Sample Of Bariatric Surgery Candidates Research Articles

Psychopathology, disordered eating, and impulsivity in patients seeking bariatric surgery.

Most patients who undergo bariatric surgery experience significant weight loss and improvements in obesity-related co-morbidities in the first 6-18 months after surgery. However, 20%-30% of patients experience suboptimal weight loss or significant weight regain within the first few postoperative years. Psychosocial functioning may contribute to suboptimal weight loss and/or postoperative psychosocial distress. Assess psychosocial functioning, eating behavior, and impulsivity in patients seeking bariatric surgery. Two university hospitals. Validated interviews and questionnaires. Impulsivity assessed via computer program. The present study included a larger (n = 300) and more racially diverse (70% non-White) sample than previous studies of these relationships. Forty-eight percent of participants had a current psychiatric diagnosis and 78% had at least 1 lifetime diagnosis. Anxiety disorders were the most common current diagnosis (25%); major depressive disorder was the most common lifetime diagnosis (44%). Approximately 6% of participants had a current alcohol or substance use disorder; 7% had a positive drug screen before surgery. A current psychiatric diagnosis was associated with greater symptoms of food addiction and night eating. Current diagnosis of alcohol use disorder or a lifetime diagnosis of anxiety disorders was associated with higher delay discounting. The study identified high rates of psychopathology and related symptoms among a large, diverse sample of bariatric surgery candidates. Psychopathology was associated with symptoms of disordered eating and higher rates of delay discounting, suggesting impulse control issues.

Prevalence of Food Addiction and Binge Eating in an Italian sample of bariatric surgery candidates and overweight/obese patients seeking low-energy-diet therapy.

The main aim of the present study was to investigate the prevalence of Food Addiction (FA) and clinical level of Binge Eating in an Italian sample of overweight/obese patients attending low energy-diet therapy, and in an Italian sample of obese bariatric surgery candidates. Participants were: i) 122 overweight/obese patients (86 women) referred to a medical center in Rome (Italy), specialized in nutritional treatment of obesity (i.e., non-surgery patients group), and ii) 281 surgery candidates (207 women) referred to the center for Bariatric Surgery at the University of Rome Tor Vergata (i.e., surgery candidates group). All patients were administered self-report measures investigating FA, binge eating, and psychopathology. Non-surgery patients and surgery candidates did not differ in the prevalence of FA (31.1% vs 26.3%), moderate level of binge eating (32.0% vs 31.8%), and severe level of binge eating (11.05% vs 13.6%). Compared to non-surgery patients, surgery candidates reported higher prevalence in two FA symptoms: i) food consumed more than planned (13.9% vs 25.3%; p=0.011) and ii) persistent desire or repeated unsuccessful attempts (89.3% vs 96.8; p=0.002). Our results confirm that both FA and clinical level of binge eating are common problems in both overweight/obese patients seeking low-energy-diet therapy and in obese bariatric surgery candidates, justifying the clinical utility of assessing these dysfunctional eating patterns.

Occupational Performance Issues of Adults Seeking Bariatric Surgery for Obesity.

We sought to describe the occupational performance issues of a sample of bariatric surgery candidates and to explore the relationships among occupational performance, satisfaction with performance, demographic characteristics, and mental health factors. We reviewed the health records of 241 bariatric surgery candidates and analyzed their scores on the Canadian Occupational Performance Measure (COPM) and standardized mental health questionnaires. Exercise and eating behavior were the most common occupational performance issues. Cognitive and affective issues were reported more frequently than physical issues. Occupational performance and satisfaction correlated negatively with anxiety and depression and positively with self-esteem. Self-esteem contributed 27% of the variance in occupational performance. COPM scores revealed a wide range of occupational performance issues and significant associations with mental health factors, supporting a psychosocial approach to occupational therapy with this population. Routine mental health screening can help ensure that mental health factors are adequately addressed.

Is Pre-operation Social Connectedness Associated with Weight Loss up to 2Years Post Bariatric Surgery?

