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.

No association between history of psychiatric treatment and postoperative weight reduction after bariatric surgery.

PURPOSE: The objective of the study was to assess whether the history of psychiatric treatment was associated with (1) body weight and BMI on admission for bariatric surgery, (2) weight loss > 5 kg prior to bariatric surgery, and (3) postoperative body weight reduction. METHODS: Data from medical records of all consecutive patients admitted for surgical treatment of obesity in the 2nd Department of General Surgery Jagiellonian University Medical College were obtained. There were 1452 records of patients who underwent bariatric surgery between 2009 and 2021 included in the study. RESULTS: History of psychiatric treatment was found in 177 (12%) of the sample and was inversely associated with body weight and BMI on admission for surgery in women. Men with history of psychiatric treatment were 54% less likely to lose > 5 kg before the surgery (OR = 0.46 95% CI = 0.24-0.88). Both in men and women %TWL did not differ significantly by history of psychiatric treatment (Me: 40.7 vs. 45.9; p = 0.130 and Me: 27.0 vs. 23.9; p = 0.383, respectively). After adjustment for covariates no association was found between history of psychiatric treatment and body weight reduction one year after surgery. CONCLUSION: Although men with preoperative history of psychiatric treatment had lower odds of losing weight before the surgery, psychiatric treatment did not differentiate the effectiveness of bariatric treatment in 1 year of observation. Bariatric surgery appears to be an effective obesity care for people treated for mental disorders. LEVEL OF EVIDENCE: III Evidence obtained from cohort or case-control analytic studies.

Differences in Psychological Health and Weight Loss after Bariatric Metabolic Surgery between Patients with and without Pain Syndromes.

PURPOSE: Chronic pain and obesity often co-occur, negatively affecting one another and psychological wellbeing. Pain and psychological wellbeing improve after bariatric metabolic surgery (BMS), however, it is unknown whether psychological wellbeing improves differently after weight loss between patients with and without chronic pain. We investigated whether weight loss is associated with greater psychological wellbeing and functioning change after BMS, comparing patients with and without preoperative pain syndromes. METHODS: Depression, health-related quality of life, self-esteem, self-efficacy to exercise and controlling eating behaviours, physical activity, and food cravings were measured before and 24 months after BMS among 276 patients with obesity. The presence of preoperative chronic pain syndromes was examined as a moderator for the relationship between 24-month weight loss and changes in psychological outcomes. RESULTS: Chronic pain syndromes were present among 46% of patients. Weight loss was associated with greater improvement in health-related quality of life, self-efficacy to exercise and controlling eating behaviours, self-esteem and greater amelioration in food cravings. Pain syndromes only moderated negatively the relationship between the postoperative weight loss and change in self-efficacy to control eating behaviours (b = -0.49, CI [-0.88,-0.12]). CONCLUSION: Patients with and without chronic pain showed similar improvements in weight and psychological wellbeing and behaviours after BMS. The relationship between weight loss and the improvement of self-efficacy to control eating behaviours was weaker among patients with chronic pain syndrome. Further work, measuring pain severity over time, is needed to shed light on the mechanism underlying pain and postoperative change in psychological wellbeing and weight loss.

Depressive Symptoms among Bariatric Surgery Candidates: Associations with Stigmatization and Weight and Shape Concern.

Bariatric surgery candidates (BSC) are a highly vulnerable group for mental health impairments. According to the theoretical model of weight stigma, weight-related experienced stigmatization (ES) negatively influences mental health through weight bias internalization (WBI). This study tested this model among BSC and investigated whether this association depends on a negative body image in terms of weight and shape concern as a potential moderator. As part of a German multicenter study, ES, WBI, weight and shape concern, and depressive symptoms were assessed via self-report questionnaires among n = 854 BSC. Simple and moderated mediation analyses were applied to analyze whether WBI influences the relationship between ES and depressive symptoms, and whether this influence depends on weight and shape concern. WBI significantly mediated the relationship between ES and depressive symptoms by partially reducing the association of ES with depressive symptoms. Weight and shape concern emerged as significant moderators in the overall model and specifically for associations between WBI and depressive symptoms. The results suggest that the association between ES and depressive symptoms among BSC is stronger in those with high WBI. This association is strengthened by weight and shape concern, especially at low and mean levels. Studies evaluating longitudinal associations between weight-related stigmatization and mental health are indicated, as well as intervention studies targeting WBI in order to reduce adverse effects of ES on mental health in BSC.

