Show abstract] [Hide abstract] ABSTRACT: Bariatric surgery as it is called now is not a new thing. First bariatric surgery was performed in 1954. Later the surgical remedy for bariatric surgery remained dormant till the popularity of laparoscopic surgery. Past decade has seen a tremendous increase in the number of bariatric or metabolic surgical procedures. This trend may continue because of the epidemic of obesity throughout globe and its rising prevalence among children. Advocates of bariatric surgery consider it the most effective and only treatment for morbid obesity and its co morbidities. To simplify; two types of procedures are performed. 1. Restrictive- where the intake of calories are prevented by restricting food intake. 2. The other one is malabsorptive- where food rich in calories is prevented to get absorbed. Operations based on these principles are-Laparoscopic adjustable gastric band and Vertical sleeve resection of stomach; for restrictive surgery and Laparoscopic biliopancreatic diversion with or without duodenal switch; for malabsorptive procedures. Both types have their own merits and demerits, many of which are almost unacceptable. To counter each other’s’ demerits certain combinations of both types are evolved like Roux-en-Y gastric bypass; it combines both restrictive and malabsorptive components. Each operation has its own merits and demerits. Important points for the patient and surgeon alike in the decision to proceed with bariatric operation include – the technical aspects of operation, post-operative complications including long term nutritional problems, Magnitude of initial and later steady weight loss over the period and correction of obesity related comorbidities. Here, the merits and demerits of present day laparoscopic bariatric surgical procedures are reviewed and related controversial aspects related to them are discussed. Right patient selection; right selection of operative procedure for an individual patient and more importantly right selection of surgeon seems criteria to measure success after such surgery.
    Full-text · Article · Dec 2014
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