Examining differences in long-term weight loss outcomes after bariatric surgery: The role of romantic relationship status.

INTRODUCTION: This study tested for differences based on relationship status at the time of surgery in baseline body mass index (BMI), weight loss outcomes (change in BMI [ΔBMI], percent total weight loss [%TWL], percent excess weight loss [%EWL]), and rates of successful weight loss (defined as ≥ 50%EWL) up to 4-year postbariatric surgery. METHOD: Data came from a secondary analysis of patients (N = 492) who were up to 4-year postsurgery and completed a presurgical psychological evaluation and postsurgical survey. RESULTS: Sixty-nine percent of participants were patients in committed relationships and 31% were single/divorced/widowed patients. Single patients had higher presurgical BMIs than those who were partnered (t = 2.28, p = .02). There were no differences between those who were partnered and singles regarding ΔBMI and %TWL, although singles had smaller %EWL (t = -2.08, p = .04), which became nonsignificant after controlling for covariates. Most participants had successful weight loss (76.8%); however, this was not related to romantic relationship status. DISCUSSION: The results suggest those who were partnered undergo surgery at better-starting weights than singles and maintain this advantage in the long term. Providers working with patients considering bariatric surgery could inquire about how their romantic and social relationships play a part in their decision-making process. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Patient perceptions regarding alcohol use after bariatric surgery.

INTRODUCTION: Patients who have undergone bariatric surgery are at increased risk of an alcohol use disorder. Though patients understand this risk, the majority engage in post-surgical alcohol use. This suggests that education alone is not sufficient to reduce post-surgical drinking. To prevent development of post-surgical alcohol use disorders, we need better understanding of the reasons patients use alcohol following surgery. The purpose of this study was to identify factors associated with post-surgical alcohol use. METHOD: Patients (N = 20) who were 1-3 years post-bariatric surgery and were consuming alcohol at least twice monthly participated in a 60-min interview. Participants responded about their knowledge regarding risk of post-surgical alcohol use and reasons why patients may start drinking. Deductive and inductive coding were completed by two independent raters. RESULTS: Although nearly all participants were aware of the risks associated with post-surgical alcohol use, most believed that lifelong abstinence from alcohol was unrealistic. Common reasons identified for using alcohol after bariatric surgery included social gatherings, resuming pre-surgical use, and addiction transfer. Inductive coding identified three themes: participants consumed alcohol in different ways compared to prior to surgery; the effect of alcohol was substantially stronger than pre-surgery; and beliefs about why patients develop problematic alcohol use following surgery. CONCLUSION: Patients consume alcohol after bariatric surgery for a variety of reasons and they do not believe recommending abstinence is useful. Understanding patient perceptions can inform interventions to minimize alcohol use after bariatric surgery. Modifications to traditional alcohol relapse prevention strategies may provide a more robust solution to decreasing negative outcomes experienced by individuals undergoing bariatric surgery.

Utility of phosphatidylethanol testing as an objective measure of alcohol use during the preoperative evaluation for bariatric surgery.

BACKGROUND: The risk of alcohol use disorder increases after bariatric surgery. Preoperative alcohol use is a risk factor, and this is evaluated during the routine preoperative psychosocial evaluation. However, it is not clear whether patients accurately report their alcohol use. OBJECTIVE: To determine whether an objective measure of alcohol use, phosphatidylethanol (PEth) testing, offers utility beyond self-reported alcohol use during the preoperative evaluation for bariatric surgery. SETTING: Single healthcare system. METHODS: PEth testing was included as part of the routine laboratory work for 139 patients undergoing evaluation for bariatric surgery. PEth testing results were compared with self-reported alcohol use and scores on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) questionnaire obtained during the preoperative psychosocial evaluation. PEth testing results were categorized into abstinent, light use, moderate use, or heavy use. There were 85 patients who completed both PEth testing and a preoperative psychosocial evaluation. RESULTS: There were 25 participants (29.4%) who had a positive PEth test; about half had moderate or heavy use values (15.3% of the total sample). The majority of participants with a positive PEth test (82.6%) denied recent alcohol use. Of those with PEth values indicating moderate or heavy use, 61.5% did not have an elevated AUDIT-C score. CONCLUSIONS: Patients appeared to underreport their alcohol use during the preoperative psychosocial evaluation. There appears to be utility for routine PEth testing as part of the evaluation process to identify those with risky drinking patterns. Patients with preoperative risky drinking could be educated about their risk and/or referred to programs to mitigate the development of preoperative alcohol misuse.

