Psychosocial Predictors of Weight Loss after Bariatric Surgery

University of Innsbruck, Innsbruck, Tyrol, Austria
Obesity Surgery (Impact Factor: 3.75). 01/2007; 16(12):1609-14. DOI: 10.1381/096089206779319301
Source: PubMed


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.

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    • "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). "
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    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.
    No preview · Article · Sep 2015 · European Eating Disorders Review
    • "Only 12 out of the initial 39 included statistical data on the frequency, associated psychological features or weight outcomes in bariatric surgery patients (see Table 3)[2,6,7,9,10,13,161718192021, and 6 studies were found with data on these eating behaviors in nonbariatric surgery samples[15,2223242526. Seventeen studies were excluded because they mentioned grazing without providing statistical data or a new definition of the behavior[1,5,8,2728293031323334353637383940, and one because it surveyed a group of bariatric patients on their ideas about the definition of grazing[41]. "
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    ABSTRACT: Background Grazing, characterized by a repetitive eating pattern, has received increased attention among bariatric surgery patients. However, different definitions and terminology have been used, preventing the accurate measurement of this phenomenon and comparison of data across studies. Objective To review existing definitions and associated clinical features of grazing among different samples and to propose a standardized definition that will allow for consistency in future work. Setting University and Clinical Research Institute. Methods Of the 39 studies found, 9 provided an original definition and 12 provided data of its association with weight outcomes. Six were studies of non-bariatric surgery populations. Based on this literature review, the most common criteria used in previous studies to define grazing were included in a survey that was sent to 24 individuals who have published work in the field. These experts were asked to provide their opinion on what should constitute grazing. Results Grazing is a frequent behavior in the bariatric surgery population as well as in eating disordered and community samples. Its association with psychopathology is not clear, but its negative impact on weight outcomes after bariatric surgery generally has been supported. Survey data provided a consensus regarding the definition of grazing as an eating behavior characterized by the repetitive eating (more than twice) of small/modest amounts of food in an unplanned manner, with what we characterize as compulsive and non-compulsive subtypes. Conclusions Given the clinical relevance of grazing among bariatric surgery patients, a unique definition is crucial to better study its associated features and impact on different populations.
    No preview · Article · May 2014 · Surgery for Obesity and Related Diseases
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    • "Binge eating is one of the most commonly examined disordered eating behaviors amongst individuals pursuing bariatric surgery; however, preoperative binge eating does not necessarily predict poorer outcomes after surgery (Bocchieri-Ricciardi et al., 2006; Burgmer et al., 2005; Kinzl et al., 2006; Legenbauer, Burgmer, Senf, & Herpertz, 2007). Rather, other postoperative eating behaviors and pathology (e.g., loss of control eating and grazing) appear to be better predictors of poorer outcomes. "
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    ABSTRACT: 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 partially explained by failure to make long-term behavioral and/or cognitive changes. We are unaware of any established clinical tools to guide providers in assessing postoperative behaviors and identifying those who may require specialized treatment. The goal of this paper is to introduce a brief screening tool, The WATCH, to help clinicians assess and identify patients who may be at risk for poor or untoward outcomes post bariatric surgery. We first review the literature on postoperative outcomes, including weight loss, resolution of comorbidities, suboptimal outcomes, and development of problematic eating behaviors. We then provide an easily-recalled, five-item tool that assesses outcomes, and discuss patient responses that may necessitate further intervention or referral.
    Full-text · Article · May 2013 · Journal of Clinical Psychology in Medical Settings
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