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. 2017 Mar;13(3):514-521.
doi: 10.1016/j.soard.2016.11.008. Epub 2016 Nov 11.

Using the presurgical psychological evaluation to predict 5-year weight loss outcomes in bariatric surgery patients

Ryan J Marek  1 , Yossef S Ben-Porath  2 , Manfred H M van Dulmen  2 , Kathleen Ashton  3 , Leslie J Heinberg  3
Affiliations

Using the presurgical psychological evaluation to predict 5-year weight loss outcomes in bariatric surgery patients

Ryan J Marek et al. Surg Obes Relat Dis. 2017 Mar.

Abstract

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 presurgical psychiatric diagnoses derived from a semi-structured clinical interview and test scores from the Minnesota Multiphasic Personality-Inventory-2 - Restructured Form (MMPI-2-RF) and 5-year Body Mass Index (BMI) outcomes.

Setting: Cleveland Clinic Bariatric and Metabolic Institute METHODS: 446 consecutively consented patients who underwent a Roux-en-Y gastric bypass (RYGB) at least 5 years prior were included in the study. A majority were women (74.2%) and Caucasian (66.2%). Patients' mean presurgical BMI was 49.14 kg/m2 [SD = 9.50 kg/m2]. Psychiatric diagnoses were obtained from a presurgical, semi-structured clinical interview and all participants were administered the MMPI-2-RF at their presurgical evaluations. BMIs were collected at 4 postoperative time points across a 5-year trajectory. This prospective design utilized latent growth curve modeling.

Results: Older patients evidenced a slower rate of BMI reduction over time. A presurgical diagnosis of Binge Eating Disorder predicted higher BMIs at the 5-year outcome. Scores on MMPI-2-RF measures of emotional and behavioral dysfunction domains incrementally predicted poorer weight loss outcomes.

Conclusion: Preoperative indicators of psychopathology, notably indicators that are dimensional in nature, are important in predicting postoperative outcomes. Closer follow-up with patients who evidence presurgical psychological factors, both before and after surgery, may help improve outcomes.

Keywords: Assessment; Bariatric surgery; Obesity; Outcome; Psychology; Weight loss.

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