A183 - Preoperative Psychosocial Factors Associated with Symptom Perception one Year after Bariatric Surgery

Abstract

Background: A subset of patients experience side effects such as dumping, fatigue and abdominal discomfort after bariatric surgery. The frequency and perceived intensity of such side effects may affect eating behavior and physical activity. Psychological processes may influence the attention, detection, and interpretation of physical symptoms. Anxiety, stress, and negative affect increase the patients selective attention to symptoms, enforce symptom sensitivity and increase symptom reporting. We aimed to study the association between preoperative stressful life events, anxiety, and negative affect with the number and degree of self-perceived side effects one year following bariatric surgery. Method: Questionnaire data from an ongoing prospective study, Oslo Bariatric Surgery Study, was collected from 302 patients preoperatively (79.3% women) and 246 (81.5%) of the participants completed the questionnaire one year after surgery. Mean age was 43.9 years, and 93% underwent Roux-en-Y gastric bypass and 7% gastric sleeve, In response to the question “Have you experienced any side effects/ changes after the operation that affect how you eat or your being physically active?ity” the patients rated the degree of impact, from 0 “No”,to 6 “Very much”, on 11 side effects: change of taste, dumping, pain, feeling full, not wanting to eat, increased hunger, heartburn, vomiting, fatigue, diarrhea, and constipation. Frequency of side effects was calculated as the sum of responses equal or greater than 1. Preoperative independent variables were anxiety and depression (Hospital Anxiety and Depression Scale), self-esteem (Rosenberg s Sself-Eesteem Sscale), and negative thinking about the one s body (The Habit Index of Negative Thinking Body ImageHabitual negative thinking about the body scale). Stressful life events consisteded of? 17 potential stressful negative events, and the respondents indicated degree of impact (1 “low” 4 “high”) and coping (“1 “poor” 3 “ well”).Two single questions measured the extent to which the patients worried that: “..the operation will be unsuccessful“ and “..complications will arise in connection with the operation”.Partial correlations adjusted for percent% weight loss were used. Results: A mean total of 6.8 (SD 2.2) side effects/changes was reported after surgery, with a mean impact of 2.3 (SD 0.6) on their eating behavior or physical activity. Feeling full (95%), dumping (89%) and fatigue (76%) were the side effects/changes most often reported, and affected behavior the most: feeling full (mean 4.3, SD 1.6), dumping (mean 2.9, SD 1.4), fatigue (mean 2.9, SD 1.6). Total degree of impact on behavior from side effects was positively associated with preoperative anxiety (r 1⁄4 0.32), frequency of stressful negative life events (r 1⁄4 0.38), worry about operation success (r 1⁄4 0.22) and complications (r 1⁄4 0.19), and negatively correlated with coping with stress (r 1⁄4 -0.23) and selfesteem (r 1⁄4 -0.20). Preoperative frequency of stressful events and anxiety wereare the factors associated with the most side effects. Diarrhea, dumping, pain, fatigue, not wanting to eat, increased hunger, and heartburn were all associated with preoperative psychological factors. No association was found with change of taste, easily feeling full, vomiting, and constipation. Conclusion: Patients reporting more stressful negative life events and difficulty coping with these events, more anxiety and worry about the treatment prior to surgery, experienced higher selfperceived frequency and impact of side effects on eating behavior and physical activity following surgery. Preoperative anxiety and experience of negative stress may increase the patients’ attention to symptoms, vigilance for detecting potential dangers, and sensitivity for internal body cues after surgery. Self-perceived symptoms are thus important targets for intervention.