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Marek RJ, Ben-Porath YS, Panigrahi E, Pona AA. Further evidence regarding the convergent and discriminant validity of Minnesota Multiphasic Personality Inventory-3 (MMPI-3) scores in the preoperative psychological evaluation of patients seeking metabolic and bariatric surgery. Surg Obes Relat Dis 2024; 20:577-586. [PMID: 38373868 DOI: 10.1016/j.soard.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/08/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Psychological testing is used in some preoperative psychological evaluations of patients seeking metabolic and bariatric surgery. The Minnesota Multiphasic Personality Inventory-3 (MMPI-3) contains new norms, updated item content, and new scales such as Eating Concerns and Impulsivity, which are relevant to the assessment of patients seeking metabolic and bariatric surgery. OBJECTIVE The goal of this investigation was to establish convergent and discriminant properties of the MMPI-3 scales with relevant clinical interview and medical record data from electronic medical records. SETTING Academic medical center in the Midwest. METHODS A sample of 790 consecutive patients who completed a preoperative psychological evaluation and took the MMPI-3 were included. Data from medical records and the assessment report were coded by a trained research assistant. RESULTS MMPI-3 scale scores demonstrated good convergent and discriminant validity. For instance, the Emotional/Internalizing Dysfunction scales correlated with depression and anxiety disorder, suicide history, sexual abuse history, psychotropic medication use, and eating behaviors. Behavioral/Externalizing Dysfunction scales correlated with alcohol, nicotine, and substance use and eating behaviors such as loss-of-control overeating. The Eating Concerns scale demonstrated the highest correlational patterns with various eating behaviors such as loss-of-control overeating, binge eating, and stress eating. CONCLUSIONS MMPI-3 scale scores perform as well as their Minnesota Multiphasic Personality Inventory-2 Restructured Form counterparts. Newer scales, such as Eating Concerns and Impulsivity, perform particularly well in the assessment of various eating behaviors.
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Affiliation(s)
- Ryan J Marek
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, Texas.
| | | | - Eva Panigrahi
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ashleigh A Pona
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, Ohio
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Walter FA, Hoyt T, Michl TM. When insurance is not a barrier: psychological factors predicting whether bariatric candidates undergo surgery. Surg Obes Relat Dis 2024:S1550-7289(24)00159-X. [PMID: 38777643 DOI: 10.1016/j.soard.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Despite the effectiveness of bariatric surgery, utilization rates have increased only marginally over the last 2 decades; candidates who are eligible for bariatric surgery regularly fail to undergo surgery. The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) has previously been used to assist in identification of those who will not move forward with surgery after being identified as eligible. However, medical insurance has been identified as a significant barrier to surgery; research in those who have universal healthcare may yield different results. OBJECTIVES Determine if MMPI-RF scales are associated with failure to undergo bariatric surgery in patients eligible to have the procedure. SETTING Large military hospital in the Northwestern U.S. METHODS This study used archival data for 279 patients psychologically screened for eligibility for bariatric surgery. All assessments took place between January 2017 and December 2019. T-tests and chi-square tests were used to compare groups of patients who did and did not have surgery on relevant medical and demographic variables. Profile analyses of patient MMPI-2-RF scores were conducted to examine scale associations with undergoing surgery. RESULTS A total of 86 bariatric surgery candidates (30.8%) did not undergo surgery. Results showed that sex, age, employment status, and arthritis were different between groups. Additionally, MMPI-2-RF scales were different between groups, including somatic complaints, neurological complaints, cynicism, and helplessness/hopelessness. CONCLUSIONS MMPI-2-RF scales were associated with not having bariatric surgery, although not all scales exceeded clinical cut-offs. Findings indicate psychological and psychosocial differences, rather than psychopathology per se, may play a role in who undergoes bariatric surgery.
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Affiliation(s)
| | - Tim Hoyt
- Madigan Army Medical Center, Tacoma, Washington.
