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Punt SE, Caicedo MR, Rhodes AC, Ilardi SS, Hamilton JL. A semi-structured interview is associated with bariatric surgery outcomes. J Behav Med 2024; 47:483-491. [PMID: 38393445 DOI: 10.1007/s10865-024-00471-9] [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: 02/26/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
Pre-surgical psychological evaluations (PSPE) are required by many insurance companies and used to help identify risk factors that may compromise bariatric post-surgical outcomes. These evaluations, however, are not yet standardized. The present study investigated the utility of a semi-structured assessment, Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), on post-surgical outcomes across 18 months. A total of 272 adult patients underwent a psychosocial evaluation and received bariatric surgery November 2017 to September 2020 at a Midwestern academic medical center. Average age at pre-surgical evaluation was 45.2 (SD = 10.7) years and 82.3% of patients were female (n = 224). With an a priori α of 0.05, multi-level modeling with weight as the outcome and regression with complications as the outcome were used. Higher SIPAT Patient Readiness, indicating difficulty with adhering to health behaviors and a reduced understanding of bariatric surgery, was associated with elevated patient weight at the 18-month follow-up (𝛽 = 0.129, p = 0.03). Higher SIPAT Social Support, was associated with patient weight at the 18-month follow-up, with reduced support associated with greater weight (𝛽 = 0.254, p = 0.004). Higher SIPAT Social Support also was associated with a greater risk of complications across the 18-month follow-up window (𝛽 = -0.108, p = 0.05). Patients with higher readiness to adhere to behavioral changes, and those reporting an intact social support system, generally weighed less at 18 months. The SIPAT may be considered as part of the standardized pre-surgical assessment, however, further research is required to elucidate its utility.
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Affiliation(s)
- Stephanie E Punt
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
| | - Mariana Rincon Caicedo
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd, Lawrence, KS, 66045, USA
| | - Ashley C Rhodes
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Stephen S Ilardi
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd, Lawrence, KS, 66045, USA
| | - Jessica L Hamilton
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
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Kiser HM, Pratt KJ, Focht BC, Wallace L, Slesnick N, Noria S, Needleman B, Pona AA. Preoperative Psychological Evaluation Outcomes, Reasoning, and Demographic and Diagnostic Correlates. Obes Surg 2023; 33:539-547. [PMID: 36538213 PMCID: PMC9765350 DOI: 10.1007/s11695-022-06414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Little is known about associations between preoperative psychiatric, disordered eating, and substance use diagnoses with the clinical decision to require follow-up after the preoperative psychological evaluation. To determine the proportion of patients who require follow-up (no required follow-up (NFU), required follow-up (RFU), placed on hold (POH)) from the preoperative psychological evaluation, associations with diagnoses, and noted reasons for follow-up. MATERIALS AND METHODS The sample included 508 patients (77.6% female; 64.4% White) pursuing bariatric metabolic surgery with completed psychological evaluations between August 2019 and December 2020 at a Midwest medical center. Patient demographics, psychological evaluation outcome and corresponding reasoning, and psychiatric, disordered eating, and substance use diagnoses were extracted from the health record. Descriptive and bivariate analyses determined associations between demographics and diagnoses with psychological evaluation outcomes and corresponding reasoning. RESULTS The breakdown of psychological evaluation outcomes was 60.6% (n = 308) NFU, 38.4% (n = 195) RFU, and 1.0% (n = 5) POH. Demographic correlates of RFU included higher BMI, being single, lower educational attainment, unemployment, public/no insurance, and receiving multiple or any psychiatric diagnosis (all p-values < 0.05). Diagnostic correlates of RFU included anxiety, depression, not having a current trauma or stressor-related disorder, disordered eating, and substance use diagnoses (all p-values < 0.001). RFU/POH was primarily due to psychiatric (61%) reasons. CONCLUSION Higher rates of RFU were observed for patients with higher economic need and with psychiatric, disordered eating, or substance use diagnoses. Future work should establish preoperative programming to assist patients with addressing ongoing psychiatric concerns prior to bariatric metabolic surgery.
