Remote assessments and behavioral interventions in post-bariatric surgery patients.

Sustained weight loss and health improvements after bariatric surgery require long-term monitoring and, for a significant minority of patients, postoperative intervention. Unfortunately, many patients demonstrate difficulty engaging in long-term follow-up and treatment due to time restrictions, geographic limitations, and financial burden. Conducting assessments and interventions remotely may help to mitigate these barriers, allowing for greater access to care and improved outcomes. This review will summarize the results of research using remote methods to conduct assessments and implement interventions with patients after bariatric surgery. Benefits and challenges of implementing these approaches will be highlighted, and future directions in this area will be discussed.

Examining the Binge Eating Scale in screening for binge eating disorder in bariatric surgery candidates.

BACKGROUND: This study assessed the utility of the Binge Eating Scale (BES) as a measure of binge eating disorder (BED) in a bariatric surgery-seeking population by (a) determining the optimal BES cut score for predicting BED, (b) calculating concordance statistics, and (c) determining the predictive value of each BES item. METHODS: Four hundred seventy-three patients presented for a psychological evaluation prior to Roux-en-Y gastric bypass surgery. The BES and the SCID semi-structured interview for BED were administered. RESULTS: Receiver operating characteristic curve analyses identified an optimal BES cut score of 17, which correctly classified 78% of patients with BED. A cut score of 27 improved this statistic, but significantly increased the number of false negatives, which is undesirable for a screening assessment. Discriminant function analyses revealed that nearly all BES items significantly predicted BED. CONCLUSIONS: The BES is a valid screener of BED for patients seeking bariatric surgery; however, false positives can be expected. Administering the BES as part of a comprehensive psychological evaluation can help improve the assessment and treatment of patients presenting for bariatric surgery.

Revisiting the revised master questionnaire for the psychological evaluation of bariatric surgery candidates.

BACKGROUND: This study aims to evaluate the Revised Master Questionnaire (MQR), a measure of cognitive and behavioral difficulties related to weight management, for use in bariatric surgery evaluations. The MQR's five domains include stimulus control, hopelessness, motivation, physical attribution, and energy balance knowledge, all of which are relevant to bariatric surgery evaluation. METHODS: Participants were 790 bariatric surgery candidates presenting for psychological evaluation in an urban medical center. Internal consistency reliability analyses were performed on the overall scale and subscales. Confirmatory factor analysis using principal components analysis was performed and the results compared with the original behavioral weight loss sample. Convergent validity with the Beck Depression Inventory (BDI) and Binge Eating Scale (BES) were evaluated. Differences in normative data for subgroups of the bariatric sample (by obesity category and by surgery type) were also evaluated. RESULTS: Alpha coefficients and mean inter-item correlations were largely acceptable and similar to the original behavioral weight loss sample. Factor analyses supported the consistency of the underlying factor structure. Convergent validity between the BDI and BES and relevant subscales was obtained. Overall, bariatric surgery candidates had significantly more adaptive scores than behavioral weight loss patients on three of the five scales; however, scores on physical attribution and energy balance knowledge were significantly lower. Candidates for gastric banding surgery had significantly more adaptive scores on all five subscales than candidates for gastric bypass surgery. CONCLUSIONS: The MQR evaluates important but under-assessed weight control-related constructs and has acceptable psychometric properties. Based on these findings, it is recommended for use as a component of the psychological evaluation for bariatric surgery.

Do patients seeking laparoscopic adjustable gastric banding surgery differ from those seeking gastric bypass surgery? A comparison of psychological profiles across ethnic groups.

BACKGROUND: Understanding presurgical psychological functioning is important in determining whether patients may benefit from psychological support before or after undergoing bariatric surgery. However, few studies have directly explored whether presurgical psychosocial profiles differ for patients presenting for different bariatric surgeries and what, if any, impact ethnic background might have. The present study compared presurgical depressive symptomatology, binge eating symptoms, and psychopathology in Caucasian and African American laparoscopic adjustable gastric banding (LAGB) and gastric bypass (RYGB) patients. METHODS: Patients (n=272) presenting for either LAGB or RYGB surgery completed self-report measures of depressive symptomatology (BDI), binge eating symptoms (BES), and psychopathology/personality (PAI) as part of the presurgical psychological evaluation. RESULTS: RYGB patients endorsed more depressive symptomatology, binge eating symptoms, somatic complaints, and antisocial features than LAGB patients, though higher BMI in the RYGB patients accounted for differences in binge eating symptoms. When the sample was examined by ethnic group, LAGB-RYGB differences were found only in African American, and not Caucasian, patients. CONCLUSIONS: Psychosocial profiles appear to differ for African American patients presenting for LAGB and RYGB surgeries; however, some of these differences are accounted for by differences in presurgical BMI. Gaining a better understanding of the initial psychological characteristics of bariatric surgery candidates may improve clinicians' abilities to identify and address specific areas of concern for these patients.

The Personality Assessment Inventory: clinical utility, psychometric properties, and normative data for bariatric surgery candidates.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.