Post-operative Psychosocial Predictors of Outcome in Bariatric Surgery

Abstract

Although there are several recent reviews of the pre-operative factors that influence treatment outcome for bariatric surgery, commensurate efforts to identify and review the predictive validity of post-operative variables are lacking. This review describes the post-operative psychosocial predictors of weight loss in bariatric surgery. Results suggest empirical support for post-operative binge eating, uncontrolled eating/grazing, and presence of a depressive disorder as negative predictors of weight loss outcomes; whereas, adherence to dietary and physical activity guidelines emerged as positive predictors of weight loss. With the exception of depression, psychological comorbidities were not consistently associated with weight loss outcomes. Results highlight the need for post-operative assessment of disordered eating and depressive disorder, further research on the predictive value of post-operative psychosocial factors, and development of targeted interventions.

The Impact of Impulsivity on Weight Loss Four Years after Bariatric Surgery

“…Thus, Gerlach and colleagues [12] propose that pathological eating behavior might mediate the association between impulsivity and weight loss outcome. This hypothesis is in line with studies that found that post-operative pathological eating behavior, especially uncontrolled eating, predicts decreased EWL after bariatric surgery [25,28]. For example, we showed in a recent study [29] that post-operative eating behavior measured with the Eating Disorder Examination explains 36% of the variance of EWL.…”

“…Concerning the way in which psychological factors such as impulsivity influence EWL in patients with bariatric surgery, evidence is insufficient and mixed [1,7], especially concerning post-operative factors [25]: Konttinen and colleagues [26] showed that less post-operative impulsivity and the amount of decrease in impulsivity after surgery is associated with a higher amount of weight loss at a 10-year follow-up. However, some researchers [12,27] did not find a predictive value of impulsivity on EWL after bariatric surgery.…”

Health-related quality of life and psychological functioning 9 years after restrictive surgical treatment for obesity

“…For example, the deterioration in improvement of mood may have been caused by disappointment from unrealistic expectations about surgical treatment or by the reoccurrence of psychiatric disorders [2,3,19]. Furthermore, changes in eating behavior, medical sequelae after surgery (e.g., plugging), the fear of weight regain leading in some cases to disturbed eating [19][20][21], dissatisfaction with body appearance and excess skin [22][23][24], or the persistence of problems after weight loss that are blamed on obesity may have contributed to the decline [19,25,26].…”

Can attention to the intestinal microbiota improve understanding and treatment of anorexia nervosa?

“…[33] For example, dysregulated affective states (e.g., increased stress and anxiety) are prevalent in patients prior to bariatric surgery, and negative affective states (e.g., anxiety) can adversely influence the maintenance of weight loss. [34] While the relationship between mood and weight is still unclear, a growing body of evidence indicates a strong connection between the brain and the intestinal microbiota. [35,36] Early findings in animal models suggest a direct association between the intestinal microbiota and stress-like and/or depressive behaviors,[36] and the collective body of evidence suggests bidirectional communication between the intestinal microbiota and brain function in times of both homeostasis and disease.…”