Exploring gender, psychiatric symptoms, and eating behaviors as predictors of attrition to bariatric surgery.

BACKGROUND: Only a small proportion of eligible individuals undergo bariatric surgery. The purpose was to examine attrition to surgery and whether psychiatric symptoms and eating behaviors differentially predicted attrition among men and women. METHOD: Data was collected from a retrospective chart review of 313 patients who underwent a pre-surgical psychosocial evaluation. RESULTS: The overall attrition rate was 33.5%; 42.6% of men and 31.7% of women experienced attrition. In the multivariate analysis of the entire sample, White patients (OR = 2.33, CI: 1.33, 4.08) and those without a history of binge eating (OR = 2.71, CI: 1.23, 5.97) were more likely to undergo surgery. In a multivariate analysis of women only, race and binge eating independently predicted attrition; however, no factors significantly predicted attrition among men. CONCLUSIONS: Factors identified at the pre-surgical psychosocial evaluation can identify patients at risk for attrition, and these factors may differ for men and women.

Hazardous Alcohol Use in the Four Years Following Bariatric Surgery.

The purpose of this study was to estimate the prevalence of hazardous drinking in the four years after bariatric surgery and investigate whether there are differences between those undergoing Roux-en-Y gastric bypass and sleeve gastrectomy. Participants (N = 564) who underwent bariatric surgery between 2014 and 2017 completed a survey regarding post-surgical alcohol use. The rate of alcohol use following bariatric surgery was significantly higher among those between 1- and 4-years post-surgery compared to those less than 1-year post-surgery. Of those who were consuming alcohol at the time of participation, 16.1% had scores indicative of hazardous drinking. The rate of hazardous drinking among those 3-4 years post-surgery was greater than those less than 1-year post-surgery with 33.3% of patients engaging in hazardous drinking at 3-4 years post-surgery. Patients undergoing sleeve gastrectomy had similar rates of hazardous drinking as RYGB (16.3% vs. 15.7%). Thus, findings showed that rates of hazardous drinking were higher among those further removed from bariatric surgery and patients undergoing sleeve gastrectomy appeared to have similar rates of hazardous drinking as those who underwent RYGB. Results suggest a need for monitoring of alcohol use for all patients pursuing bariatric surgery, regardless of surgery type.

The association between number of children and weight loss outcomes among individuals undergoing bariatric surgery.

BACKGROUND: Existing research demonstrates that parity is associated with risk for obesity. The majority of those who undergo bariatric surgery are women, yet little is known about whether having children before bariatric surgery is associated with pre- and postsurgical weight outcomes. OBJECTIVES: We aim to evaluate presurgical body mass index (BMI) and postsurgical weight loss among a racially diverse sample of women with and without children. SETTING: Metropolitan hospital system. METHODS: Women (n = 246) who underwent bariatric surgery were included in this study. Participants self-reported their number of children. Presurgical BMI and postsurgical weight outcomes at 1 year, including change in BMI (ΔBMI), percentage excess weight loss (%EWL), and percentage total weight loss (%TWL) were calculated from measured height and weight. RESULTS: Those with children had a lower presurgical BMI (P = .01) and had a smaller ΔBMI (P = .01) at 1 year after surgery than those without children, although %EWL and %TWL at 1 year did not differ by child status or number of children. After controlling for age, race, and surgery type, the number of children a woman had was related to smaller ΔBMI at 1 year post surgery (P = .01). CONCLUSIONS: Although women with children had lower reductions in BMI than those without children, both women with and without children achieved successful postsurgical weight loss. Providers should assess for number of children and be cautious not to deter women with children from having bariatric surgery.

The Influence of Health Literacy and Health Numeracy on Weight Loss Outcomes Following Bariatric Surgery.

BACKGROUND: Although cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss. SETTING: Single bariatric center. METHODS: Patients (N = 567) who underwent bariatric surgery from 2014-2017 completed a brief survey including current weight. Retrospective chart reviews were conducted to gather information from the presurgical evaluation including weight, body mass index (BMI), health literacy, health numeracy and score on a cognitive screener. RESULTS: Among participants in the weight loss period (< 2 years postsurgery), health literacy, health numeracy and cognitive functioning were not related to change in BMI (ΔBMI), percent total weight loss (%TWL) or percent excess weight loss (%EWL). However, for participants in the weight maintenance period (2-4 years postsurgery), higher health literacy scores were related to greater change in ΔBMI, and higher health numeracy scores were related to greater ΔBMI, %TWL, and %EWL. DISCUSSION: Although health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health literacy and health numeracy.

