Predictors of Chronic Pain 6 Months and 1 Year After Bariatric Surgery.

BACKGROUND: Obesity and chronic pain (CP) represent serious, interrelated global public health concerns that have a profound impact on individuals and society. Bariatric surgery is increasing in popularity and has been proven safe and efficacious, providing long-term weight loss and improvements in many obesity-related co-morbidities. A decrease in CP is often a motivation for bariatric surgery. The purpose of this study was to investigate the changes in CP postoperatively and to examine the relationship between psychosocial measures and pain. METHODS: A total of 155 adult bariatric surgery patients were recruited and completed self-report measures for CP severity and interference, neuropathic pain, anxiety, depression, emotion regulation and perceived social support at three timepoints preoperative and 6 and 12 months postoperative. RESULTS: Pain significantly decreased between preoperative and postoperative timepoints, and preoperative pain was the most significant predictor of postoperative pain. Preoperative CP was correlated with anxiety (p < 0.05) and depression (p < 0.01) at 6 months postoperatively and perceived social support (p < 0.01) at 1 year postoperatively. However, regression analyses with psychological variables were not significant. CONCLUSION: CP decreases after bariatric surgery, but further research with larger sample sizes is needed to establish whether psychosocial characteristics impact this outcome.

Anxious Attachment Style Predicts Dietary Adherence 1-Year Post-bariatric Surgery.

PURPOSE: Adherence to dietary guidelines is critical for optimizing health and weight outcomes after metabolic and bariatric surgery, yet many patients have difficulty. The purpose of this study was to identify the types and frequency of post-surgery non-adherent dietary behaviors and to determine pre-surgery predictors of adherence at 1-year post-surgery. MATERIALS AND METHODS: We completed a prospective cohort study of 348 adults who underwent sleeve gastrectomy (n = 25) or Roux-en-Y gastric bypass (n = 323) at an academic medical center between 2013 and 2017. Pre- and post-surgery parameters were demographics, adherence to dietary recommendations and mental health symptoms. Descriptive statistics and regression analyses were used. RESULTS: Pre-surgery, 264 (75.9%) participants were classified as adherent to nutrition recommendations by a Registered Dietitian (RD). At 1-year post-surgery, 203 (58.3%) were adherent, a statistically significant decrease (p < 0.05). The three most frequent non-adherent eating behaviors were insufficient protein intake (32.4%), inadequate vitamin intake (26.1%), and grazing (21.1%). Pre-surgery predictors in the bivariate regression analysis were anxious attachment (p = 0.01), poorer emotion regulation (p = 0.01), poorer perceived social support (p = 0.01), and RD disposition of dietary adherence (p = 0.02). In the best subset multivariate regression analysis, anxious attachment emerged as the significant predictor. CONCLUSION: Several types of non-adherent eating behaviors were identified. Pre-surgery, anxious attachment style, dietary adherence, emotion regulation, and perceived social support were predictors of adherence to dietary guidelines 1-year post-surgery. These factors should be assessed and patients provided with relevant support and education.

Efficacy of Telephone-Based Cognitive Behavioral Therapy for Weight Loss, Disordered Eating, and Psychological Distress After Bariatric Surgery: A Randomized Clinical Trial.