Longitudinal trajectories and psychological predictors of weight loss and quality of life until 3 years after metabolic and bariatric surgery.

OBJECTIVE: This study aimed to describe longitudinal trajectories of Total Weight Loss (%TWL), and mental and physical health related quality of life (HRQOL), as well as to identify preoperative psychological predictors of these trajectories. METHODS: A prospective observational study including Dutch patients treated with metabolic and bariatric surgery (n = 420, age 44.8 ± 10.3 years, 78.6% females) was performed. Trajectories of %TWL and HRQOL from screening to 1-, 2-, and 3-years post-surgery were described using growth mixture modelling. Multivariable and lasso regression models were used to identify predictors. RESULTS: Three trajectories described %TWL, varying in the degree of first-year weight loss. No pre-surgical psychological factors were associated with %TWL trajectories. We identified four physical and five mental HRQOL trajectories. Approximately 25-30% of patients exhibited patterns of initial improvements followed by decline, or persistently low levels of HRQOL. Higher depressive symptoms were associated with these unfavourable physical HRQOL trajectories (OR 1.20, 95%CI 1.04-1.39), adjusted for confounders. Unfavourable mental HRQOL trajectories were predicted by depressive and anxiety symptoms, neuroticism, insecure attachment, and maladaptive coping. In contrast, self-esteem, extraversion, and conscientiousness were associated with favourable mental HRQOL trajectories. DISCUSSION: Psychological factors did not predict weight loss, but they significantly impacted patient's HRQOL after metabolic and bariatric surgery. A subgroup with unsuccessful HRQOL after surgery was identified, who would benefit from tailored preoperative counselling to optimize surgery outcomes. Metabolic and bariatric surgery may not be universally beneficial for all patients, challenging the conventional approach to surgical interventions for severe obesity and advocating for a more nuanced, individualized assessment of potential candidates.

Racial differences after bariatric surgery: 24-month follow-up of a randomized, controlled trial for postoperative loss-of-control eating.

BACKGROUND: While some bariatric surgery outcomes vary by race/ethnicity, less is known about racial/ethnic differences in loss-of-control (LOC) eating and psychosocial outcomes post-surgery. OBJECTIVE: This prospective study examined and extended initial short-term findings regarding racial differences in post-bariatric surgery LOC eating and weight loss to longer-term outcomes through 24-month follow-ups. SETTING: Academic medical center in the United States. METHODS: Participants were 140 patients (46.4% non-White) in a 3-month randomized, controlled trial for LOC eating performed about 6 months after bariatric surgery. Participants were reassessed at 6, 12, 18, and 24 months after treatment ended (about 33 mo after surgery). Doctoral assessors administered the Eating Disorder Examination-Bariatric Surgery Version interview to assess LOC eating and eating-disorder psychopathology at 12- and 24-month follow-ups. The Beck Depression Inventory II was repeated, and measured weight was obtained at all follow-ups. RESULTS: White patients had significantly greater percent excess weight loss at all follow-ups than non-White patients (p < .03). White patients reported significantly more LOC eating at 12- (p = .004) and 24-month (p = .024) follow-ups and significantly greater eating disorder psychopathology at 12-month follow-up (p < .028). Racial groups did not differ significantly in eating disorder psychopathology at 24-month follow-ups or in Beck Depression Inventory II depression scores at any follow-ups. CONCLUSIONS: Our findings suggest that among patients with LOC eating after bariatric surgery, non-White patients attain a lower percent excess weight loss than White patients but have comparable or better outcomes in LOC eating, associated eating disorder psychopathology, and depression over time.

The role of obesity severity in Minnesota multiphasic personality inventory-2-restructured form prediction of 12-month bariatric surgery outcomes.