Racial Differences in Psychological Symptoms and Eating Behaviors Among Bariatric Surgery Candidates.

BACKGROUND: Black patients typically lose less weight than White patients following bariatric surgery; however, the reasons for this racial disparity are unclear. The purpose of the current study was to evaluate whether there are differences in psychiatric symptoms and problematic eating behaviors between White and Black patients pursuing bariatric surgery as this may aid in understanding postsurgical weight loss disparities and inform psychosocial assessment of bariatric candidates. METHODS: A retrospective chart review was conducted of participants (N = 284) who completed a psychological evaluation prior to surgery. Information collected included history of binge eating and purging as well as data from measures administered (i.e., the Hospital Anxiety and Depression Scale, the Emotional Eating Scale, and the Yale Food Addiction Scale 2.0). RESULTS: White patients reported higher levels of eating in response to anger/frustration (p = .03) and eating in response to depression (p = .01) than Black patients. White patients also reported more symptoms of food addiction, a difference that was trending toward significance (p = .05). No significant differences were found on measures of anxiety or depression. CONCLUSION: White patients appear to have higher levels of presurgical problematic eating as compared with Black patients pursuing bariatric surgery; thus, these measurements of problematic eating may not explain the racial disparity in outcomes. However, future research should determine whether measures are valid among diverse populations and identify additional factors that may contribute to racial disparities in bariatric outcomes.

Predictors of Alcohol Use after Bariatric Surgery.

Patients undergoing bariatric surgery are at risk for devloping an alcohol use disorder (AUD). The purpose of this study was to investigate pre-surgical psychosocial risk factors for post-surgical alcohol consumption and hazardous drinking. Participants (N = 567) who underwent bariatric surgery between 2014 and 2017 reported their post-surgical alcohol use. Information was collected from the pre-surgical evaluation including history of alcohol use, psychiatric symptoms, and maladaptive eating behaviors (i.e., binge eating, purging, and emotional eating). Younger age and pre-surgical alcohol use predicted post-surgical alcohol use and hazardous drinking. In addition, higher levels of depressive symptoms and maladaptive eating patterns predicted post-surgical binge drinking. Clinicians conducting pre-surgical psychosocial evaluations should be aware of the multiple risk factors related to post-surgical problematic alcohol use. Future research should evaluate whether preventive interventions for high-risk patients decrease risk for post-surgical alcohol misuse.

Relationship between depression, weight, and patient satisfaction 2 years after bariatric surgery.

BACKGROUND: Findings regarding longer term symptoms of depression and the impact of depression on outcomes such as weight loss and patient satisfaction, are mixed or lacking. OBJECTIVES: This study sought to understand the relationship between depression, weight loss, and patient satisfaction in the two years after bariatric surgery. SETTING: This study used data from a multi-institutional, statewide quality improvement collaborative of 45 different bariatric surgery sites. METHODS: Participants included patients (N = 1991) who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2015-2018. Participants self-reported symptoms of depression (Patient Health Questionnaire-8 [PHQ-8]), satisfaction with surgery, and weight presurgery and 1 year and 2 years postsurgery. RESULTS: Compared to presurgery, fewer patients' PHQ-8 scores indicated clinically significant depression (PHQ-8≥10) at 1 year (P < .001; 14.3% versus 5.1%) and 2 years postsurgery (P < .0001; 8.7%). There was a significant increase in the prevalence of clinical depression from the first to second year postsurgery (P < .0001; 5.1% versus 8.7%). Higher PHQ-8 at baseline was related to less weight loss (%Total Weight Loss [%TWL] and %Excess Weight Loss [%EWL]) at 1 year postsurgery (P < .001), with a trend toward statistical significance at 2 years (P = .06). Postoperative depression was related to lower %TWL and %EWL, and less reduction in body mass index (BMI) at 1 year (P < .001) and 2 years (P < .0001). Baseline and postoperative depression were associated with lower patient satisfaction at both postoperative time points. CONCLUSIONS: This study suggests improvements in depression up to 2 years postbariatric surgery, although it appears that the prevalence of depression increases after the first year. Depression, both pre- and postbariatric surgery, may impact weight loss and patient satisfaction.

Socioeconomic and Racial Disparities in Bariatric Surgery.