Importance: Weight regain after bariatric surgery is associated with recurrence of obesity-related medical comorbidities and deterioration in quality of life. Developing efficacious psychosocial interventions that target risk factors, prevent weight regain, and improve mental health is imperative. Objective: To determine the efficacy of a telephone-based cognitive behavioral therapy (tele-CBT) intervention at 1 year after bariatric surgery in improving weight loss, disordered eating, and psychological distress. Design, Setting, and Participants: This multisite randomized clinical trial was conducted at 3 hospital-based bariatric surgery programs, with recruitment between February 2018 and December 2021. Eligibility for participation was assessed among 314 adults at 1 year after bariatric surgery who were fluent in English and had access to a telephone and the internet. Patients with active suicidal ideation or poorly controlled severe psychiatric illness were excluded. Primary and secondary outcome measures were assessed at baseline (1 year after surgery), after the intervention (approximately 15 months after surgery), and at 3-month follow-up (approximately 18 months after surgery). Data were analyzed from January to February 2023. Interventions: The tele-CBT intervention consisted of 6 weekly 1-hour sessions and a seventh booster session 1 month later. The control group received standard postoperative bariatric care. Main Outcomes and Measures: The primary outcome was postoperative percentage total weight loss. Secondary outcomes were disordered eating (Binge Eating Scale [BES] and Emotional Eating Scale [EES]) and psychological distress (Patient Health Questionnaire-9 item scale [PHQ-9] and Generalized Anxiety Disorder-7 item scale [GAD-7]). The hypotheses and data-analytic plan were developed prior to data collection. Results: Among 306 patients 1 year after bariatric surgery (255 females [83.3%]; mean [SD] age, 47.55 [9.98] years), there were 152 patients in the tele-CBT group and 154 patients in the control group. The group by time interaction for percentage total weight loss was not significant (F1,160.61 = 2.09; P = .15). However, there were significant interactions for mean BES (F2,527.32 = 18.73; P < .001), EES total (F2,530.67 = 10.83; P < .001), PHQ-9 (F2,529.93 = 17.74; P < .001), and GAD-7 (F2,535.16 = 15.29; P < .001) scores between the tele-CBT group and control group across all times. Conclusions and Relevance: This study found that tele-CBT delivered at 1 year after surgery resulted in no change in short-term weight outcomes but improved disordered eating and psychological distress. The impact of these psychosocial improvements on longer-term weight outcomes is currently being examined as part of this longitudinal multisite randomized clinical trial. Trial Registration: ClinicalTrials.gov Identifier: NCT03315247.

Telephone-based cognitive behavioural therapy for patients with postoperative bariatric surgery to manage COVID-19 pandemic-related mental health issues and distress (TELE-BARICARE): a protocol for a randomised controlled trial.

INTRODUCTION: Bariatric surgery is currently the most effective treatment for obesity, and is performed yearly in over 8000 patients in Canada. Over 50% of those who live with obesity also have a history of mental health disorder. The COVID-19 pandemic has made it difficult for people living with obesity to manage their weight even after undergoing bariatric surgery, which combined with pandemic-related increases in mental health distress, has the potential to adversely impact obesity outcomes such as weight loss and quality of life. Reviews of virtual mental health interventions during COVID-19 have not identified any interventions that specifically address psychological distress or disordered eating in patients with obesity, including those who have had bariatric surgery. METHODS AND ANALYSIS: A randomised controlled trial will be conducted with 140 patients across four Ontario Bariatric Centres of Excellence to examine the efficacy of a telephone-based cognitive behavioural therapy intervention versus a control intervention (online COVID-19 self-help resources) in postoperative bariatric patients experiencing disordered eating and/or psychological distress. Patients will be randomised 1:1 to either group. Changes in the Binge Eating Scale and the Patient Health Questionnaire 9-Item Scale will be examined between groups across time (primary outcomes). Qualitative exit interviews will be conducted, and data will be used to inform future adaptations of the intervention to meet patients' diverse needs during and post-pandemic. ETHICS AND DISSEMINATION: This study has received ethics approvals from the following: Clinical Trials Ontario (3957) and the University Health Network Research Ethics Committee (22-5145), the Board of Record. All participants will provide written informed consent prior to enrolling in the study. Results will be made available to patients with bariatric surgery, the funders, the supporting organisations and other researchers via publication in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: NCT05258578.

The Impact of Telephone-Based Cognitive Behavioral Therapy on Mental Health Distress and Disordered Eating Among Bariatric Surgery Patients During COVID-19: Preliminary Results from a Multisite Randomized Controlled Trial.

BACKGROUND: Patients undergoing bariatric surgery have high rates of psychiatric comorbidity, which may increase their vulnerability to COVID-19-related mental health distress. Exacerbation of mental health distress and disordered eating could have significant negative effects on long-term weight management and quality of life for these patients if untreated. OBJECTIVE: To determine the efficacy of a telephone-based cognitive behavioral therapy (Tele-CBT) intervention in improving depressive, anxiety, and disordered eating symptoms during COVID-19. METHODS: Participants were recruited as part of a larger randomized controlled trial study (clinicaltrials.gov ID: NCT03315247) between March 2020 and March 2021 and randomized 1:1 to receive Tele-CBT or standard bariatric care. Outcomes of Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Emotional Eating Scale (EES), and Binge Eating Scale (BES) were measured at baseline, immediately post-intervention, and 3 months post-intervention. Linear mixed models were used to test the effect of intervention group, time, and group-by-time interaction for each outcome. RESULTS: Eighty-one patients were included in the intention-to-treat analysis. Mean (SD) age of participants was 47.68 (9.36) years and 80.2% were female. There were significant group-by-time interactions for all outcomes and significant differences between groups across time. There were significant decreases in mean GAD-7 (p = 0.001), PHQ-9 (p < 0.001), EES-Total (p = 0.001), EES-Anger (p = 0.003), EES-Anxiety (p < 0.001), EES-Depression (p < 0.001), and BES (p = 0.002) scores for the Tele-CBT group at post-intervention and follow-up when compared to baseline and the control group. CONCLUSION: Tele-CBT is a feasible and effective treatment for improving psychological distress and disordered eating among post-operative bariatric surgery patients during the COVID-19 pandemic.