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Marek RJ, Ben-Porath YS, Heinberg LJ. Six-year postoperative associations between the Minnesota Multiphasic Personality Inventory - 3 (MMPI-3) and weight recurrence, eating behaviors, adherence, alcohol misuse, and quality of life. Surg Obes Relat Dis 2024; 20:391-398. [PMID: 38216363 DOI: 10.1016/j.soard.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/20/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) leads to beneficial and sustained outcomes. However, many patients evidence weight recurrence and psychosocial functioning may be associated with weight recurrence. The Minnesota Multiphasic Personality Inventory - 3 (MMPI-3) is validated for use in presurgical MBS evaluations and likely has clinical utility in understanding weight recurrence and other aspects of postoperative functioning. OBJECTIVE The objective of the current investigation is to understand how postoperative psychosocial functioning relates to weight recurrence and other behaviors and constructs 6 years after MBS. SETTING Cleveland Clinic Bariatric and Metabolic Institute. METHODS A sample of 163 participants consented to take a battery of self-report measures related to psychological functioning, eating behaviors, adherence, alcohol misuse, and quality of life along with their postoperative weight. MMPI-3 scale scores were prorated from the Minnesota Multiphasic Personality Inventory - 2 - Restructured Form (MMPI-2-RF) or scored from the Minnesota Multiphasic Personality Inventory - 2 - Restructured Form - Expanded (MMPI-2-RF-EX). RESULTS Weight recurrence was quite variable in this sample. Postoperative MMPI-3 scales related to emotional/internalizing dysfunction were modestly associated with higher weight recurrence. Postoperative MMPI-3 scale scores also demonstrated associations with other postoperative outcomes including measures of eating behaviors, adherence, alcohol misuse, and quality of life. CONCLUSIONS Postoperative psychosocial functioning as assessed by the MMPI-3 was associated with weight recurrence and a number of other problematic psychological outcomes beyond weight recurrence.
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Affiliation(s)
- Ryan J Marek
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, Texas.
| | | | - Leslie J Heinberg
- Department of Psychiatry and Psychology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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Hoyt T, Walter FA, Michl TM. The role of obesity severity in Minnesota multiphasic personality inventory-2-restructured form prediction of 12-month bariatric surgery outcomes. Surg Obes Relat Dis 2024; 20:267-274. [PMID: 37880030 DOI: 10.1016/j.soard.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/04/2023] [Accepted: 09/04/2023] [Indexed: 10/27/2023]
Abstract
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.
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Affiliation(s)
- Tim Hoyt
- Department of Behavioral Health, Madigan Army Medical Center, Tacoma, Washington.
| | - Fawn A Walter
- Department of Behavioral Health, Madigan Army Medical Center, Tacoma, Washington
| | - Tegan M Michl
- Department of Behavioral Health, Madigan Army Medical Center, Tacoma, Washington
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Hoyt T, Walter FA, Michl TM. Psychological Profiles and 12-Month Weight Outcomes of Women Evaluated for Reoperative Bariatric Surgery. Obes Surg 2023:10.1007/s11695-023-06583-6. [PMID: 37061626 DOI: 10.1007/s11695-023-06583-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND The use of psychological screening instruments prior to bariatric surgery has been well established. However, there is currently no specific literature on psychological screening of candidates for reoperative bariatric surgery. METHODS This study evaluated archival data for 40 women who were candidates for reoperative bariatric surgery and completed the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). Profile analysis examined differences between patient groups who did and did not undergo reoperative surgery. MMPI-2-RF profiles for reoperative patients then were compared to previous samples of preoperative and postoperative patients. Hierarchical linear modeling was used to predict BMI following reoperative surgery over a 12-month period based on MMPI-2-RF scales while controlling for age and initial BMI. RESULTS Profile analysis results showed no significant differences on MMPI-2-RF scale scores between reoperative candidates who did and did not undergo a second surgery. With some minor differences attributed to minimization of symptoms, there were no systematic differences in MMPI-2-RF scale scores for reoperative surgery patients compared to preoperative and postoperative patient groups. BMI outcomes over a 12-month period showed that age and initial BMI were significantly better predictors than MMPI-2-RF scores. CONCLUSIONS Administration of MMPI-2-RF for reoperative bariatric surgery patients likely is equivalent to its typical use in preoperative screening. Only the MMPI-2-RF Disconstraint scale showed any relationship to BMI outcomes over time following reoperative surgery.
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Affiliation(s)
- Tim Hoyt
- Madigan Army Medical Center, 9040 Fitzsimmons Dr, Tacoma, WA, 98431, USA.