BACKGROUND: The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) has been widely used in bariatric surgery samples. However, questions remain regarding its utility when predicting changes in body mass index over time following bariatric surgery. OBJECTIVES: Examine whether MMPI-2-RF scales differentially predict 12-month changes in body mass index (BMI) following bariatric surgery when comparing patients with Class III or higher versus Class II or lower obesity. SETTING: Military hospital in the Northwestern United States. METHODS: This retrospective study evaluated data from 193 bariatric surgery patients who completed the MMPI-2-RF as part of presurgical evaluation requirements. Hierarchical linear modeling was used to predict body mass index over a 12-month postsurgical period based on MMPI-2-RF scales. Loss to follow-up rate was 30% during this period. RESULTS: Among patients with Class II or lower obesity, the Symptom Validity, Adjustment Validity, Response Bias, Cynicism, Aggression, Stress/Worry, and Anger Proneness scales showed a significant relationship to BMI after bariatric surgery. Among patients with Class III or higher obesity, the Infrequent Psychopathology Responses, Emotional / Internalizing Dysfunction, Ideas of Persecution, Multiple Specific Fears, and Inefficacy scales showed a significant relationship to body mass index after bariatric surgery. CONCLUSIONS: Certain MMPI-2-RF scales may have better utility in predicting bariatric surgery outcomes based on the patient's obesity severity. The interaction of metabolic and personality factors may play a significant role in weight change following bariatric surgery.

Cannabis use following bariatric surgery is associated with anxiety and maladaptive eating.

BACKGROUND: There are limited data regarding the association of cannabis use with outcomes after bariatric surgery. As such, it is challenging to know how to counsel patients using cannabis. OBJECTIVES: The purpose of this study was to examine whether postsurgical cannabis use was associated with psychiatric symptoms and maladaptive eating among individuals up to 4 years after bariatric surgery. SETTING: Single health system. METHODS: All patients who underwent bariatric surgery over a 4-year period were invited to participate. Participants (N = 765) completed questionnaires online regarding postsurgical cannabis use, psychiatric symptoms, and maladaptive eating. RESULTS: Any cannabis use after bariatric surgery was associated with increased likelihood of having elevated symptoms of anxiety (odds ratio [OR] = 1.88, P = .003; 37.8% versus 24.4%), increased likelihood of grazing behaviors (OR = 1.77, P = .01; 71.2% versus 58.2%), and higher scores for eating in response to depression (P = .01; 12.13 versus 10.75). Weekly cannabis use was associated with loss of control eating (OR = 1.81, P = .04; 37.2% versus 24.7%), binge eating (OR = 2.16, P = .03; 20.0% versus 10.4%), and night eating behaviors (OR = 2.11, P = .01; 40.0% versus 24.0%). Cannabis use was not associated with depression (P > .05). CONCLUSIONS: Cannabis use after bariatric surgery was associated with anxiety symptoms and engaging in maladaptive eating behaviors. Frequent cannabis use (i.e., ≥1 per week) was associated with additional types of maladaptive eating. Clinicians involved in presurgical and postsurgical care may want to counsel patients currently using cannabis, especially those who are engaging in frequent use.

Post-surgical psychiatric symptoms, maladaptive eating patterns, and lifestyle behaviors associated with weight recurrence after bariatric surgery.

BACKGROUND: A significant proportion of patients who undergo bariatric surgery experience weight recurrence; however, the most important areas to target to prevent weight recurrence remain unknown. OBJECTIVES: The purpose was to examine whether psychiatric symptoms, maladaptive eating behaviors, and lifestyle factors were associated with weight recurrence. SETTING: Single healthcare system. METHODS: Individuals who underwent bariatric surgery were invited to complete a web-based survey in which they reported their current weight and completed measures of psychiatric symptoms, maladaptive eating behaviors, and lifestyle behaviors. Participants were included if they were at least 2 years postsurgery. Weight recurrence was measured from the 1-year follow-up to the survey date. RESULTS: Participants (n = 169) were predominantly female and White or Black, with a mean age of 45 years. The rate of significant weight recurrence was 23.1%. Those who underwent sleeve gastrectomy were more likely to experience weight recurrence (odds ratio [OR] = 12.99; P = .01). In bivariate analyses, anxiety and depressive symptoms, emotional eating, loss of control eating, binge eating, and night eating were associated with weight recurrence (P < .05). Those who did not eat mindfully, take 20 minutes to eat, or get adequate sleep were also more likely to have weight recurrence (P < .05). In a multivariate model, only a lack of mindful eating (OR = 4.84; P = .03) and inadequate sleep (OR = 7.30; P = .02) remained statistically significant predictors. CONCLUSION: Engaging in mindful eating and obtaining adequate sleep may protect against weight recurrence following bariatric surgery. Clinicians may want to screen and monitor these behaviors.

Peripheral inflammation associated with depression and reduced weight loss: a longitudinal study of bariatric patients.

