Rethinking the Preoperative Psychological Evaluation – A New Paradigm for Improved Outcomes and Predictive Power

Abstract

Weight loss surgery (WLS) has become increasingly commonplace, as rates of morbid obesity and its serious medical consequences continue to rise in developed countries worldwide (Nguyen et al., 2005; Steinbrook, 2004). From 1998 to 2002, an increase in WLS of approximately 450% was observed in the United States alone, and from 2002 to 2004, it was estimated that more than 357,300 adults in the United States had undergone WLS (Wysoker, 2005). Most patients benefit from the procedure; however there remain at least 20% of patients who fail to lose the expected amount of weight or who regain a significant amount of lost weight (Christou, Look, & Maclean, 2006; Kalarchian et al., 2007; Kinzl et al., 2006). Some researchers have identified 7-10 year failure rates of up to 35% for gastric bypass patients and up to 57% for laparoscopic banding patients (Ayyad & Andersen, 2000; Fischer et al., 2007). A recent long-term follow-up of 200 gastric banded patients found that excess weight loss (EWL) was gradually regained, resulting in only 15.6% EWL after 14 years and a reoperation rate of 30.5% (Stroh, Hohmann, Schramm, Meyer, & Manger, 2011). While a minority of these failures or suboptimal outcomes may be due to technical surgical errors or complications, the majority of them are attributable to psychological and behavioral factors that interfere with patients’ abilities to make or maintain lasting changes in lifestyle (Boeka, Prentice-Dunn, & Lokken, 2010; Buchwald et al., 2004; Pessina, Andreoli, & Vassallo, 2001). Long-term failure rates highlight the need to selectively identify patients at-risk for minimal weight loss or weight regain (O'Brien, McPhail, Chaston, & Dixon, 2006; Stroh et al., 2011).