Attitude Matters! How Attitude towards Bariatric Surgery Influences the Effects of Behavioural Weight Loss Treatment

Abstract

<b><i>Introduction:</i></b> Multidisciplinary obesity services at university hospitals usually treat patients with more complex and severe obesity. In addition, patients with Class 3 obesity, in particular, have different attitudes regarding the choices of therapy. <b><i>Methods:</i></b> This explorative study investigated the effect of patient attitudes towards bariatric surgery on body weight change (primary outcome) and psychological improvement (secondary outcomes: quality of life, depression, anxiety, and eating behaviour) in a 6-month moderate behavioural weight loss (BWL) programme in a university outpatient setting. <b><i>Results:</i></b> 297 patients with mostly Class 3 obesity participated in the programme. The patients did not yet have any indications for bariatric surgery. Of the participants, 37% had a positive attitude towards bariatric surgery (POS), whereas 38% had a negative attitude (NEG). The drop-out rate was 8%. NEG participants lost significantly more body weight than the POS participants (intention-to-treat population: 4.5 [SD: 6.3] kg versus 0.4 [SD: 5.8] kg; <i>p</i> < 0.001). In both subgroups, anxiety, depression, the mental score for quality of life, and eating behaviour improved. <b><i>Conclusion:</i></b> A BWL treatment in a clinical setting identified 2 distinct groups with different attitudes towards bariatric surgery that were associated with different body weight change outcomes. These groups may require differently targeted programmes to achieve the best body weight loss results.

Effects of Lifestyle and Educational Bridging Programs before Bariatric Surgery on Postoperative Weight Loss: A Systematic Review and Meta-Analysis

“…In terms of psychological well-being, the situation is completely unclear. Despite minor weight loss in patients wishing to undergo bariatric surgery in the abovementioned study by Bauer et al [ 29 ], depressive and anxiety symptoms and quality of life had similar improvement in comparison to the patients not wishing to undergo bariatric surgery. Especially for psychologically unstable patients, such lifestyle interventions could help improve compliance post-bariatric surgery, which is known to be critical, e.g., in patients with depression [ 30 ].…”

“…The results indicate that participation in such preoperative lifestyle interventions before bariatric surgery led to minor BWL, which contribute to decreased risk during the procedure. However, these intervention programs may have their limitations since Bauer et al [ 29 ] recently showed that having a positive attitude toward bariatric surgery per se hinders an individual's weight loss in a 6-month, multimodal lifestyle intervention. Personal exhaustion toward conservative weight loss programs and a lack of motivation may be underlying factors.…”

“…Since there appears to be no or only minor benefit in undergoing lifestyle intervention programs prior to surgery in terms of body weight reduction, the question arises whether there are other benefits from these interventions for bariatric surgery candidates. As mentioned above, improvement of psychological stability can be expected from such programs independent of attitude toward bariatric surgery, which may be especially important for patients with psychological burden [ 29 , 50 ].…”

Patient-Related Predictors for Seeking and Receiving Obesity Surgery

“…Previous evidence indicated that patients preferring OS versus BWLT differed in sociodemographic characteristics, being more likely to be younger [11,12], men [11], and less educated [12], although evidence is mixed [13,14]. Clinically, patients with versus without a preference for OS had a higher BMI [11,13], more previous WL attempts [11,13,14], showed more severe general psychopathology [11] and lower quality of life (QoL) [12], while evidence on depressive symptoms and eating disorder psychopathology is scarce and conflicting [11][12][13][14]. Notably, these were cross-sectional results, comparing patients preferring OS versus BWLT before intervention.…”

Gender and Emotional Representation Matter: Own Illness Beliefs and Their Relationship to Obesity

“…Timeline, consequences, and emotional representations were reduced, and they felt more personal control. Bauer et al ( 64 ) showed that matching the patient's attitude and the treatment methods lead to better weight loss results. Therefore, the evaluation of illness beliefs, that is, the “patient perspective” could be useful parameters for the individualisation and the success of obesity treatment ( 65 , 66 ).…”