BACKGROUND: Research implicates inflammation in the vicious cycle between depression and obesity, yet few longitudinal studies exist. The rapid weight loss induced by bariatric surgery is known to improve depressive symptoms dramatically, but preoperative depression diagnosis may also increase the risk for poor weight loss. Therefore, we investigated longitudinal associations between depression and inflammatory markers and their effect on weight loss and clinical outcomes in bariatric patients. METHODS: This longitudinal observational study of 85 patients with obesity undergoing bariatric surgery included 41 cases with depression and 44 controls. Before and 6 months after surgery, we assessed depression by clinical interview and measured serum high-sensitivity C-reactive protein (hsCRP) and inflammatory cytokines, including interleukin (IL)-6 and IL-10. RESULTS: Before surgery, depression diagnosis was associated with significantly higher serum hsCRP, IL-6, and IL-6/10 ratio levels after controlling for confounders. Six months after surgery, patients with pre-existing depression still had significantly higher inflammation despite demonstrating similar weight loss to controls. Hierarchical regression showed higher baseline hsCRP levels predicted poorer weight loss (ß = -0.28, p = 0.01) but had no effect on depression severity at follow-up (ß = -0.02, p = 0.9). Instead, more severe baseline depressive symptoms and childhood emotional abuse predicted greater depression severity after surgery (ß = 0.81, p < 0.001; and ß = 0.31, p = 0.001, respectively). CONCLUSIONS: Depression was significantly associated with higher inflammation beyond the effect of obesity and other confounders. Higher inflammation at baseline predicted poorer weight loss 6 months after surgery, regardless of depression diagnosis. Increased inflammation, rather than depression, may drive poor weight loss outcomes among bariatric patients.

Psychometric Properties of the Brief Coping Orientation to Problems Experienced Inventory Among Patients Pursuing Bariatric Surgery.

The Brief COPE Inventory is a widely used scale that measures how a person copes with a specific situation. Despite its widespread use, the factor structure of this scale is somewhat unclear and has not been tested among patients pursuing bariatric surgery. We tested competing factor analytic models of the Brief COPE Inventory among patients pursuing bariatric surgery to identify the best fitting factor model for use in pre-surgical psychological evaluations. We also examined reliability and validity of the subscales from the best fitting model of coping. Participants included 1984 patients pursuing bariatric surgery (Mage = 42.58 years, SD = 10.89, 81.39% female). The best fitting model of the Brief COPE Inventory among patients pursuing bariatric surgery was a three-factor model including interpersonal, intrapersonal, and maladaptive coping strategies. These results were replicated in a subset of the original sample and demonstrated appropriate convergent and discriminant validity with several key outcomes. The Brief COPE Inventory can be conceptualized as a multidimensional scale assessing interpersonal coping, intrapersonal coping, and maladaptive coping among patients pursuing bariatric surgery. Future work should examine how these subscales are related to surgical outcomes among people receiving treatment for excess weight.

Mental health from 5 years before to 10 years after bariatric surgery in adolescents with severe obesity: a Swedish nationwide cohort study with matched population controls.

