Additional preconditioning program for bariatric surgery: Any benefits? A large cohort study.

Postbariatric outcomes may improve by providing an additional preconditioning program (APP) in targeted patients. However, APPs are a demand for health resources while only little and inconsistent evidence consists to support their effectiveness. This cohort study aims to evaluate the effectiveness of APP, by comparing outcomes of patients with and without such APP. We carried out a retrospective single-centre cohort study in a before-after design. Patients signing up for primary gastric bypass or sleeve gastrectomy and eligible for surgery were included if screened as vulnerable patients. Vulnerable patients screened between September 2017 and March 2018 followed an APP and formed the APP-group. Due to a policy change, APPs were no longer performed since September 2018. Vulnerable patients screened between September 2018 and March 2019 thus did not receive an APP (comparator-group). Multidisciplinary follow-up remained unchanged. Endpoints included percentage total weight loss (%TWL), bodyweight, evolution of comorbidities, protein intake, and number of no-shows. The APP-group comprised 231 patients and the comparator-group 153. %TWL differed statistically significantly at 7 (Δ1.5%, p = .01) and 12 months postoperative (Δ2.8%, p < .01) in favour of the comparator-group, as did bodyweight 12 months postoperative (Δ1.8 kg, p < .01). Statistically significant differences were also found in the evolution of comorbidities, protein intake, and the number of no-shows, most in favour for the comparator-group. APP proofed not to be superior to Non-App. It is debatable whether statically significant differences are clinically relevant given their small magnitude. A care pathway without an APP seems at least as effective as a care pathway without.

Health-related quality of life following vertical banded gastroplasty.

BACKGROUND: Morbid obesity is associated with increased risks of morbidity and mortality as well as poor quality of life (QoL). Therefore, the goal of bariatric surgery should not only be reducing weight and treatment of comorbid conditions, but also improving QoL. Moreover, enhanced QoL may motivate patients to adhere to adequate health behavior in order to maintain the surgically established weight loss. METHODS: We evaluated early postoperative health-related quality of life (HRQoL) over time. Preoperatively as well as 6, 12, and 24 months after vertical banded gastroplasty (VBG), 107 patients were psychologically assessed using a semistructured interview and the RAND 36-item Health Survey (RAND-36). RESULTS: Over time, we found significant changes in weight: 2 years after surgery, excess weight loss (EWL) was 58.4%. HRQoL showed significant improvements over time, especially in the physical domains. Two years after surgery, 74% of patients were satisfied with the results of the operation and 94.1% would opt for surgery again. CONCLUSIONS: VBG not only leads to considerable weight loss, but also to significant improvements in HRQoL. However, some of the initially reported improvements lessened over time and not all patients appeared to profit in the same way.

Psychosocial predictors of success after vertical banded gastroplasty.

BACKGROUND: Psychosocial and behavioral factors contribute to successful postoperative outcomes. Patients' psychological factors may be predictive of postsurgical adjustment. The identification of these factors would allow targeting patients at risk of a poor outcome. Furthermore, it would enable better patient selection and preoperative and/or postoperative counseling to improve long-term outcomes. Unfortunately, no such consistent and reproducible predictors have been found so far. METHODS: The present study investigated in morbid obese patients who underwent vertical banded gastroplasty (VBG) the predictive value of preoperative parameters, especially health-related quality of life (HRQoL), personality, psychosocial functioning, body image, and eating behavior for 2-year changes in these variables, as well as weight loss. RESULTS: Two years after VBG, patients had significant weight loss and reported improvements in physical HRQoL, personality and psychosocial functioning, body image, and eating behavior. Although we were not able to find psychosocial predictors of excess weight loss or excess body mass index loss 2 years after VBG, we did find psychosocial predictors of 2-year changes in HRQoL, personality and psychosocial functioning, body image, and eating behavior. CONCLUSION: Preoperative psychological assessment may not be necessary with respect to weight loss. However, it is helpful in targeting patients at risk of poor psychological outcomes after VBG.

Bariatric surgery and bariatric psychology: evolution of the Dutch approach.