To date, little attention has been paid to supportive relationships as factors contributing to weight loss from bariatric surgery. This prospective study examined whether total percentage weight loss (%TWL) at 3, 12 and 24months post-surgery varies by distinct aspects of pre-surgery social support (received emotional and practical support and contact with friends and family) in a sample of bariatric surgery candidates (n = 182). These associations were tested with linear regression models adjusted for gender, age, ethnicity, employment status, self-esteem, mastery and time elapsed since the day of surgery. One hundred fifty-four participants underwent a bariatric procedure, and all but seven provided weight loss data at least at one occasion. Emotional support and contact with friends were positively associated with %TWL at 3, 12 and 24months, and the magnitude of these associations was large. For instance, in the fully adjusted models, %TWL at 24months increased by 2.36% (SE 1.17, p = 0.048) with each increase of one standard deviation in emotional support and was higher by 9.23% (SE 4.31, p = 0.035) for participants who reported seeing 1-5 friends per month compared with those who saw none. There was some evidence for a positive association between practical support and %TWL at 3 and 12months post-surgery. Supportive relationships are important contributors to weight loss from bariatric surgery. If replicated in future studies, these findings could inform clinical care and interventions aimed at improving support systems of bariatric surgery candidates.

Cognitive function and quality of life in bariatric surgery candidates

BackgroundBoth poor quality of life (QoL) and cognitive impairment are common in persons with severe obesity. Work in other patient populations show that cognitive impairment is associated with poorer QoL, though this possibility has not been examined in bariatric surgery candidates. ObjectivesWe sought to determine the association between cognitive performance and QoL, both total and work related, in a sample of bariatric surgery candidates. SettingThree sites were used for data collection, including the Neuropsychiatric Research Institute in Fargo, North Dakota, Columbia University in New York, and Cornell University in New York. MethodsSixty participants from the Longitudinal Assessment of Bariatric Surgery project were assessed at preoperative baseline. ResultsHierarchical regression analyses showed that poorer cognitive function was independently associated with lower total QoL and that both reported and objectively measured cognitive impairment were associated with poorer work-related QoL. ConclusionsThese preliminary findings suggest that cognitive impairment may contribute to poorer total and work-related QoL in bariatric surgery candidates. Future studies should examine whether interventions to improve cognitive function can improve QoL and other outcomes in this population.

Replication and evaluation of a proposed two-factor Binge Eating Scale (BES) structure in a sample of bariatric surgery candidates

BackgroundThe Binge Eating Scale (BES) is a widely-used self-report measure of binge eating severity. Hood et al. [1] reported a 2-factor structure for the BES in a sample of bariatric surgery candidates, with factors labeled feelings/cognitions and behavioral manifestations. The present study aims to replicate and extend the factor structure obtained by Hood et al. [1] by testing the utility of a bifactor model that removes binge eating severity variance, which the total BES score purports to assess, in another sample of bariatric surgery candidates. MethodsBariatric surgery candidates (n = 517; 71.2% women; mean body mass index = 49.50 kg/m2; SD = 10.17) were sampled. Twenty-four percent met DSM-IV-TR diagnostic criteria for binge eating disorder. ResultsConsistent with previous research, a 2-factor structure for the BES was supported; however, the 2 factors were substantially correlated (r = .89). A bifactor model significantly improved model fit, supporting the presence of a higher-order severity factor accounting for a significant amount of variance. This factor was primarily marked by binge eating severity as demonstrated by associations with number of objective binge eating episodes and DSM-IV-TR diagnosis. In the bifactor model, the feelings/cognitions factor was modestly associated with self-reported mood psychopathology. However, contrary to expectations, the behavioral manifestation factor was not associated with empirically derived behavioral problems. ConclusionsThe current findings partially converge with those of Hood et al. [1] However, the use of the BES as a 2-factor measure is not recommended at this point because of lack of incremental validity demonstrated by the behavioral manifestation factor. Continued use of the BES as a unidimensional measure of binge eating severity, in conjunction with a comprehensive clinical interview, can provide useful guidance for presurgical treatment recommendations.

Impact of using DSM‐5 criteria for diagnosing binge eating disorder in bariatric surgery candidates: Change in prevalence rate, demographic characteristics, and scores on the minnesota multiphasic personality inventory – 2 restructured form (MMPI‐2‐RF)

Binge eating disorder (BED) was recently included in the DSM-5. The prevalence rate for BED using the DSM-IV-TR research criteria tends to be higher in bariatric surgery candidates than the normative population; however, no studies have examined how many more bariatric surgery candidates will meet the new, less conservative criteria of DSM-5. We explore the current BED prevalence rate change in a sample of bariatric surgery candidates. Data were obtained for 1,283 bariatric surgery candidates. 84 men and 213 women were diagnosed with current BED using DSM-IV-TR research criteria. A semi-structured interview, the binge eating scale (BES), and a Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) were given to every patient as part of standard procedures mandated by the facility. An additional 3.43% (p < .001) of bariatric surgery candidates met the diagnostic threshold for BED when using DSM-5 criteria. These individuals were demographical similar and produced similar MMPI-2-RF and BES scores when compared with patients who met DSM-IV-TR criteria for BED. Thus, the current investigation indicates that individuals meeting BED criteria based on DSM-5 are similar to those meeting the more conservative diagnostic threshold outlined in DSM-IV-TR in a sample of bariatric surgery candidates.

