Abstract
Twenty to thirty percent of patients experience weight regain at mid and long-term follow-up. Impaired cognitive functions are prevalent in people suffering from obesity and in those with binge eating disorder, thereby, affecting the weight-loss outcomes. The aim of our study was to investigate neurocognitive and psychopathological predictors of surgical efficacy in terms of percentage of excess weight loss (%EWL) at follow-up intervals of one year and 4-year. Psychosocial evaluation was completed in a sample of 78 bariatric surgery candidates and included psychometric instruments and a cognitive battery of neuropsychological tests. A schedule of 1-year and 4-year follow-ups was implemented. Wisconsin Sorting Card Test total correct responses, scores on the Raven’s Progressive Matrices Test, and age predicted %EWL at, both, early and long-term periods after surgery while the severity of pre-operative binge eating (BED) symptoms were associated with lower %EWL only four years after the operation. Due to the role of pre-operative BED in weight loss maintenance, the affected patients are at risk of suboptimal response requiring ongoing clinical monitoring, and psychological and pharmacological interventions when needed. As a result of our findings and in keeping with the latest guidelines we encourage neuropsychological assessment of bariatric surgery candidates. This data substantiated the rationale of providing rehabilitative interventions tailored to cognitive domains and time specific to the goal of supporting patients in their post-surgical course.
Highlights
Individuals suffering from obesity reported mild and specific cognitive deficiencies compared to the general population [1, 2]
According to the body mass index (BMI) cut-off of the International Classification of Diseases (ICD) 8 (10.3%) patients were included in class I obesity (i.e., 30 Kg/m2 ≤ BMI ≤ 34.99 Kg/m2), 20 (25.6%) patients in class II obesity (i.e., 35 Kg/m2 ≤ BMI ≤ 39.99 Kg/m2), and 50 (64.1%) in class III obesity (i.e., BMI ≥ 40 Kg/m2)
According to the BMI cutoff of the International Classification of Diseases (ICD) 4 (6.3%) patients were included in class I obesity (i.e., 30 Kg/m2 ≤ BMI ≤ 34.99 Kg/m2), 17 (26.5%) patients in class II obesity (i.e., 35 Kg/ m2 ≤ BMI ≤ 39.99 Kg/m2), and 43 (67.2%) in class III obesity (i.e., BMI ≥ 40 Kg/m2)
Summary
Individuals suffering from obesity reported mild and specific cognitive deficiencies compared to the general population [1, 2]. Decreased executive functions, such as problem solving and planning, attention, memory, and inhibitory control were the most cited dysfunctions [3, 4]. There are only limited studies exploring the role of neurocognition on weight loss after surgery, with the most long-term findings being the association between cognitive dysfunction and suboptimal weight loss at 36-month follow-up [12]
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