BACKGROUND: Success of bariatric surgery is largely dependent on patients' abilities to change their lifestyle and underlying psychosocial and behavioral factors; these factors should be carefully scrutinized. However, no consensus or guidelines exist for these evaluations. MATERIALS AND METHODS: To get a better understanding of the practice of bariatric surgery and bariatric psychology in The Netherlands and its evolution, a survey of bariatric surgery programs was conducted. RESULTS: Between 2000 and 2005, performance of bariatric surgery in The Netherlands has increased from 564 to more than 2,000 annually, mostly adjustable gastric banding. Most hospitals have a multidisciplinary selection process, and in 89% of the cases, a mental health specialist was involved. CONCLUSION: Bariatric surgery in The Netherlands has increased tremendously; however, it is mostly limited to restrictive procedures, and there is no consensus regarding the psychological evaluation of patients.

Psychosocial functioning, personality, and body image following vertical banded gastroplasty.

BACKGROUND: In addition to increased risks of morbidity and mortality, extreme obesity is substantially associated with psychosocial problems. Therefore, the ultimate goal of bariatric surgery should not only be reducing weight and counteracting comorbid conditions but also improving psychosocial functioning. In addition to being an important goal of bariatric surgery, enhanced psychosocial functioning may motivate patients to adhere to adequate health behavior to maintain the surgically established weight loss. METHODS: We evaluated early postoperative psychosocial functioning in several domains over time. Preoperatively as well as 6, 12, and 24 months after vertical banded gastroplasty, 104 patients were psychologically assessed using a semi-structured interview and psychological questionnaires focusing on psychosocial functioning, personality, and body image. RESULTS: Over time, we found significant changes in weight: 2 years excess weight loss was 58.6%. In addition, most aspects of psychosocial functioning showed significant improvements over time. However, initial improvements in depressive symptoms, sleeping problems, and neuroticism did not last. With respect to personality features, only short-term changes in self-esteem were found. The most robust improvements were seen in the case of body image. Finally, within the patient group, there was a wide variability in changes. CONCLUSION: Vertical banded gastroplasty not only leads to considerable weight loss but also to significant improvements in psychosocial functioning. However, some improvements waned over time, and successful postoperative functioning did not apply to all patients.

Weight loss and eating behavior following vertical banded gastroplasty.

BACKGROUND: Bariatric surgery is the treatment of choice for patients with morbid obesity. In addition to surgery, postoperative dietary behavior is an important mediator of weight loss and, therefore, critical in influencing outcome. Surgical treatment of obesity is not an alternative to dieting but a method to enforce dieting. METHODS: We evaluated early weight loss and postoperative eating behavior over time. Preoperatively as well as 6 months, 1 and 2 years after vertical banded gastroplasty (VBG), 91 patients were psychologically assessed using a semi-structured interview and a psychological questionnaire focusing on eating behavior. RESULTS: Over time, we found significant changes in weight, mostly in the 1st postoperative year (EWL= 52.0%); at 2 years, EWL was 61.5%. Patients reported substantial changes in feelings of hunger, appetite, satiety, and eating behavior; however, most improvements waned over time. In addition, there was a wide variability in changes within our patient group, and changes in weight loss appeared to be related to changes in restrained eating. CONCLUSION: VBG not only leads to considerable weight loss, but also to significant improvements in eating behavior, at least within 2 years. However, most improvements wane over time and not all patients profit in the same way.

Psychosocial functioning following bariatric surgery.

Morbid obesity is associated with an increased risk of morbidity and mortality as well as psychosocial problems and poor quality of life. The ultimate goal of bariatric surgery is not only reduced weight and reduction of co-morbidities, but also improved psychosocial functioning and quality of life. However, not all patients are successful. A systematic literature search of recent articles identified relevant variables reflecting postoperative psychosocial functioning. Most studies showed that bariatric surgery does not only lead to substantial weight reduction, but also to improvement or cure of physical as well as psychological co-morbidities. Although most studies are optimistic and report broad psychosocial improvement, a significant minority of patients do not benefit psychologically from surgery. Although there are mixed results, the overall improvements in psychosocial functioning provide additional justification for surgical treatment of morbid obesity.

Psychological profile of candidates for vertical banded gastroplasty.