The purpose of this study was to examine the associations among race and socioeconomic factors (receiving social security disability, insurance type, and income) with undergoing bariatric surgery and weight loss outcomes in a racially diverse, urban cohort of bariatric surgery candidates (N = 314). Patients with private insurance and who identified as Caucasian were more likely to undergo bariatric surgery. Income significantly predicted percentage of excess weight loss 1 year after surgery, although this was no longer significant when accounting for race. Race and socioeconomic factors should be considered during psychosocial evaluations to support patients at risk of surgical attrition and poorer weight loss outcomes. Future research should explore policy solutions to improve access, while qualitative work may help with understanding racial disparities in bariatric surgery.

Health Literacy, Health Numeracy, and Cognitive Functioning Among Bariatric Surgery Candidates.

Inadequate health literacy or numeracy and probable cognitive impairment influence patients' medical outcomes. The study purpose was to examine the prevalence of inadequate health literacy, inadequate health numeracy, and probable cognitive impairment among bariatric surgery candidates and examine associations with undergoing bariatric surgery. Patients (N = 314) completed measures assessing these constructs during a required pre-surgical psychological evaluation. Approximately 9.6%, 24.2%, and 29.5% of the sample had inadequate health literacy, inadequate health numeracy, and probable cognitive impairment, respectively. In univariate analyses, those with inadequate levels of health literacy, inadequate health numeracy, and probable cognitive impairment were less likely to undergo surgery. In a multivariate model, inadequate health literacy independently predicted a lower likelihood of undergoing bariatric surgery. Findings underscore the importance of assessing these factors.

A Review of Psychosocial Risk Factors Among Transgender Patients Seeking Bariatric Surgery.

As nearly one third of transgender individuals in the USA are obese, more transgender patients may pursue bariatric surgery as a means of sustaining weight loss. Transgender individuals, like bariatric surgery patients, have high rates of mood pathology, substance use, abuse, and self-harm behaviors. However, there is no research on transgender bariatric surgery candidates. The aim of this review is to elucidate potential psychosocial risk factors, including sex hormone management, which may impact surgical clearance, presurgical psychosocial assessment, and treatment recommendations.

Patient Recall of Education about the Risks of Alcohol Use Following Bariatric Surgery.

Patients who undergo bariatric surgery are at increased risk of developing alcohol problems. The purpose of this study was to evaluate whether patients who underwent bariatric surgery recalled receiving education about alcohol prior to having surgery and to investigate their alcohol use patterns. Patients (N = 567) who underwent bariatric surgery completed a survey regarding their knowledge of risks related to post-surgical alcohol use. Although most patients recalled receiving education about abstinence from alcohol after surgery, at least one-third of patients do not appear to understand the risks involved with alcohol consumption, suggesting that patients did not retain the information. Despite recalling receiving education, many patients still consumed alcohol after surgery. It appears that additional interventions are needed to decrease alcohol use after bariatric surgery.

Validation of the Yale Food Addiction Scale 2.0 Among a Bariatric Surgery Population.

INTRODUCTION: Addictive eating, a highly debated problematic eating behavior, may contribute to obesity and impede the success of individuals seeking bariatric surgery. The original Yale Food Addiction Scale (YFAS) was validated for use among patients who underwent bariatric surgery; however, the YFAS was revised to reflect changes in substance use criteria in the DSM-5. The purpose of this study was to validate the use of the revised measure, the YFAS 2.0, among patients pursuing bariatric surgery. METHODS: A retrospective chart review was conducted of 314 patients who underwent pre-surgical psychological evaluation for bariatric surgery. Information gathered included symptoms of addictive eating (YFAS 2.0), emotional eating (Emotional Eating Scale; EES), and a history of substance use and binge eating. RESULTS: In this sample, 27.3% met criteria for "food addiction" according to the YFAS 2.0. Of those, more than half met criteria for severe food addiction. The YFAS 2.0 was related to all factors of the EES: anger/frustration (p < .001); anxiety (p < .001); and depression (p < .001). There was no relationship between the YFAS 2.0 and a history of substance use. The YFAS 2.0 accounted for significant variance in history of binge eating after controlling for emotional eating (p < .001; Exp(B) = 1.30). CONCLUSIONS: Results were similar to a prior validation of the YFAS among a bariatric population, and the updated YFAS 2.0 may be useful in assessing addictive eating among bariatric surgery candidates to further explore the concept of "food addiction."