Psychometric Properties of the Patient Health Questionnaire (PHQ-9) as a Depression Screening Tool for Bariatric Surgery Candidates

Major depressive disorder has been shown in some studies to attenuate weight loss and psychosocial outcomes following surgery. Given the potential implications of depression on surgery outcomes, presurgery psychiatric assessment is recommended to assess suitability for bariatric surgery. The purpose of this study was to examine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) in detecting depression in bariatric surgery candidates. Bariatric surgery candidates (n = 244) completed the PHQ-9 and the Mini International Neuropsychiatric Interview (MINI) as part of their presurgery psychiatric assessment. The operating characteristics of the PHQ-9 were examined. The study was replicated in an independent sample of bariatric surgery candidates (n = 275). Rates of current and lifetime major depressive episodes were 1.6% to 3.8% and 33.8% to 35.5%, respectively, as assessed by the MINI. According to the PHQ-9, 52.5% to 54.9% of patients exceeded the cutoff for moderate depression (PHQ-9 ≥ 10), and 27.6% to 29.1% for moderate severe depression (PHQ-9 ≥ 15). The optimal dichotomization cutoff point on the PHQ-9 was ≥15 in both studies (sensitivity 75%, specificity 75% to 76%). Our results suggest that the PHQ-9 has adequate operating characteristics compared with a criterion standard measure. A PHQ-9 cutoff of 15 is recommended to identify bariatric surgery candidates who may require further assessment of depressive symptoms.

The Personality Assessment Inventory: Clinical Utility, Psychometric Properties, and Normative Data for Bariatric Surgery Candidates

The Personality Assessment Inventory (PAI), an overall measure of personality and psychopathology, features a number of dimensions that may be useful in the psychological assessment of bariatric surgery candidates. However, its clinical utility is limited because psychometric properties of the PAI with bariatric surgery candidates have never been evaluated, and normative data for this population have never been published. We examined the psychometric properties and clinical utility of the PAI with a large sample of bariatric surgery candidates (n = 546) presenting for evaluation in an urban medical center. Internal consistency reliability analyses were performed on the PAI full scales and subscales. Exploratory factor analysis using principal components analysis with oblique rotation was performed and the results compared with community, clinical, and medical samples. Normative data and scale elevation frequencies for the bariatric sample are presented. Alpha coefficients and mean interitem correlations were acceptable and similar to the test standardization samples. Factor analyses supported the consistency of the underlying factor structure with bariatric surgery candidates and also revealed a factor for warmth and social support. Normative data indicate that overall bariatric surgery candidates appear quite similar to the community standardization sample. Sixteen percent of candidates reported significant (T >or= 70) somatic complaints, consistent with the greater health problems in this sample. Our findings support the clinical utility of the PAI in the psychological assessment of bariatric surgery candidates. The availability of PAI normative data and profile elevation statistics will help to facilitate clinical interpretation and inform treatment recommendations for candidates undergoing bariatric surgery.

Examination of the MMPI-2 Restructured Clinical (RC) Scales in a Sample of Bariatric Surgery Candidates

The current study examined the MMPI-2 Restructured Clinical (RC) scales (Tellegen et al., MMPI-2 Restructured Clinical (RC) scales: Development, validation, and interpretation. Minneapolis: University of Minnesota Press, 2003) in a sample of 1,091 bariatric surgery candidates. The RC scales were developed to address concerns about limited discriminant validity of the Clinical scales. Internal consistency and external validity analyses were conducted to evaluate the RC scales in this setting. Results indicated that the RC scales are generally more internally consistent than the Clinical scales and display significantly better convergent and discriminant validity in predicting a variety of behavioral, psychological, and developmental variables relevant to preoperative bariatric psychological evaluations. Implications of the results and recommendations for future research with the RC scales in medical settings are discussed.