Understanding bariatric patients' experiences of self-management post-surgery: A qualitative study.

Although most bariatric patients achieve significant weight loss and improvements in both physical and mental health-related quality of life (HRQoL) in the short-term, there is wide variability in weight and long-term HRQoL outcomes. The role of bariatric patients' self-management style in explaining variability in long-term outcomes is unclear. This qualitative study examined bariatric patients' self-management experiences after bariatric surgery in relation to long-term outcomes. A qualitative study was conducted using semi-structured individual interviews with post-surgery patients (n = 23) at a Canadian bariatric surgery program. A constant comparative approach was used to systematically analyse the data and identify overarching themes. Variation in patients' experiences and follow-up time were the two primary units of analysis. Patients were predominantly female (n = 19; 82.6%) and had a mean age of 50 ± 8.49 years. The median time post-surgery was 2 years (range: 6 months-7 years). Three distinct phases described the process of self-management post-bariatric surgery: (1) rediscovering self-esteem and confidence in one's ability to self-manage (1-month to 1.5-years post-surgery), (2) achieving weight maintenance and addressing emotion dysregulation (1.5-3-years post-surgery) and (3) embracing a flexible balanced lifestyle (beyond 3-years). Bariatric surgery patients experience distinct challenges relative to their post-surgery time course. Facilitating access to interprofessional bariatric care after surgery allowed patients to acquire the self-management knowledge and skills necessary to address challenges to following the bariatric guidelines in the long-term.

The impact of COVID-19 pandemic on bariatric patients' self-management post-surgery.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had far reaching consequences on the health and well-being of the general public. Evidence from previous pandemics suggest that bariatric patients may experience increased emotional distress and difficulty adhering to healthy lifestyle changes post-surgery. OBJECTIVE: We aimed to examine the impact of the novel COVID-19 public health crisis on bariatric patients' self-management post-surgery. METHOD: In a nested-qualitative study, semi-structured telephone interviews were conducted with 23 post-operative bariatric patients who had undergone Roux-en-Y gastric bypass (RYGB) at a Canadian Bariatric Surgery Program between 2014 and 2020. A constant comparative approach was used to systematically analyze the data and identify the overarching themes. RESULTS: Participants (n = 23) had a mean age of (48.82 ± 10.03) years and most were female (n = 19). The median time post-surgery was 2 years (range: 6 months-7 years). Themes describing the impact of COVID-19 pandemic on patients' post-bariatric surgery self-management included: coping with COVID-19; vulnerability factors and physical isolation; resiliency factors during pandemic; and valuing access to support by virtual care. The need for patients to access post-operative bariatric care during COVID-19 differed based on gender and socioeconomic status. CONCLUSION: This study showed that the COVID-19 pandemic has impacted patients' ability to self-manage obesity and their mental health in a variety of ways. These findings suggest that patients may experience unique psychological distress and challenges requiring personalized care strategies to improve obesity self-care and overall well-being.

"If you're offered help, take it": A qualitative study examining bariatric patients' experience of telephone-based cognitive behavioural therapy.

The increased recognition of patients' mental health needs after bariatric surgery has resulted in the emergence of accessible psychosocial interventions; however, there is a dearth of literature on patient experience and satisfaction with these interventions. We explored patients' perceptions and experiences of telephone-based cognitive behavioural therapy (Tele-CBT) in this qualitative study. Ten participants from the Toronto Western Hospital Bariatric Surgery Program in Toronto, Canada who completed the Tele-CBT (ClinicalTrials.gov Identifier: NCT02920112) were individually interviewed from November 2014 to June 2016 until thematic saturation occurred (ie, no more new coding groups emerged). Interviews were transcribed, independently coded, checked for discrepancies, and analysed using grounded theory. Four themes emerged: (1) participants were generally satisfied with Tele-CBT (eg, therapeutic alliance, resources provided, relevance of therapy to their own bariatric journey), (2) participants noticed emotional, cognitive, and behavioural changes following therapy, (3) the optimal time to deliver the Tele-CBT was when weight loss plateaued, generally at one-year post-surgery, and (4) participants found the telephone modality convenient. CBT was generally found to be helpful and the telephone format increased convenience and accessibility. Patients reported learning skills and receiving resources that could help them improve their well-being following bariatric surgery.