- Office of Force Resiliency, 4000 Defense Pentagon, Washington, DC, 20301-4000, USA.
| | - Fawn A Walter
- Madigan Army Medical Center, 9040 Fitzsimmons Dr, Tacoma, WA, 98431, USA
| | - Tegan M Michl
- Madigan Army Medical Center, 9040 Fitzsimmons Dr, Tacoma, WA, 98431, USA
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de Lourdes M, Cerqueira L, Pinto-Bastos A, Marôco J, Palmeira L, Brandão I, Vaz AR, Conceição E. Understanding Uncontrolled Eating after Bariatric Surgery: The Role of Excessive Skin and Body Image Shame. J Clin Med 2021; 10:jcm10132967. [PMID: 34279452 PMCID: PMC8268132 DOI: 10.3390/jcm10132967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/03/2022] Open
Abstract
Excess skin and disordered eating behaviors are referred to as some of the major negative consequences of bariatric surgery as well as body image shame. This study sought to explore how discomfort with excessive skin, body image shame, psychological distress, eating-related psychopathology, and negative urgency interact to understand uncontrolled eating among woman submitted to bariatric surgery. A cross-sectional sample of 137 women was evaluated postoperatively through self-report questionnaires assessing discomfort with excess skin, body image shame, eating-related psychopathology, negative urgency, and uncontrolled eating in a hospital center in the north of Portugal. Pearson correlations and Structural Equation Modeling (SEM) were performed. Body image shame mediated the relationship between discomfort with excess skin and eating-related psychopathology. In turn, the relationship between eating-related psychopathology and uncontrolled eating was mediated by negative urgency. This study highlights the impact of excess skin and body image shame on eating behavior post-bariatric-surgery. Considering the proven impact of uncontrolled eating on weight-loss results post-surgery, understanding the mechanisms underlying this problem is highly important. Our findings provide helpful insight for multidisciplinary teams committed to providing care to bariatric patients struggling with body image and eating difficulties.
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Affiliation(s)
- Marta de Lourdes
- School of Psychology, University of Minho, 4710-057 Braga, Portugal; (M.d.L.); (L.C.); (A.P.-B.); (A.R.V.)
| | - Luísa Cerqueira
- School of Psychology, University of Minho, 4710-057 Braga, Portugal; (M.d.L.); (L.C.); (A.P.-B.); (A.R.V.)
| | - Ana Pinto-Bastos
- School of Psychology, University of Minho, 4710-057 Braga, Portugal; (M.d.L.); (L.C.); (A.P.-B.); (A.R.V.)
| | - João Marôco
- William James Centre for Research, ISPA–Instituto Universitário, 1100-304 Lisboa, Portugal;
| | - Lara Palmeira
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, 3001-802 Coimbra, Portugal;
| | - Isabel Brandão
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- University Hospital Center of São João, 4200-319 Porto, Portugal
| | - Ana Rita Vaz
- School of Psychology, University of Minho, 4710-057 Braga, Portugal; (M.d.L.); (L.C.); (A.P.-B.); (A.R.V.)
| | - Eva Conceição
- School of Psychology, University of Minho, 4710-057 Braga, Portugal; (M.d.L.); (L.C.); (A.P.-B.); (A.R.V.)
- Correspondence:
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Marek RJ, Martin-Fernandez K, Heinberg LJ, Ben-Porath YS. An Investigation of the Eating Concerns Scale of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) in a Postoperative Bariatric Surgery Sample. Obes Surg 2020; 31:2335-2338. [PMID: 33196980 DOI: 10.1007/s11695-020-05113-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 01/24/2023]
Abstract
Eating pathology is common pre-operatively and continues to be prevalent following bariatric surgery. A new version of the Minnesota Multiphasic Personality Inventory (MMPI), the MMPI-3, contains a new scale called Eating Concerns (EAT) that aims to assess problematic eating behaviors. The current investigation seeks to establish preliminary convergent validity of the MMPI-3 EAT scale in a postoperative bariatric surgery sample. Thirty-eight consecutive participants took the MMPI-3 and the Eating Disorder Examination-Questionnaire (EDE-Q). Higher MMPI-3 EAT scale scores were meaningfully associated with %Weight Regain (r = .37) and scale scores on the EDE-Q [Eating Concerns (r = .67), Weight Concerns (r = .39), Shape Concerns (r = .54), and the EDE total score (r = .59)]. Initial examination of the EAT Specific Problem Scale of the MMPI-3 yields good clinical utility in assessing eating pathology in a postoperative bariatric surgery sample.
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Affiliation(s)
- Ryan J Marek
- Department of Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, 2700 Bay Area Blvd, Houston, TX, 77058, USA.
| | | | - Leslie J Heinberg
- Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue/M61, Cleveland, OH, 44195, USA
| | - Yossef S Ben-Porath
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
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