Surgery type and psychosocial factors contribute to poorer weight loss outcomes in persons with a body mass index greater than 60 kg/m2

Abstract

BackgroundThe current investigation aims to predict 3-year postoperative percent total weight loss among a sample of bariatric surgery patients with super-super obesity. ObjectivePrevious research implies that persons with presurgical super-super obesity (body mass index [BMI] ≥60 kg/m2) tend to have poorer loss outcomes compared with those with a lower presurgical BMI after bariatric surgery. SettingCleveland Clinic, Bariatric & Metabolic Institute, Cleveland, OH. MethodsBariatric surgery candidates (N = 1231; 71.9% female; 65.8% Caucasian) completed a presurgical psychological evaluation and the Minnesota Multiphasic Personality Inventory–2–Restructured Form. Participants with a baseline BMI ≥60 (n = 164) were compared with BMI<60 (n = 1067) on psychosocial and demographic factors, the Minnesota Multiphasic Personality Inventory–2–Restructured Form, and in the subset that had surgery (n = 870), percent total weight loss extending to the 3-year follow-up. ResultsPatients with a BMI ≥60 were younger, less educated, and more likely to be male compared with lower BMI patients. Patients with a BMI ≥60 had greater psychosocial sequelae as evidenced by being more likely to have a history of sexual abuse, history of psychiatric hospitalization, more binge eating episodes, and higher prevalence of major depression disorder and binge eating disorder. On the Minnesota Multiphasic Personality Inventory–2–Restructured Form, those with BMI ≥60 reported greater demoralization, low positive emotions, ideas of persecution, and dysfunctional negative emotions. After controlling for surgery type, weight loss for individuals with BMI ≥60 did not greatly differ from weight loss in patients with BMI<60. Variables predictive of less weight loss at 3 years regardless of presurgical BMI, included being older, having a sexual abuse history, and higher ideas of persecution scores. ConclusionAlthough patients with BMI ≥60 evidenced more psychopathology before surgery, findings suggest that the relationship between higher BMI and poorer outcome may better be explained by other co-morbid factors.