Food Addiction Is Associated with Binge Eating and Psychiatric Distress among Post-Operative Bariatric Surgery Patients and May Improve in Response to Cognitive Behavioural Therapy.

The current study examined clinical correlates of food addiction among post-operative bariatric surgery patients, compared the clinical characteristics of patients with versus without food addiction, and examined whether a brief telephone-based cognitive behavioural therapy (Tele-CBT) intervention improves food addiction symptomatology among those with food addiction. Participants (N = 100) completed measures of food addiction, binge eating, depression, and anxiety 1 year following bariatric surgery, were randomized to receive either Tele-CBT or standard bariatric post-operative care, and then, repeated the measure of food addiction at 1.25 and 1.5 years following surgery. Thirteen percent of patients exceeded the cut-off for food addiction at 1 year post-surgery, and this subgroup of patients reported greater binge eating characteristics and psychiatric distress compared to patients without food addiction. Among those with food addiction, Tele-CBT was found to improve food addiction symptomatology immediately following the intervention. These preliminary findings suggest that Tele-CBT may be helpful, at least in the short term, in improving food addiction symptomatology among some patients who do not experience remission of food addiction following bariatric surgery; however, these findings require replication in a larger sample.

Differences in physical and mental health-related quality of life outcomes 3 years after bariatric surgery: a group-based trajectory analysis.

BACKGROUND: While bariatric surgery has proven to be effective to achieve significant weight loss and short-term improvements in both physical and mental (HRQoL), little is known about the factors associated with long-term decline in mental HRQoL after bariatric surgery. OBJECTIVE: To examine differences in physical and mental HRQoL trajectories in a bariatric patient population 3 years after bariatric surgery and examine associated sociodemographic, weight, and mental health factors. SETTING: A Canadian academic bariatric care center. METHODS: A group-based trajectory model was used to examine physical and mental HRQoL trajectories 3 years after bariatric surgery. In a prospective cohort bariatric sample (n = 2270), demographic factors, body mass index, binge eating symptoms, anxiety symptoms (Generalized Anxiety Disorder-7), depressive symptoms (Patient Health Questionnaire-9), and physical and mental HRQoL (Short-form health survey-36 (SF-36)), were measured at baseline, 6 months, 1, 2, and 3 years respectively. The effect of time-varying covariates (body mass index, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7) were investigated to examine effects on physical and mental HRQoL trajectories. RESULTS: Five distinct trajectories described changes in (n = 1939 of 2270) individuals' physical HRQoL outcomes (SF-36-physical health component summary score) and five other trajectories described changes in mental HRQoL (SF-36-mental health component summary score) outcomes from baseline to 3 years postsurgery. The group-based distribution for the 5 physical HRQoL trajectories were as follows: (1) low baseline-stable low (5.8%); (2) low baseline-moderate rise (12%); (3) low baseline-stable high (41.1%); (4) high baseline-stable high (33.2%); and (5) moderate baseline-decline (7.9%). The 5 mental HRQoL trajectories were as follows: (1) low baseline-slow decline (10%); (2) low baseline-stable high (25%); (3) high baseline-unstable rise (12%); (4) high baseline-stable high (48.9%); and (5) high baseline-transient decline (4.1%). Compared with physical HRQoL, mental HRQoL trajectories were not associated with changes in body mass index, yet strongly correlated with changes in binge eating symptoms, Generalized Anxiety Disorder-7, and Patient Health Questionnaire measures at all time points. CONCLUSION: This study demonstrates distinct patterns in physical and mental HRQoL trajectories after bariatric surgery. The decline in mental HRQoL trajectories was more heterogeneous and associated with several psychosocial predictors that may be useful to guide risk prediction of long-term physical and mental HRQoL outcomes postbariatric surgery.

Psychiatric Management of Bariatric Surgery Patients: A Review of Psychopharmacological and Psychological Treatments and Their Impact on Postoperative Mental Health and Weight Outcomes.

