Abstract
BackgroundBariatric surgery is an effective treatment for the obesity epidemic, but the poor attendance and adherence rates of post-surgery recommendations threaten treatment effectiveness and health outcomes. Preoperatively, we investigated the unique contributions of clinical (e.g., medical and psychiatric comorbidities), sociodemographic (e.g., sex, age, and educational level), and psychopathological variables (e.g., binge eating severity, the general level of psychopathological distress, and alexithymia traits) on differing dimensions of adherence in a group of patients seeking bariatric surgery.MethodsThe final sample consisted of 501 patients (346 women). All participants underwent a full psychiatric interview. Self-report questionnaires were used to assess psychopathology, binge eating severity, alexithymia, and three aspects of adherence: knowledge, attitude, and barriers to medical recommendations.ResultsAttitude to adherence was associated with alexithymia (β = ˗2.228; p < 0.001) and binge eating disorder (β = 0.103; p = 0.047). The knowledge subscale was related to medical comorbidity (β = 0.113; p = 0.012) and alexithymia (β = −2.256; p < 0.001); with age (β = 0.161; p = 0.002) and psychiatric comorbidity (β =0.107; p = 0.021) manifesting in the barrier subscale.ConclusionWe demonstrated that alexithymia and psychiatric and eating disorders impaired adherence reducing attitude and knowledge of treatment and increasing the barriers. Both patient and doctor can benefit from measuring adherence prior to surgery, with a qualitative approach shedding light on the status of adherence prior to the postsurgical phase when the damage regarding adherence is, already, done.Graphical
Highlights
The long-term benefit of bariatric surgery goes largely beyond a well-performed operation and weight loss
There were 160 individuals (31.9%) who met the criteria for a diagnosis of at least one psychiatric disorder, and 78 (15.6%) who met the criteria for binge eating disorder (BED)
According to the TAS-20 cutoff scores [38], there were 88 subjects (17.6%) who met the criteria for possible alexithymia and 58 (11.6%) who met the criteria for a diagnosis of alexithymia
Summary
The long-term benefit of bariatric surgery goes largely beyond a well-performed operation and weight loss. The increase of metabolic status, lifestyle habits, and better psychosocial functioning are of critical importance. In this view, from the preoperative phase to the postsurgical period, the multidisciplinary bariatric team is a determining factor in the support of patients on their journey to recovery. There is a growing consensus on the role of poor adherence to nutritional and lifestyle recommendations as being the health-related behavior that may hinder, either directly or indirectly, satisfactory long-term outcomes [2]. We investigated the unique contributions of clinical (e.g., medical and psychiatric comorbidities), sociodemographic (e.g., sex, age, and educational level), and psychopathological variables (e.g., binge eating severity, the general level of psychopathological distress, and alexithymia traits) on differing dimensions of adherence in a group of patients seeking bariatric surgery
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