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

Abstract

Bariatric surgery has serious implications on metabolic health. The reasons for a failure of bariatric surgery, i.e., limited weight loss, are multifactorial and include psychological factors. We established a theoretical model of how impulsivity is related to weight loss outcome. We propose that depressive symptoms act as a mediator between impulsivity and pathological eating behavior, and that pathological eating behavior has a direct impact on weight loss outcome. We calculated excessive weight loss (%EWL) and assessed self-reported impulsivity (using the Baratt Impulsiveness Scale (BIS-15) total score), depressive symptoms (the Patient Health Questionnaire (PHQ-9) score), and pathological eating behavior (the Eating Disorder Inventory 2 (EDI-2) total score) in 65 patients four years after laparoscopic sleeve gastrectomy. Regression and mediation analyses were computed to validate the theoretical model. The BIS-15, PHQ-9, and EDI-2 have medium to high correlations between each other, and EDI-2 correlated with %EWL. The mediation analysis yielded that the PHQ-9 represents a significant mediator between BIS-15 and EDI-2. The regression model between EDI-2 and %EWL was also significant. These results support our theoretical model, i.e., suggest that impulsivity has an indirect impact on weight loss outcome after bariatric surgery, mediated by depression and transferred through pathological eating behavior. Thus, the underlying psychological factors should be addressed in post-operative care to optimize weight loss outcome.

Identifying prebariatric subtypes based on temperament traits, emotion dysregulation, and disinhibited eating: A latent profile analysis

“…Current depression rates in “Severely RC” patients (44.1%) were considerably higher than those found in other prebariatric samples (3.4–25.3%) (Malik et al, ), indicating that this cluster should receive particular attention of clinicians. Previous research indicated that negative mood was associated with uncontrolled eating in prebariatric patients with both impulsive personality and deficits in emotion regulation (Leehr et al, ; Schag et al, ), suggesting that patients of the “Severely RC” subtype show problematic eating behaviors to regulate their negative feelings as they may lack alternative, healthier strategies. Of note, little to no probable cases of depression were detected in the “Slightly RC” and “Resilient” group which is in line with the results on eating disorder diagnoses.…”

“…Impulsive behavior is closely connected to affective states, either accompanied by highly positive (i.e., extraversion/sensation seeking) or highly negative affect (i.e., neuroticism/negative urgency) (Sharma et al, ; Gullo, Loxton, & Dawe, ). For individuals with obesity and especially for bariatric patients, impulsivity is likely to be triggered by food cues and is particularly associated with negative affect (Gerlach, Herpertz, & Loeber, ; Leehr et al, ; Schag et al, ; Schag, Schönleber, Teufel, Zipfel, & Giel, ). In addition, prebariatric patients often present a range of clinical and subclinical pathological eating behaviors, e.g., binge‐eating disorder (BED) (American Psychiatric Association, ) and emotional eating, which are characterized by emotion dysregulation (Baldofski et al, ; Koball et al, ; Micanti et al, ; Schag et al, ), defined as deficits in recognizing and managing negative affect.…”

Is weight regain after bariatric surgery associated with psychiatric comorbidity? A systematic review and meta‐analysis

“…In fact, different domains of impulsivity had been linked to obesity development . Nevertheless, there are conflicting results in this area, and further investigation of impulsivity in patients submitted to BS and its possible relationship to WR must be done …”

Comportamentos Alimentares Problemáticos após Cirurgia Bariátrica: Um Estudo com Amostra Nacional Portuguesa

“…Os modelos de mediação testados sugerem que a urgência negativa é um mediador significativo da relação entre o tempo decorrido desde a cirurgia e CAPs, e entre distress psicológico e CAPs. Estes resultados contrapõem--se com os publicados por Schag et al, 23 no qual se defende a possibilidade de existir um resultado indireto da impulsividade na perda de peso, possivelmente mediado através da sintomatologia depressiva e do comportamento alimentar disfuncional. No nosso estudo, porém, os modelos testados com a variável de distress psicológico no papel de mediadora (dados não apresentados) não se mostraram significativos.…”