Post-operative psychosocial predictors of outcome in bariatric surgery.

Although there are several recent reviews of the pre-operative factors that influence treatment outcome for bariatric surgery, commensurate efforts to identify and review the predictive validity of post-operative variables are lacking. This review describes the post-operative psychosocial predictors of weight loss in bariatric surgery. Results suggest empirical support for post-operative binge eating, uncontrolled eating/grazing, and presence of a depressive disorder as negative predictors of weight loss outcomes; whereas, adherence to dietary and physical activity guidelines emerged as positive predictors of weight loss. With the exception of depression, psychological comorbidities were not consistently associated with weight loss outcomes. Results highlight the need for post-operative assessment of disordered eating and depressive disorder, further research on the predictive value of post-operative psychosocial factors, and development of targeted interventions.

Depressed mood in class III obesity predicted by weight-related stigma.

BACKGROUND: Greater depressed mood in Class III obese surgery-seeking clients may be due to weight-related stigma, weight-related physical disability (e.g. mobility) or the presence of binge-eating (BE). METHODS: 60 Class III obese surgery-seeking adults were administered the Beck Depression Inventory (BDI), weight-related physical disability (IWQOL-PF) and another weight-related stigma (IWQOL-PD), and assessed for BE (SCID-1 or Questionnaire of Eating and Weight Patterns) before surgery. RESULTS: In a hierarchical regression analysis, BMI, gender, and age of obesity onset did not account for a significant portion of the variance in BDI scores in the first step. The second step of the model was statistically significant (F(3,53)=8.469, P<0.000), accounting for 33.6% of the variance in BDI scores. IWQOL-PD scores were the only significant predictor of BDI scores (b=0.518, P=0.001), and this independently contributed to 32.6% of the variance in BDI scores. CONCLUSION: This suggests that depressed mood seen in Class III obese surgery-seeking individuals may be most related to weight-related stigma rather than BE status, or weight-related physical disability.

Pre-surgery binge eating status: effect on eating behavior and weight outcome after gastric bypass.

BACKGROUND: The impact of pre-surgical binge eating on postoperative outcomes is poorly understood. Previous studies have found marked preoperative differences between binge eaters (BE) and non-binge eaters (NBE) in hunger and disinhibition using the Three-Factor Eating Questionnaire (TFEQ). Short-term prospective data are mixed regarding whether these differences persist after surgery and if preoperative binge eating impacts postoperative weight outcomes. The purpose of the present study was to compare self-reported eating behavior and weight outcomes between BE and NBE after the first postoperative year. METHODS: Prior to surgery, 72 Roux-en-Y gastric bypass (RYGBP) patients completed the Questionnaire of Eating and Weight Patterns (QEWP) or QEWP-Revised (QEWP-R), to assess binge eating status which was defined as one objective binge episode per week over the past 6 months. Subjects also completed the TFEQ prior to surgery and again > or = 12 months after surgery. RESULTS: For BE, higher scores were found for both hunger and disinhibition prior to surgery. At a mean of 18 months after surgery, BE and NBE were indistinguishable on these subscales and there were no differences in weight lost. CONCLUSIONS: RYGBP surgery has an equally positive impact on eating behavior and weight loss for both BE and NBE. Within a multidisciplinary clinic, preoperative BE status does not appear to be a negative prognostic indicator for RYGBP surgery in the domains of weight loss and disinhibition. Further replication is needed with longer follow-up times and larger samples.