Psychological predictors of poor weight loss following LSG: relevance of general psychopathology and impulsivity

Abstract

Purpose After bariatric surgery (BS) a significant minority of patients do not reach successful weight loss or tend to regain weight. In recent years, interest for the psychological factors that predict post-surgical weight loss has increased with the objective of developing interventions aimed to ameliorate post-surgical outcomes. In the present study, predictive models of successful or poor weight loss 12 months after BS were investigated considering pre-surgery level of psychopathological symptoms, dysfunctional eating behaviors and trait impulsivity at baseline (pre-surgery). Methods Sixty-nine patients with morbid obesity canditates for laparoscopic sleeve gastrectomy were assessed regarding metabolic and psychological dimensions. Successful post-surgery weight loss was defined as losing at least 50% of excess body weight (%EWL). Results Logistic models adjusted for patient sex, age and presence of metabolic diseases showed that the baseline presence of intense psychopathological symptoms and low attentional impulsivity predict poor %EWL (< 50%), as assessed 12-month post-surgery. Conclusions The present findings suggest that intensity of general psychopathology and impulsivity, among other psychological factors, might affect post-surgery %EWL. Conducting adequate psychological assessment at baseline of patients candidates for BS seems to be crucial to orient specific therapeutic interventions. Level of evidence Level III, case-control analytic study.

Psychological Outcomes and Predictors of Weight Loss in Adolescents With Severe Obesity Following a Reversible Endoscopic Bariatric Procedure

“…This finding suggests that some psychological variables, like depressive symptoms and food restraining, themselves does not have significantly strong effect on weight loss, but in combination overeating episodes does. Our results support the theory that mildly elevated symptoms of depression do not have effect on post-operative weight loss ( 44 ), while worse clinical manifestations (depression as psychiatric disorder) does ( 43 ). Similar, food restraining alone did not predict weight loss, but in combination with overeating become significant predictor.…”

“…Previous research has focused mainly on physical and mental health benefits of more invasive bariatric procedures (24). From mental health perspective bariatric surgeries were found to be associated with sustained improvement in quality of life for adolescents with severe obesity, specifically in weight related quality of life and physical health related quality of life (25)(26)(27). Some research studies have also found that after surgical procedure adolescents showed significantly fewer symptoms of anxiety and depression and significantly improved self-concept compared to baseline (27,28).…”

“…Binge eating status has also been reported to predict poorer weight loss in some studies in adults ( 38 , 39 ), however, others have reported that binge eating, assessed before surgery does not predict weight loss outcome ( 35 , 40 – 43 ). In a recent study, neither anxiety nor depression levels significantly predicted successful weight loss, although patients achieving successful weight loss were characterised by lower mean scores of anxiety and depressive symptoms ( 44 ). Conversely, in other study adults with psychiatric disorders, including depressive disorder, had poorer outcomes in terms of weight loss 30 months after the bariatric surgery ( 43 ).…”

Influence of Weight Loss on Obesity‐Associated Complications After Metabolic and Bariatric Surgery in Adolescents

“…Preoperative predictors of weight loss are poorly defined, and the predictors that have been found explain very little of the overall variance in weight outcomes (24). Some adult data suggest that cognitive and behavioral variables as well as preoperative weight loss may be used to predict postoperative weight loss; however, others have found no correlation (25‐27). We, like others, have demonstrated that most of the weight loss that will occur in adolescents is achieved within the first year following MBS (28).…”

Early Life Adversity and Polygenic Risk for High Fasting Insulin Are Associated With Childhood Impulsivity

“…This reinforces the idea that insulin signaling, which is implicated in metabolism and child growth, also plays a role in neurodevelopment. Previous studies have shown that impulsivity is a core feature of both psychopathology and metabolic diseases ( Schachar and Logan, 1990 ; Silveira et al, 2012 ; Testa et al, 2019 ). Therefore, the interaction described here could be the basis to explain the co-morbidity associated with ELA exposure.…”