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Affiliation(s)
- Haley M. Kiser
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210 USA
| | - Keeley J. Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210 USA ,Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH 43210 USA
| | - Brian C. Focht
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210 USA
| | - Lorraine Wallace
- Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, OH 43210 USA
| | - Natasha Slesnick
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210 USA
| | - Sabrena Noria
- Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH 43210 USA
| | - Bradley Needleman
- Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH 43210 USA
| | - Ashleigh A. Pona
- Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus, OH 43210 USA
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Kiser HM, Pona AA, Focht BC, Wallace L, Slesnick N, Noria S, Needleman B, Pratt KJ. Associations between psychological evaluation outcomes, psychiatric diagnoses, and outcomes through 12 months after bariatric surgery. Surg Obes Relat Dis 2022; 19:594-603. [PMID: 36610864 DOI: 10.1016/j.soard.2022.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/10/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is limited evidence about how patients' initial preoperative psychological evaluation outcomes (require follow-up [RFU], no required follow-up [NFU], and place on hold [POH]) and current psychiatric diagnoses associate with postoperative outcomes. OBJECTIVES To test the hypotheses that patients who receive a clinical decision of RFU versus NFU from their initial psychological evaluation will be (1) more likely to experience postoperative complications, readmissions, and emergency room visits and (2) experience less weight loss over 12-months. Specific diagnoses (any psychiatric diagnosis, depression, and anxiety) are also examined for their association with weight loss over 12 months. SETTING Midwestern medical center, United States. METHODS The sample included 322 patients (81.1% female and 64.0% White) with completed psychological evaluations between August 2019 and December 2020. Patient demographics, psychological evaluation outcomes, current diagnoses, and postoperative outcomes were extracted from the health record. Bivariate analyses determined associations between NFU/RFU and postoperative complications (yes, no), readmissions (yes, no), and emergency room visits (yes, no). Mixed multilevel models were conducted with dichotomous variables NFU/RFU, any psychiatric diagnoses (yes, no), depression diagnoses (yes, no), or anxiety diagnoses (yes, no) as the main fixed within-group factors with weight loss (weight or percent total weight loss) used as the repeated measures. Insurance and surgical procedure were included as covariates. RESULTS There were no significant differences in postoperative complications, readmissions, and emergency room visits between NFU and RFU groups. Patients who received a RFU versus an NFU had higher weights over 12 months (P = .001). CONCLUSION Hypothesis 2 was only partially supported. Patients who received an RFU versus an NFU had higher weights over 12 months, but this association was not found for percent total weight loss or any of the psychiatric within-subjects variables (i.e., psychiatric diagnoses, depression, and anxiety).
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Affiliation(s)
- Haley M Kiser
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio
| | - Ashleigh A Pona
- Department of Psychiatry and Behavioral Health, College of Medicine, Ohio State University, Columbus, Ohio
| | - Brian C Focht
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio
| | - Lorraine Wallace
- Department of Biomedical Education and Anatomy, College of Medicine, Ohio State University, Columbus, Ohio
| | - Natasha Slesnick
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio
| | - Sabrena Noria
- Department of Surgery, Ohio State University Medical Wexner Center, Columbus, Ohio
| | - Bradley Needleman
- Department of Surgery, Ohio State University Medical Wexner Center, Columbus, Ohio
| | - Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio; Department of Surgery, Ohio State University Medical Wexner Center, Columbus, Ohio.