BACKGROUND: Bariatric surgery is an effective treatment for severe obesity; however, high rates of psychiatric comorbidity complicate bariatric surgery care. As a result, importance has been placed on the need for ongoing psychiatric support in patients undergoing bariatric surgery. Given the lack of conclusive presurgery psychosocial predictors of postoperative mental health outcomes, studies have now shifted their focus to understand the long-term psychosocial sequalae that arise after surgery. Increasing evidence has demonstrated the potential for psychiatric care to stabilize psychiatric symptoms and minimize patient distress. OBJECTIVE: To review psychopharmacological and psychological interventions for patients undergoing bariatric surgery and their impact on mental health and weight outcomes after surgery. METHODS: We performed a comprehensive literature search in Ovid MEDLINE for studies examining the impact of psychopharmacological and psychological treatments on bariatric patients' postoperative mental health and weight outcomes. RESULTS: Overall, 37 studies were included in the review. Preliminary evidence suggests that psychiatric medications do not negatively impact weight loss or health-related quality of life in the short term; however, more rigorous research designs are needed. There are insufficient data on specific psychiatric medications and long-term impact on weight loss and psychosocial outcomes. Postoperative psychological interventions have evidence for improving eating psychopathology, anxiety, and depressive symptoms; however, effects on weight loss remain unclear. CONCLUSION: Evidence for psychopharmacological and psychological treatments remains preliminary. Consideration should be given to integrated, stepped-care models to provide personalized psychiatric interventions after surgery. Future research on expanding current psychiatric interventions, timing of delivery, and predictors of response is needed.

Predictors of suicidal ideation one-year post-bariatric surgery: Results from the Toronto Bari-Psych Cohort Study.

OBJECTIVE: Previous studies have shown higher rates of death by suicide, suicide attempts, suicidal ideation and non-suicidal self-directed violence (NS-SDV) in bariatric surgery patients. METHODS: Data came from the Toronto Bari-Psych Cohort study of adult patients who underwent bariatric surgery between 2010 and 2016. The MINI International Neuropsychiatric Interview was used to obtain lifetime psychodiagnostic data. Information about lifetime suicidal ideation, suicide attempts, NS-SDV and hospitalizations related to any of these phenomena was collected during clinical interview. Pre-surgery sociodemographic data, lifetime psychiatric disorders, mental health symptoms, mental health treatment, suicidal ideation and surgical complications were covariates. Logistic regression analyses were used to examine the relationship between these variables and suicidal ideation one-year post-surgery. RESULTS: Among a total of 284 participants, 4.2% reported a past suicide attempt and 15.1% reported past suicidal ideation. One-year post-surgery, no suicide attempts were reported. In the multivariate regression model, a history of suicidal ideation was the strongest predictor of suicidal ideation one-year post-surgery (p < 0.01), followed by younger age (p = 0.05). Mental health symptoms decreased from pre to post-surgery. CONCLUSION: One-year post-surgery, a history of suicidal ideation was the strongest predictor of post-surgery suicidal ideation. Results should be interpreted with caution given the short duration of follow-up.

Psychiatric Medication Use and Weight Outcomes One Year After Bariatric Surgery.

BACKGROUND: Given the high rates of psychiatric comorbidity in bariatric surgery patients, pharmacotherapy is common and could potentially influence weight loss outcomes. OBJECTIVE: We aimed to identify the impact of psychotropic medication use on percent total weight loss (%TWL) 1 year after bariatric surgery. METHODS: In this prospective cohort study, 190 patients were compared based on demographic variables (age, sex, relationship status, employment status), body mass index, %TWL, and psychotropic medication use before and 1 year after bariatric surgery. An analysis of variance test was used as a global test of significance for psychotropic medication comparisons related to %TWL. Significance of post hoc comparisons was calculated with the Tukey's Honestly Significance Difference test. RESULTS: Sixty-one of 190 (32.1%) patients were taking psychiatric medications before surgery; of those, 82% (50/61) continued to take psychiatric medications 1-year after surgery. %TWL did not significantly differ between patients taking no psychiatric medications, one medication, or more than one medication 1 year after surgery (31.4% vs. 29.9% vs. 34.4%, respectively). Among patients taking antidepressants, those taking serotonin-norepinephrine reuptake inhibitors had a significantly higher %TWL than those taking selective serotonin reuptake inhibitors (36.4% vs. 27.8%; P = 0.032). CONCLUSION: This longitudinal study suggests that psychiatric medication use was not associated with poorer %TWL at 1 year after bariatric surgery. Within class, antidepressant use may have differential effects on weight loss after bariatric surgery and warrants further investigation.