BACKGROUND: Because bariatric surgery is a forced behavior modification and the operation represents only one element in it, behavioral and psychological factors play an important role in its results. Consequently, better understanding of candidates for bariatric surgery may improve selection for and success with this intervention. METHODS: In this study, the psychological profile of candidates for vertical banded gastroplasty (VBG) was investigated. In the context of preoperative psychological evaluation, 153 patients were interviewed by a psychologist and completed a battery of psychological tests. RESULTS: Compared to varying samples of the general population, candidates for VBG, especially females, experienced more psychological difficulties, more disturbed eating patterns, poor body attitude, and poor quality of life (QoL). In addition, 3 subgroups could be identified, ranging from relatively good to relatively poor psychological functioning. CONCLUSION: Preoperatively, candidates for VBG struggle with a diversity of problems; however, some patients are less negatively affected by their obesity than others.

Psychosocial predictors of success following bariatric surgery.

BACKGROUND: Bariatric surgery is the treatment of choice for morbid obesity, but it does not lead to equal results in every patient. In addition to surgery, a number of non-surgical and psychological factors may influence patients' ability to adjust to the postoperative condition. Understanding the relationship between potential predictive variables and success after bariatric surgery will enable better patient selection, and the development of interventions to improve outcome. METHODS: A systematic literature search identified relevant variables, such as demography, preoperative weight, motivation, expectations, eating behavior, psychological functioning, personality, and psychiatric disorders, which may have predictive value for success after bariatric surgery. RESULTS: Greater success following bariatric surgery appears to occur in patients who are young and female, and have a high self-esteem, good mental health, a satisfactory marriage, and high socio-economic status, who are self-critical and cope in a direct and active way, are not too obese, were obese before the age of 18, suffer from and are concerned about their obesity, have realistic expectations and undisturbed eating behaviors. Occasionally, these variables may have poor or no predictive value. Although reliable predictors are lacking, most treatment teams propose their own exclusion criteria. CONCLUSION: The existing literature about potential predictors of success after bariatric surgery is far from conclusive; it is still uncertain which factors can predict success. Even where psychosocial functioning does not predict outcome, it is important to identify patients' characteristics which may be linked to their prognosis and to provide necessary pre- and postoperative psychosocial interventions.

Psychological profile of the morbidly obese.

BACKGROUND: In the surgical treatment of morbid obesity, surgery on its own represents only one element. In fact, bariatric surgery is a forced behavior modification; in addition to surgery, psychological factors play an important role in its results. Because of the importance of the psychological factors and the possibility to intervene in them, there is a need for a better understanding of morbidly obese patients, especially those who are candidates for bariatric surgery. Thus, this article reviews their psychological profile. METHODS: A systematic literature search identified relevant variables reflecting personality and psychopathology, eating behavior, social problems, and quality of life. RESULTS: Morbidly obese patients are described as depressed, anxious,having poor impulse control, low self-esteem, and impaired quality of life. Dieting, rigid control, and disinhibition characterize their eating behavior. This seems to be especially true for morbidly obese patients seeking surgical treatment for their obesity. CONCLUSION: The existing literature about the characteristics of the morbidly obese is far from conclusive; this may in part be due to the use of poor methods of assessment.

Bariatric surgery and bariatric psychology: general overview and the Dutch approach.

BACKGROUND: Obesity is a chronic, multifactorially caused disease with serious somatic and psychosocial comorbidity as well as economical consequences. In the Netherlands, between 1993 and 1997, the prevalence of morbid obesity was 0.2% for men and 0.6% for women. Although bariatric surgery generally is an effective intervention, it does not lead to equal results in every patient. The long-term efficacy is predominantly determined by compliance to adequate dietary rules in which psychosocial factors can play a major role. METHODS: Questionnaires were sent to the surgery departments of all hospitals in the Netherlands. Subsequently, a second questionnaire was sent to clinical psychology departments of hospitals which perform bariatric surgery. RESULTS: In 28 Dutch hospitals (19%), bariatric surgery is being performed, mostly using restrictive procedures. Almost all hospitals have a multidisciplinary selection-process, and all surgeons and psychologists use multiple selection-criteria. Regarding these criteria, there is more consensus between surgeons than between psychologists. In most hospitals, patients are psychologically assessed prior to surgery. However, postoperative assessment is relatively rare, as is preoperative and postoperative psychological treatment. CONCLUSION: In the Netherlands, bariatric surgery is still relatively uncommon and mostly limited to restrictive procedures. Irrespective of BMI and eating behavior, the majority of patients will be offered a restrictive procedure. The involvement by the psychological and/or psychiatric discipline is not optimal yet; especially, postoperative assessment and pre- and postoperative treatment are not frequently performed, in spite of the fact that these programs can enhance the success rate of bariatric surgery.