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Punt SE, Rhodes AC, Ilardi SS, Hamilton JL. Use of the Stanford Integrative Psychosocial Assessment for Transplant as a Pre-surgical Psychological Evaluation Tool for Bariatric Surgery. J Clin Psychol Med Settings 2022; 29:808-817. [DOI: 10.1007/s10880-022-09850-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
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Dirks RC, Athanasiadis DI, Hilgendorf WA, Ziegler KM, Waldrop C, Embry M, Selzer DJ. High-risk bariatric candidates: does red-flagging predict the post-operative course? Surg Endosc 2021; 36:2591-2599. [PMID: 33987766 DOI: 10.1007/s00464-021-08549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Standards for preoperative bariatric patient selection include a thorough psychological evaluation. Using patients "red-flagged" during preoperative evaluations, this study aims to identify trends in long-term follow-up and complications to further optimize bariatric patient selection. METHODS A multidisciplinary team held a case review conference (CRC) to discuss red-flagged patients. A retrospective chart review compared CRC patients to control patients who underwent bariatric surgery in the same interval. Patients under 18 years old, undergoing revisional bariatric surgery, or getting band placement were excluded. High-risk characteristics causing CRC inclusion, preoperative demographics, percent follow-up and other postoperative outcomes were collected up to 5 years postoperatively. If univariate analysis revealed a significant difference between cohorts, multivariable analysis was performed. RESULTS Two hundred and fifty three patients were red-flagged from 2012 to 2013, of which 79 underwent surgery. After excluding 21 revisions, 3 non-adult patients, and 6 band patients, 55 red-flagged patients were analyzed in addition to 273 control patients. Patient age, sex, initial BMI, ASA, and co-morbidities were similar between groups, though flagged patients underwent RYGB more frequently than control patients. Notably, percent excess BMI loss and percent follow-up (6 months-5 years) were similar. In multivariable analysis, minor complications were more common in flagged patients; and marginal ulcers, endoscopy, and dilation for stenosis were more common in flagged versus control patients who underwent RYGB. Perforation, reoperation, revision, incisional hernia, and internal hernia were statistically similar in both groups, though reoperation was significantly more common in patients with multiple reasons to be flagged compared to controls. CONCLUSION Bariatric patients deemed high risk for various psychosocial issues have similar follow-up, BMI loss, and major complications compared to controls. High-risk RYGB patients have greater minor complications, warranting additional counseling of high-risk patients.
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Affiliation(s)
- Rebecca C Dirks
- Department of Surgery, University School of Medicine, Indiana, USA.
| | | | | | - Kathryn M Ziegler
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Caitlyn Waldrop
- Department of Surgery, University School of Medicine, Indiana, USA
| | - Marisa Embry
- Department of Surgery, University School of Medicine, Indiana, USA
| | - Don J Selzer
- Department of Surgery, University School of Medicine, Indiana, USA
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Hilgendorf W, Monfared S, Monfared SHB, Athanasiadis DI, Selzer D, Choi JN, Banerjee A, Stefanidis D. Can a brief assessment of social support predict outcomes after bariatric surgery? Clin Obes 2021; 11:e12419. [PMID: 33021349 DOI: 10.1111/cob.12419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/19/2020] [Accepted: 09/23/2020] [Indexed: 01/04/2023]
Abstract
Social support is important to optimize bariatric surgery outcomes, but limited tools exist for brief and effective assessment preoperatively. The aims of the study were to determine the extent to which two ratings of social support can predict bariatric surgery outcomes, and to examine any associations between these two methods.In this retrospective study, patients were included for whom the Cleveland clinic behavioral rating system (CCBRS) and Flanagan quality of life scale (FQoLS) scores were obtained as part of their preoperative psychosocial evaluation. They were followed up for 6 to 24 months after bariatric surgery. Linear and logistic regressions were performed with patients' CCBRS and FQoLS scores as independent variables, and percent excess weight loss (%EWL), length of stay (LOS), complications, readmissions and loss to follow-up as dependent variables. The prediction of CCBRS ratings from FQoLS social support items was also evaluated. A total of 415 patients were included in the analysis. There were significant associations between the CCBRS and three of the four relevant FQoLS self-ratings. As CCBRS and FQoLS scores increased, complications decreased significantly. The CCBRS alone additionally predicted decreased length of hospital stay and approached significance for predicting decreased readmission rates. There were no associations between %EWL and behavior ratings. The degree of patients' social support is associated with important bariatric surgery outcomes. It is possible to obtain this valuable information via the administration of brief assessments prior to bariatric surgery.