Telephone-based cognitive behavioural therapy for female patients 1-year post-bariatric surgery: A pilot study.

OBJECTIVE: Although bariatric surgery is a durable treatment for patients with severe obesity, it does not directly address behavioural and psychological factors that potentially contribute to weight regain post-surgery. Psychological interventions, such as cognitive behavioural therapy (CBT), can be challenging to access due to physical limitations and practical barriers. Telephone-based CBT (Tele-CBT) can improve eating psychopathology and psychological distress before and after surgery. Given the frequent occurrence/recurrence of problematic eating-related and psychological issues many patients face 1-year post-surgery, this open-trial pilot study aimed to evaluate the effectiveness of Tele-CBT delivered 1-year post-surgery as an adjunctive treatment to the usual standard of bariatric care. METHODS: Patients (n=43) received six 1-h Tele-CBT sessions delivered weekly beginning at 1-year post-surgery. Patients completed questionnaire packages before and after the intervention to assess changes in binge eating (BES), emotional eating (EES), depression (PHQ-9), and anxiety (GAD-7). RESULTS: Thirty-two patients completed Tele-CBT yielding a 74.4% completion rate. Participants reported significant improvements on the Binge Eating Scale (t(31)=3.794, p=0.001), Emotional Eating Scale (t(31)=3.508, p=0.001), Patient Health Questionnaire-9 Item Scale (z=-2.371, p=0.018), and Generalised Anxiety Disorder-7 Item Scale (z=-3.546, p<0.001) immediately following Tele-CBT. DISCUSSION: The results demonstrate that Tele-CBT delivered 1-year post-surgery may improve binge eating, emotional eating, depression, and anxiety. Additional research is warranted to examine whether these changes translate into long-term improvements in bariatric surgery outcomes.

Prospective Study of Attachment as a Predictor of Binge Eating, Emotional Eating and Weight Loss Two Years after Bariatric Surgery.

Bariatric surgery remains the most effective treatment for severe obesity, though post-surgical outcomes are variable with respect to long-term weight loss and eating-related psychopathology. Attachment style is an important variable affecting eating psychopathology among individuals with obesity. To date, studies examining eating psychopathology and attachment style in bariatric surgery populations have been limited to pre-surgery samples and cross-sectional study design. The current prospective study sought to determine whether attachment insecurity is associated with binge eating, emotional eating, and weight loss outcomes at 2-years post-surgery. Patients (n = 108) completed questionnaires on attachment style (ECR-16), binge eating (BES), emotional eating (EES), depression (PHQ-9), and anxiety (GAD-7). Multivariate linear regression analyses were conducted to examine the association between attachment insecurity and 2-years post-surgery disordered eating and percent total weight loss. Female gender was found to be a significant predictor of binge eating (p = 0.007) and emotional eating (p = 0.023) at 2-years post-surgery. Avoidant attachment (p = 0.009) was also found to be a significant predictor of binge eating at 2-years post-surgery. To our knowledge, this study is the first to explore attachment style as a predictor of long-term post-operative eating pathology and weight outcomes in bariatric surgery patients.

Disparities in Receipt of Bariatric Surgery in Canada: An Analysis of Data From an Ontario Bariatric Surgery Referral Center.

BACKGROUND: Patients with lower socioeconomic status (SES) in the United States have reduced access to many health services including bariatric surgery. It is unclear whether disparities in bariatric surgery exist in countries with government-sponsored universal health benefits. The authors used data from a large regional Canadian bariatric surgery referral center to examine the relationship between SES and receipt of bariatric surgery. METHODS: The Toronto Western Hospital bariatric surgery registry was used to identify all adults referred for bariatric surgery assessment from 2010 to 2017. The authors compared demographics, SES measures, and clinical measures among patients who did not and did undergo bariatric surgery (Roux-en-Y or sleeve gastrectomy). Multiple logistic regression was used to examine differences in receipt of bariatric surgery according to patient demographic characteristics and SES factors. RESULTS: Among 2417 patients included in the study, 646 (26.7%) did not receive surgery and 1771 patients (73.2%) did. Patients who did not undergo surgery were more likely to be male individual (29.1% vs. 19.3%; P<0.001), black (12.1% vs. 8.3%; P=0.005), South Asian/Middle Eastern (8.2% vs. 4.5%; P<0.001), and less likely to be white (68.9% vs. 76.7%; P<0.001). In multiple logistic regression, factors associated with not receiving surgery were male sex, Black and South Asian/Middle Eastern ethnicity, being single, lack of employment, and history of psychiatric illness. CONCLUSIONS: Among patients referred for bariatric surgery, those who were male individuals, nonwhite, single, and unemployed were less likely to undergo surgery. Our results suggest that even with equal insurance, there are disparities in receipt of bariatric surgery.

