Abstract
Bariatric surgery has serious implications on metabolic health. The reasons for a failure of bariatric surgery, i.e., limited weight loss, are multifactorial and include psychological factors. We established a theoretical model of how impulsivity is related to weight loss outcome. We propose that depressive symptoms act as a mediator between impulsivity and pathological eating behavior, and that pathological eating behavior has a direct impact on weight loss outcome. We calculated excessive weight loss (%EWL) and assessed self-reported impulsivity (using the Baratt Impulsiveness Scale (BIS-15) total score), depressive symptoms (the Patient Health Questionnaire (PHQ-9) score), and pathological eating behavior (the Eating Disorder Inventory 2 (EDI-2) total score) in 65 patients four years after laparoscopic sleeve gastrectomy. Regression and mediation analyses were computed to validate the theoretical model. The BIS-15, PHQ-9, and EDI-2 have medium to high correlations between each other, and EDI-2 correlated with %EWL. The mediation analysis yielded that the PHQ-9 represents a significant mediator between BIS-15 and EDI-2. The regression model between EDI-2 and %EWL was also significant. These results support our theoretical model, i.e., suggest that impulsivity has an indirect impact on weight loss outcome after bariatric surgery, mediated by depression and transferred through pathological eating behavior. Thus, the underlying psychological factors should be addressed in post-operative care to optimize weight loss outcome.
Highlights
Bariatric surgery is the most effective treatment for patients with severe obesity that on average results in 20%–35% of body weight loss from initial weight after 2–3 years [1] and substantially decreases somatic comorbidities associated with metabolic syndrome [1,2,3]
The validation of theoretical models can help to elucidate the factors contributing to limited weight loss after bariatric surgery
This is the first study that tested a model concerning the impact of post-operative impulsivity on weight loss outcome in bariatric surgery patients in a four-year follow-up
Summary
Bariatric surgery is the most effective treatment for patients with severe obesity that on average results in 20%–35% of body weight loss from initial weight after 2–3 years [1] and substantially decreases somatic comorbidities associated with metabolic syndrome [1,2,3]. Impulsivity might be one personality factor contributing to a limited benefit from bariatric surgery [12]. Impulsivity is considered to be a fairly stable personality trait. It is a multifactorial trait with a neurobiological basis in the mesolimbic reward system and the prefrontal cortex [13,14,15]. It leads to rash and spontaneous behavior without consideration of possible consequences
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