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Affiliation(s)
| | - Sara Monfared
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Dimitrios I Athanasiadis
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Don Selzer
- Indiana University Health North Hospital, Carmel, Indiana, USA
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jennifer N Choi
- Indiana University Health North Hospital, Carmel, Indiana, USA
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ambar Banerjee
- Indiana University Health North Hospital, Carmel, Indiana, USA
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dimitrios Stefanidis
- Indiana University Health North Hospital, Carmel, Indiana, USA
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Martin-Fernandez KW, Marek RJ, Heinberg LJ, Ben-Porath YS. Six-year bariatric surgery outcomes: the predictive and incremental validity of presurgical psychological testing. Surg Obes Relat Dis 2021; 17:1008-1016. [PMID: 33640259 DOI: 10.1016/j.soard.2021.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Research identifying preoperative psychosocial predictors of bariatric surgery outcomes has yielded inconsistent results with minimal examination of longer-term outcomes. Utilizing a broadband measure of personality and psychopathology during the preoperative evaluation helps to identify preoperative risk factors for suboptimal bariatric surgery outcomes. OBJECTIVE Examine predictors of outcome and the incremental contribution of presurgical psychological testing to various long-term bariatric surgery outcomes. SETTING Academic medical center. METHOD A total of 168 postoperative patients (average of 6 postoperative years) consented to participate in the outcome study. Participants were weighed by the trained research/clinical staff and completed a battery of self-report questionnaires, including measures assessing eating attitudes and behaviors and weight-related quality-of-life (QoL). Patients had completed the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) as part of the institution's routine preoperative psychosocial evaluation. Weight loss was calculated as percent total weight loss (%TWL) and percent weight regain (%WR) was calculated as a percentage of maximum weight loss. Other preoperative data were obtained from a review of each patient's electronic medical record (EMR). From the initial sample, 145 patients were retained for analyses in the present study. RESULTS Preoperative problematic eating variables predicted long-term postoperative problematic eating behaviors and body image concerns. Scores on preoperative MMPI-2-RF scales measuring Demoralization, Dysfunctional Negative Emotions, Antisocial Behaviors, and Hypomanic Activation were consistent incremental predictors of 6-year outcomes, accounting for an additional 3%-24% of the variability in postoperative eating behaviors and QoL. CONCLUSIONS The preoperative psychological evaluation can be used to identify predictors of long-term bariatric surgery outcomes. Identification of these risk factors provides important targets for pre- and postoperative clinical interventions to maximize surgical outcomes.
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Affiliation(s)
| | - Ryan J Marek
- Department of Primary Care, Sam Houston State University College of Osteopathic Medicine, Conroe, Texas
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Sarwer DB, Heinberg LJ. A review of the psychosocial aspects of clinically severe obesity and bariatric surgery. ACTA ACUST UNITED AC 2021; 75:252-264. [PMID: 32052998 DOI: 10.1037/amp0000550] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
For the past 2 decades, clinically severe obesity (operationalized as a body mass index ≥40 kg/m2) has increased at a more pronounced rate that less severe obesity. As a result, the surgical treatment of obesity (bariatric surgery) has become a more widely accepted, yet still underutilized, treatment for persons with severe obesity and significant weight-related health problems. Psychologists play a central role on the multidisciplinary team involved in the preoperative assessment and postoperative management of patients. They also have played a central role in clinical research which has enhanced understanding of the psychosocial and behavioral factors that contribute to the development of severe obesity as well as how those factors and others contribute to postoperative outcomes. This article, written specifically for psychologists and other mental health professionals who currently work with these patients or are considering the opportunity to do so in the future, reviews these contributions over the past 20 years. The article highlights how this work has become a fundamental part of international clinical care guidelines, which primarily focus on preoperative psychosocial screening. The article also outlines avenues for future research in the field, with a specific focus on the need for additional behavioral and psychosocial interventions to promote lifelong success after bariatric surgery. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University
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Ye Y, Abu El Haija M, Morgan DA, Guo D, Song Y, Frank A, Tian L, Riedl RA, Burnett CML, Gao Z, Zhu Z, Shahi SK, Zarei K, Couvelard A, Poté N, Ribeiro-Parenti L, Bado A, Noureddine L, Bellizzi A, Kievit P, Mangalam AK, Zingman LV, Le Gall M, Grobe JL, Kaplan LM, Clegg D, Rahmouni K, Mokadem M. Endocannabinoid Receptor-1 and Sympathetic Nervous System Mediate the Beneficial Metabolic Effects of Gastric Bypass. Cell Rep 2020; 33:108270. [PMID: 33113371 PMCID: PMC7660289 DOI: 10.1016/j.celrep.2020.108270] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/18/2020] [Accepted: 09/23/2020] [Indexed: 12/27/2022] Open
Abstract
The exact mechanisms underlying the metabolic effects of bariatric surgery remain unclear. Here, we demonstrate, using a combination of direct and indirect calorimetry, an increase in total resting metabolic rate (RMR) and specifically anaerobic RMR after Roux-en-Y gastric bypass (RYGB), but not sleeve gastrectomy (SG). We also show an RYGB-specific increase in splanchnic sympathetic nerve activity and "browning" of visceral mesenteric fat. Consequently, selective splanchnic denervation abolishes all beneficial metabolic outcomes of gastric bypass that involve changes in the endocannabinoid signaling within the small intestine. Furthermore, we demonstrate that administration of rimonabant, an endocannabinoid receptor-1 (CB1) inverse agonist, to obese mice mimics RYGB-specific effects on energy balance and splanchnic nerve activity. On the other hand, arachidonoylethanolamide (AEA), a CB1 agonist, attenuates the weight loss and metabolic signature of this procedure. These findings identify CB1 as a key player in energy regulation post-RYGB via a pathway involving the sympathetic nervous system.