BACKGROUND: The long-term effects of bariatric surgery on the mental health of adolescents with severe obesity remain uncertain. We aimed to describe the prevalence of psychiatric health-care visits and filled prescription psychiatric drugs among adolescents with severe obesity undergoing bariatric surgery in the 5 years preceding surgery and throughout the first 10 years after surgery, and to draw comparisons with matched adolescents in the general population. METHODS: Adolescents with severe obesity and who underwent bariatric surgery were identified through the Scandinavian Obesity Surgery Registry. We included adolescents who had bariatric surgery between 2007 and 2017 and were younger than 21 years at time of surgery. Each adolescent patient was matched with ten adolescents from the general population by age, sex, and county of residence. Specialist psychiatric care and filled psychiatric prescriptions were retrieved from nationwide data registers. FINDINGS: 1554 adolescents (<21 years) with severe obesity underwent bariatric surgery between 2007 and 2017, 1169 (75%) of whom were female. At time of surgery, the mean age was 19·0 years [SD 1·0], and the mean BMI was 43·7 kg/m2 (SD 5·5). 15 540 adolescents from the general population were matched with adolescents in the surgery group. 5 years before the matched index date, 95 (6·2%) of 1535 surgery patients and 370 (2·5%) of 14 643 matched adolescents had a psychiatric health-care visit (prevalence difference 3·7%; 95% CI 2·4-4·9), whereas 127 (9·8%) of 1295 surgery patients and 445 (3·6%) of 12 211 matched adolescents filled a psychiatric drug prescription (prevalence difference 6·2%; 95% CI 4·5-7·8). The year before the matched index date, 208 (13·4%) of 1551 surgery patients and 844 (5·5%) of 15 308 matched adolescents had a psychiatric health-care visit (prevalence difference 7·9%; 95% CI 6·2-9·6), whereas 319 (20·6%) of 1551 surgery patients and 1306 (8·5%) of 15 308 matched adolescents filled a psychiatric drug prescription (prevalence difference 12·0%; 10·0-14·1). The prevalence difference in psychiatric health-care visits peaked 9 years after the matched index date (12·0%; 95% CI 9·0-14·9), when 119 (17·6%) of 675 surgery patients and 377 (5·7%) of 6669 matched adolescents had a psychiatric health-care visit. The prevalence difference in filled psychiatric drug prescription was highest 10 years after the matched index date (20·4%; 15·9-24·9), when 171 (36·5%) of 469 surgery patients and 739 (16·0%) of 4607 matched adolescents filled a psychiatric drug prescription. The year before the matched index date, 19 (1·2%) of 1551 surgery patients and 155 (1·0%) of 15304 matched adolescents had a health-care visit associated with a substance use disorder diagnosis (mean difference 0·2%, 95% CI -0·4 to 0·8). 10 years after the matched index date, the prevalence difference had increased to 4·3% (95% CI 2·3-6·4), when 24 (5·1%) of 467 surgery patients and 37 (0·8%) of 4582 matched adolescents had a health-care visit associated with a substance use disorder diagnosis. INTERPRETATION: Psychiatric diagnoses and psychiatric drug prescriptions were more common among adolescents with severe obesity who would later undergo bariatric surgery than among matched adolescents from the general population. Both groups showed an increase in prevalence in psychiatric diagnoses and psychiatric drug prescriptions leading up to the time of surgery, but the rate of increase in the prevalence was higher among adolescents with severe obesity than among matched adolescents. With the exception of health-care visits for substance use disorders, these prevalence trajectories continued in the 10 years of follow-up. Realistic expectations regarding mental health outcomes should be set preoperatively. FUNDING: Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare.

Feeding and Eating Disorders in Bariatric Surgery: A Retrospective Study.

INTRODUCTION: Obese subjects undergoing bariatric surgery often display medical and psychiatric comorbidities, influencing post-operative course and long-term prognosis. Candidates for bariatric surgery are evaluated through a multidisciplinary assessment in the pre-operative phase, including a psychiatric visit. The psychiatric examination aims to screen psychiatric comorbidities, including feeding and eating disorders (FEDs). Indeed, there is evidence of the association between obesity and several psychiatric disorders, such as FEDs, but also anxiety disorders, mood disorders, psychotic disorders, neurodevelopment disorders and personality disorders, particularly B and C cluster personalities. This study aims to evaluate the presence of psychiatric comorbidities among a population of candidates for bariatric surgery, and to underline the clinical correlates of FEDs diagnosis at the pre-operative assessment. SUBJECTS AND METHODS: Patients were recruited at the outpatient service of the Section of Psychiatry, Clinical Psychology and Rehabilitation of the General Hospital/University of Perugia. Psychiatric comorbidities were investigated by a psychiatric interview and hetero-administered scales for the evaluation of DSM-5 psychiatric syndromes (Structured Interview for DSM-5 Disorders - clinical version - SCID-5-CV), psychopathological and personality characteristics (Minnesota Multiphasic Personality Inventory - MMPI-2 and Structured Clinical Interview for DSM-5-Personality Disorders - SCID-5-PD) and specific scales for the evaluation of FEDs (Binge Eating Scale - BES, Obesity Questionnaire - OQ, Bulimia Test-Revised - BULIT-R and Body Shape Questionnaire - BSQ). After performing descriptive statistics, we performed bivariate analyses to assess significant differences between subjects with and without FEDs diagnosis (p˂0.05). RESULTS: The sample was composed of 160 subjects (70.6% F versus 29.4% M). The average BMI was 42.90 ±6.258 and 86.8% of subjects had a Class 3 Obesity (BMI ≥40). 41.3% of patients received a psychiatric diagnosis and, specifically, a diagnosis of FEDs was highlighted in 28.7% cases. Individuals with FEDs more frequently had a family history of obesity and FEDs. As for psychopathological characteristics, altered scores on the BES and on the BULIT-R were more frequent in the group with psychiatric disorders excluding FEDs. CONCLUSIONS: Patients evaluated in bariatric surgery pre-operative assessment often display FEDs. Patients with FEDs more frequently suffer from other psychiatric disorders, showing the need for specific support pathways in this group of patients.