Physical activity and its association with psychosocial health following bariatric surgery.

Physical activity (PA) helps sustain weight loss and may also provide psychological benefits in patients undergoing bariatric surgery. Using a set of questionnaires, we demonstrated that bariatric patients with increased level of PA at 1-year follow-up had better psychosocial outcomes including depressive symptoms and mental health-related quality of life compared with those who had reduced or unchanged level of PA. Our findings indicate the benefit of incorporating PA in the postoperative care for bariatric patients. Novelty Postoperative behavioural change in terms of physical activity improves psychosocial health in patients undergoing bariatric surgery.

Employment Outcomes 2 Years After Bariatric Surgery: Relationship to Quality of Life and Psychosocial Predictors.

OBJECTIVES: Bariatric surgery is the most effective long-term treatment for severe obesity. In addition to sustained weight loss, bariatric surgery can result in improvements in mental and physical health-related quality of life (HRQOL) and, consequently, work capacity. The purpose of our study was to evaluate changes to employment impairment (EI) and related HRQOL in patients 2 years post-bariatric surgery. METHODS: Prospective data was collected on a cohort of 211 patients who underwent bariatric surgery. The Lam Employment Absence and Productivity Scale (LEAPS) and the 36-Item Short Form Survey (SF-36) were used to assess pre- and post-operative EI and physical and mental HRQOL, respectively. Predictors of work impairment changes were analyzed via multiple regression analysis and included demographic variables, history of psychiatric illness, and depression and anxiety self-report measures. RESULTS: Significant improvements in employment outcomes 2 years following surgery were noted with 68% of participants reporting an overall decrease in EI (total LEAPS score change = - 2.43 ± 5.76, p < 0.001), and 44% participants reporting an increase in work productivity (LEAPS productivity score change = - 0.67 ± 2.38, p < 0.001). Bariatric surgery was also associated with significant improvements in physical (change = 17.41 ± 10.72, p < 0.001) and mental (change = 2.67 ± 12.89, p = 0.001). Improvements in HRQOL predicted improvements in work-related impairment and productivity, while history of psychiatric illness predicted was associated with reduced improvement in work productivity. CONCLUSIONS: Our results provide further evidence of improvement in work productivity and reduction in EI post-bariatric surgery. This study also provides insights into potential predictors of work-related impairment and productivity.

Psychosocial Predictors of Cognition in Bariatric Surgery.

BACKGROUND: Obesity affects individuals worldwide and is currently the 5th leading cause of death according to the WHO. Bariatric surgery is an effective strategy that produces durable long-term weight loss. There is a bidirectional interplay between mental health and obesity; with higher depression and anxiety in the obese population as well as significant effects on weight loss for people with mental health disorders. OBJECTIVE: Our cross-sectional study aimed to examine psychosocial predictors of cognition for the pre-operative bariatric surgery population and its effect on work productivity. METHODS: Demographic data, perceived cognitive deficits (PDQ-5), depression scale (PHQ-9), anxiety (GAD-7), Quality of life (SF36) and work impairment (LEAPS) was collected from 302 pre-operative bariatric surgery candidates at their initial assessment. Multiple regression was conducted with perceived cognitive deficits as the dependent variable. A secondary analysis was done controlling for anxiety and depression. RESULTS: Variables that were significantly associated with perceived cognition were anxiety, depression, work productivity and overall mental health quality of life. Perceived cognition was also significantly associated with work impairment independent of mood symptoms. DISCUSSION: Anxiety and depression are prevalent in the pre-operative bariatric surgery population, significantly affecting cognition, and should be routinely screened. Work performance was also affected by cognition in our population but the link between obesity and cognition needs to be further explored. CONCLUSIONS: We identified a significant association between perceived cognition and psychosocial factors in pre-operative bariatric surgery candidates. Further studies will be needed to better explore obesity and its impact on cognition.