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Affiliation(s)
- Yuanchao Ye
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Marwa Abu El Haija
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Donald A Morgan
- Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Deng Guo
- Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Yang Song
- College of Pharmacy, China Medical University, 77 Puhe Rd., Liaoning 110122, P.R. China
| | - Aaron Frank
- The Biomedical Research Department, Diabetes and Obesity Research Division, Cedars Sinai Medical Center, Beverly Hills, CA 90048, USA
| | - Liping Tian
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, P.R. China
| | - Ruth A Riedl
- Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Colin M L Burnett
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Zhan Gao
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Zhiyong Zhu
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Shailesh K Shahi
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Kasra Zarei
- Medical Scientist Training Program, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Anne Couvelard
- INSERM U1149, Centre de Recherche sur l'Inflammation, Université de Paris, Paris 75018, France; Department of Pathology, Bichat Hospital, AP-HP, Paris 75018, France
| | - Nicolas Poté
- INSERM U1149, Centre de Recherche sur l'Inflammation, Université de Paris, Paris 75018, France; Department of Pathology, Bichat Hospital, AP-HP, Paris 75018, France
| | - Lara Ribeiro-Parenti
- INSERM U1149, Centre de Recherche sur l'Inflammation, Université de Paris, Paris 75018, France; Department of General and Digestive Surgery, Bichat Hospital, AP-HP, Paris 75018, France
| | - André Bado
- INSERM U1149, Centre de Recherche sur l'Inflammation, Université de Paris, Paris 75018, France
| | - Lama Noureddine
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Andrew Bellizzi
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Paul Kievit
- Division of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR 97006, USA
| | - Ashutosh K Mangalam
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Interdisciplinary Graduate Program in Immunology and Molecular Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Leonid V Zingman
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Fraternal Orders of Eagles Diabetes Research Center, Iowa City, IA 52242, USA; Veterans Affairs Health Care System, Iowa City, IA 52242, USA; Obesity Research & Education Initiative, University of Iowa, Iowa City, IA 52242, USA
| | - Maude Le Gall
- INSERM U1149, Centre de Recherche sur l'Inflammation, Université de Paris, Paris 75018, France
| | - Justin L Grobe
- Departments of Physiology and Biomedical Engineering, Medical College of Wisconsin, Milwaukee, MI 53226, USA
| | - Lee M Kaplan
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; Obesity, Metabolism, and Nutrition Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Deborah Clegg
- College of Nursing and Health Professions, Drexel University, 1601 Cherry Street, Philadelphia, PA 19102, USA
| | - Kamal Rahmouni
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Medical Scientist Training Program, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Fraternal Orders of Eagles Diabetes Research Center, Iowa City, IA 52242, USA; Veterans Affairs Health Care System, Iowa City, IA 52242, USA; Obesity Research & Education Initiative, University of Iowa, Iowa City, IA 52242, USA
| | - Mohamad Mokadem
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Fraternal Orders of Eagles Diabetes Research Center, Iowa City, IA 52242, USA; Veterans Affairs Health Care System, Iowa City, IA 52242, USA; Obesity Research & Education Initiative, University of Iowa, Iowa City, IA 52242, USA.