Eating disorders among bariatric surgery patients: The chicken or the egg?

ABSTRACT: Postoperative eating behaviors and unhealthy weight control measures are leading causes of bariatric surgery complications. Candidates for bariatric surgery and individuals with eating disorders may share common risk factors, such as a history of dieting, and/or being bullied or teased for their weight. Binge-eating disorder, night eating syndrome, and bulimia nervosa are the most common eating disorders among candidates for bariatric surgery before the operation. Malnutrition, stress, and intense fear of weight gain can lead to the development of an eating disorder after surgery as well. Plugging, grazing, loss of control eating, dumping, and food avoidance are specific disordered behaviors that may present after bariatric surgery. To improve physical and psychological outcomes for individuals under their care, clinicians can screen for these disordered behaviors and distinguish them from a healthy diet and the expected postsurgical course.

The nature of expectations of bariatric surgery in patients during the pre- and post-operative period: A unicentric, qualitative study of patient perspectives.

Many patients (20%-30%) experience suboptimal weight loss (WL) after bariatric surgery (BS), and unrealistic preoperative WL expectations may be a contributing factor. This study aimed to describe the nature of patients' general expectations of BS during the pre-surgical period, and how patients determined whether their expectations and WL goals (WLGs) were realistic. The extent to which patients' expectations and WLGs were met and/or changed during the post-surgical period was also assessed. Semi-structured interviews were conducted with 15 preoperative patients recruited approximately 6-months before surgery. Focus groups were also conducted with 14 post-operative patients recruited approximately 6-months after surgery. Interviews and focus groups were audio-recorded, transcribed verbatim and analysed using qualitative content analysis. Preoperative patients reported expectations that BS would positively impact physical and psychological health, social relationships, as well as quality of care. Preoperative patients perceived that they and their health care professionals had unrealistically high expectations of WL. Post-operative patients reported being generally satisfied with the outcomes of surgery, even though many did not reach their expected WL. Finally, most post-operative patients reported changing their expectations from pre- to post-surgery. This study provides data that may help inform the development of preoperative interventions focusing on helping patients set realistic expectations for WL and related outcomes, which could better prepare patients for the challenges they will face after surgery.

Intrapersonal coping predicts greater weight loss 24 months after bariatric surgery.

PURPOSE: Coping is related to numerous health outcomes, including weight loss. However, the relationship between coping and weight loss after bariatric surgery remains unclear. OBJECTIVES: The first objective of this study was to examine cross-sectional relationships between coping, anxiety, and depression. The second objective was to determine whether baseline anxiety and depression predicted weight loss 24 months after bariatric surgery. The final objective was to identify which aspects of coping are related to weight loss 24 months after bariatric surgery. MATERIALS AND METHODS: Participants included 1203 adults who completed a pre-surgical bariatric evaluation, including 841 patients who underwent bariatric surgery, 396 of whom had 24-month weight data. Psychological variables were collected during a pre-surgical psychological evaluation. Weight-related variables were obtained through patients' electronic medical records 24 months after surgery. RESULTS: Baseline intrapersonal coping (e.g., problem-solving, acceptance) predicted both weight loss variables at 24 months after surgery. However, baseline interpersonal and maladaptive coping were not related to weight loss. Baseline anxiety and depression similarly did not predict weight loss after surgery. CONCLUSION: Use of intrapersonal coping strategies at baseline predicted weight loss 24 months after bariatric surgery. Clinicians should assess and bolster these self-reliant coping strategies prior to surgery to improve patient outcomes.

Long-term weight loss outcomes after bariatric surgery: a propensity score study among patients with psychiatric disorders.

