Weight loss trajectories and psychobehavioral predictors of outcome of primary and reoperative bariatric surgery: a 2-year longitudinal study

Abstract

BackgroundLong-term behavioral and psychological aspects associated with weight outcomes after reoperative bariatric surgery have rarely been investigated. ObjectivesThis study sought (1) to identify differences in weight loss trajectories during the first 24 months in reoperative bariatric surgery (R group) and primary bariatric surgery (P group) and (2) to investigate pre- and postsurgery psychobehavioral predictors of weight loss and weight regain for both groups. SettingHospital center and university, Portugal. MethodsThis longitudinal study compared an R group (n = 157) and a P group (n = 216). Patients were assessed at presurgery and at 6, 12, 18, and 24 months postsurgery. Assessment included the Eating Disorder Examination–Questionnaire and Repetitive Eating Questionnaire diagnostic interviews and a set of self-report measures assessing eating disorder symptomatology, grazing, depression, anxiety, and impulsive behavior. ResultsThe P and R groups presented a similar trajectory for the percentage of total weight loss (%TWL) (β = 1.46, standard error = 1.96; Wald χ2 = .55, P = .457) and weight regain (β = 1.66, standard error = 2.72; Wald χ2 = .24, P = .622). No significant presurgery predictors of weight loss and weight regain were found for the P and R groups. Regarding postsurgery predictors, higher Eating Disorder Examination–Questionnaire scores (Wald χ2(1) = 6.88, P = .009) and grazing behavior (Wald χ2(1) = 8.30, P = .004) were associated with less %TWL for both groups. Belonging to the P group emerged as a significant predictor of more weight loss (Wald χ2(1) = 7.25, P = .007). Postsurgery anxiety predicted less %TWL in R group (Wald χ2(1) = 3.89, P = .043). Considering weight regain, higher postoperative disordered eating (global Eating Disorder Examination–Questionnaire; Wald χ2(1) = 4.66, P = .031) was associated with increased weight regain for the P and R groups. ConclusionsProblematic eating behaviors and psychological distress are significant predictors of poor weight outcomes for both groups.