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Self-Reported Smoking Compared to Serum Cotinine in Bariatric Surgery Patients: Smoking Is Underreported Before the Operation. Obes Surg 2020; 30:23-37. [PMID: 31512159 DOI: 10.1007/s11695-019-04128-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Smoking has been associated with postoperative complications and mortality in bariatric surgery. The evidence for smoking is based on self-report and medical charts, which can lead to misclassification and miscalculation of the associations. Determination of cotinine can objectively define nicotine exposure. We determined the accuracy of self-reported smoking compared to cotinine measurement in three phases of the bariatric surgery trajectory. METHODS Patients in the phase of screening (screening), on the day of surgery (surgery), and more than 18 months after surgery (follow-up) were consecutively selected. Self-reported smoking was registered and serum cotinine was measured. We evaluated the accuracy of self-reported smoking compared to cotinine, and the level of agreement between self-report and cotinine for each phase. RESULTS In total, 715 patients were included. In the screening, surgery, and follow-up group, 25.6%, 18.0%, and 15.5%, respectively, was smoking based on cotinine. The sensitivity of self-reported smoking was 72.5%, 31.0%, and 93.5% in the screening, surgery, and follow-up group, respectively (p < 0.001). The specificity of self-report was > 95% in all groups (p < 0.02). The level of agreement between self-report and cotinine was 0.778, 0.414, and 0.855 for the screening, surgery, and follow-up group, respectively. CONCLUSIONS Underreporting of smoking occurs before bariatric surgery, mainly on the day of surgery. Future studies on effects of smoking and smoking cessation in bariatric surgery should include methods taking into account the issue of underreporting.
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Presurgical Psychological Evaluation: Risk Factor Identification and Mitigation. J Clin Psychol Med Settings 2019; 27:396-405. [PMID: 31473887 DOI: 10.1007/s10880-019-09660-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Presurgical psychological evaluations (PPEs) are becoming an established component of the surgical process, though methods of conducting PPEs are variable. There is a lack of clarity about the goals of PPEs, the types of information that should be included, and the process for integrating information and making recommendations to the referring physicians/surgeons. This review proposes an empirically supported model for PPEs that is systematic, but flexible enough to be utilized across the broad range of surgical evaluations. This five-step method is termed the Risk Identification and Mitigation (RIM) model and is discussed in detail. The RIM model presented in this review can both serve as a structure to be utilized in under-researched PPE areas and as a stimulus for future empirical investigations.
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Time savings and accuracy of a simulated flexible and conditional administration of the MMPI-2-RF in presurgical psychological evaluations of bariatric surgery candidates. Surg Obes Relat Dis 2019; 15:732-738. [PMID: 30904425 DOI: 10.1016/j.soard.2019.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has empirically validated utility in presurgical psychological evaluations of bariatric surgery patients. However, clinicians may prefer shorter, symptom-focused measures. OBJECTIVES The purpose of the present study is to evaluate the feasibility and potential administration time savings of a proposed flexible and conditional (FCA) administration of the MMPI-2-RF in presurgical evaluations of bariatric surgery candidates. SETTING Bariatric surgery candidates evaluated at a large hospital as well as a private practice in the Midwest. METHODS MMPI-2-RF scores were available for a total of 4099 adult bariatric surgery candidates from 2 separate samples. The hospital sample included 911 males and 2430 females. The average BMI was 49.3 kg/m2 (SD = 11.0). The private practice sample included 105 males, 640 females, and 13 individuals who did not report gender. The average BMI was 48.8 kg/m2 (SD = 8.4). The authors used a simulation design in which existing MMPI-2-RF responses were used to simulate an FCA administration. RESULTS The findings indicated that an FCA of the MMPI-2-RF closely approximates the amount of information typically gained from a full administration of the test in the 2 samples of bariatric surgery candidates. Items savings and estimated time savings ranged from 44% to 88% in both samples, depending on the number of conditionally administered scales. CONCLUSIONS The present study supports the feasibility of an FCA of the MMPI-2-RF, potentially shortening administration time and reducing patient burden. However, the findings are limited because the accuracy and time savings are based on a simulation, not actual FCA administrations.