INTRODUCTION: To analyze the safety and long-term result of bariatric surgery in patients with psychiatric disorders. MATERIAL AND METHODS: From January 2009 to December 2018, n = 961 patients underwent bariatric surgery in a tertiary center. Among them, two groups of patients were created: a group of patients with psychiatric disorders (PG) and a group without psychiatric disorders (CG), using a propensity score matched (PSM). Primary endpoint was long-term outcomes and secondary endpoints were the postoperative morbidity 90 days after surgery, late morbidity, occurrence of psychiatric adverse events, and resolution of obesity-related comorbidities. RESULTS: Analysis with PSM permitted to compare 136 patients in each group, with a ratio 1:1. TWL% at 2 years in the PG was 32.7% versus 36.6% in the CG (p = 0.002). Overall surgical morbidity was higher in the PG than the CG (28% vs 17%, p = 0.01). Severe surgical complications were not statistically significant (4% vs 3%, p = 0.44). Psychiatric adverse events were significantly more frequent in the PG than in the CG. The resolution of obesity comorbidities was equivalent for both groups at 2 years. CONCLUSION: Substantial weigh loss was reported among patients with psychiatric disorders receiving bariatric surgery at the cost of more non-severe surgical complications. Further, a psychiatric postoperative follow-up visit may be warranted for patients with preoperative psychiatric disorders, given the incidence of psychiatric adverse events.

[Surgical components in the management of severe obesity]. / Les composantes chirurgicales dans la prise en charge de l'obésité sévère.

Bariatric surgery, combined with nutritional and psychological care and physical activity, is currently the most effective treatment for morbid obesity. The multidisciplinary team at the Caen Normandy obesity center explains the prerequisites of this therapeutic approach, and the monitoring and vigilance to be developed in partnership with the patient.

What is the role of psychology in bariatric surgery? A survey of the differing views of psychologists, the multidisciplinary team, and patients in the UK.

Although psychologists are a key member of the bariatric multidisciplinary team (MDT), there is a lack of clarity about the specific remit of their role. This exploratory study was conducted to identify differences, priorities and clarify how the role of psychology is perceived in the United Kingdom. We conducted surveys of three major stakeholder groups (psychologists, patients, and the bariatric multidisciplinary team) which focused on their perception of psychology in bariatric surgery. The results showed that in UK bariatric services, psychologists are spending the majority of their clinical time providing pre-operative assessments. Differences emerged between psychologists and MDT in how they viewed the purpose of these assessments, with the MDT viewing them as identifying contraindications to surgery whereas psychologists viewed them as identifying readiness for surgery. A total of 51% of patients reported they had not been able to access psychology services when needed and viewed provision of post-operative psychological support to be a key priority. Key themes and tensions emerged around (a) high demand for services yet limited psychology resource, (b) the purpose of the pre-operative assessment and (c) the provision of pre-operative versus post-operative support. These themes combine and interact in a way that currently makes it extremely challenging to provide coherent psychology services. There is clearly a need for education, consensus and adequate resourcing of the psychology role within bariatric surgery services in the United Kingdom.

Eating disorders and emotional dysregulation are associated with insufficient weight loss after bariatric surgery: a 1-year observational follow-up study.

PURPOSE: Subjects with obesity, especially those seeking bariatric surgery, exhibit high rates of mental disorders and marked psychopathological traits. The primary objective of this prospective, non-interventional study was to investigate whether the presence of different psychiatric disorders, attention deficit/hyperactivity disorder (ADHD) symptomatology and emotional dysregulation influenced weight loss at 1-year follow-up after surgery. METHODS: Subjects consecutively referred for pre-surgical evaluation at the Obesity Center of Pisa University Hospital were recruited. Psychiatric diagnoses were made through the Mini-International Neuropsychiatric Interview (MINI) and ADHD symptomatology was assessed with the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS). Emotional dysregulation was investigated through the WRAADDS and self-report questionnaires. After surgery, weight and obesity-related comorbidities were monitored during follow-up. RESULTS: Of the 99 participants recruited, 76 underwent surgery and 65 could be reevaluated 1 year after surgery. Subjects with insufficient weight loss (excess body mass index loss ≤ 53%, n = 15) had more frequent lifetime binge eating disorder (BED) and BED-mood disorders comorbidity than subjects with favorable post-surgical outcome. Additionally, they scored higher on both physician-administered and self-report scales assessing emotional dysregulation, which represents a nuclear symptom of ADHD in adults. At the logistic regression analysis, older age, higher preoperative excess body mass index and greater affective instability were predictors of reduced weight loss at 1-year follow-up. CONCLUSION: Emotional dysregulation seems to be associated with a worse outcome after bariatric surgery. Further studies with larger samples and longer follow-up are needed to confirm the influence of different psychiatric disorders and psychopathological traits on post-surgical outcome. LEVEL OF EVIDENCE: V, prospective descriptive study.