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Hilgendorf W, Butler A, Timsina L, Choi J, Banerjee A, Selzer D, Stefanidis D. A behavioral rating system predicts weight loss and quality of life after bariatric surgery. Surg Obes Relat Dis 2018; 14:1167-1172. [PMID: 29853194 DOI: 10.1016/j.soard.2018.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/25/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Bariatric surgery represents the most effective intervention for severe obesity available today; however, significant variability in postoperative outcomes exists. Effective tools that predict postoperative outcomes are needed for decision-making and patient counseling. OBJECTIVES We hypothesized that a validated behavioral assessment tool, the Cleveland Clinic Behavioral Rating Scale (CCBRS), would predict excess weight loss, health-related quality of life, depression, anxiety, and alcohol use after bariatric surgery. SETTING Hospital in the United States. METHODS A prospective observational study with 2-year planned follow-up was conducted with patients who completed a psychological clinical interview, the Short Form 36 (SF-36) v.2 Health Survey and brief self-report questionnaires measuring depression (PHQ-9), anxiety (GAD-7), and alcohol use (AUDIT) preoperatively. At the conclusion of the preoperative psychological evaluation, the psychologist completed the CCBRS. All questionnaires were readministered at 6, 12, 18, and 24 months after surgery. Generalized estimating equations were used to assess whether any CCBRS ratings predicted surgery outcomes. RESULTS One hundred seventy-nine patients (113 Roux-en-Y gastric bypass and 66 sleeve gastrectomy) were included in the analyses. SF-36 scores, PHQ-9 scores, and the AUDIT total scores improved significantly after surgery, while GAD-7 scores did not change appreciably. Higher preoperative CCBRS ratings predicted higher SF-36 scores, and lower PHQ-9, GAD-7 and AUDIT scores. The CCBRS social support rating predicted higher postoperative percent excess weight loss. CONCLUSION A behavioral rating scale (CCBRS) completed before bariatric surgery predicted postoperative weight loss, quality of life, depression, and anxiety. Therefore, this tool may prove useful in patient counseling and expectation management before surgery.
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Affiliation(s)
- William Hilgendorf
- Indiana University Health North Hospital, Carmel, Indiana; Indiana University School of Medicine, Indianapolis, Indiana.
| | - Annabelle Butler
- Indiana University Health North Hospital, Carmel, Indiana; Indiana University School of Medicine, Indianapolis, Indiana
| | - Lava Timsina
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Jennifer Choi
- Indiana University Health North Hospital, Carmel, Indiana; Indiana University School of Medicine, Indianapolis, Indiana
| | - Ambar Banerjee
- Indiana University Health North Hospital, Carmel, Indiana; Indiana University School of Medicine, Indianapolis, Indiana
| | - Don Selzer
- Indiana University Health North Hospital, Carmel, Indiana; Indiana University School of Medicine, Indianapolis, Indiana
| | - Dimitrios Stefanidis
- Indiana University Health North Hospital, Carmel, Indiana; Indiana University School of Medicine, Indianapolis, Indiana
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Christensen BJ, Schmidt JB, Nielsen MS, Tækker L, Holm L, Lunn S, Bredie WLP, Ritz C, Holst JJ, Hansen T, Hilbert A, le Roux CW, Hulme OJ, Siebner H, Morville T, Naver L, Floyd AK, Sjödin A. Patient profiling for success after weight loss surgery (GO Bypass study): An interdisciplinary study protocol. Contemp Clin Trials Commun 2018; 10:121-130. [PMID: 30023446 PMCID: PMC6046467 DOI: 10.1016/j.conctc.2018.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 12/14/2022] Open
Abstract
Despite substantial research efforts, the mechanisms proposed to explain weight loss after gastric bypass (RYGB) and sleeve gastrectomy (SL) do not explain the large individual variation seen after these treatments. A complex set of factors are involved in the onset and development of obesity and these may also be relevant for the understanding of why success with treatments vary considerably between individuals. This calls for explanatory models that take into account not only biological determinants but also behavioral, affective and contextual factors. In this prospective study, we recruited 47 women and 8 men, aged 25–56 years old, with a BMI of 45.8 ± 7.1 kg/m2 from the waiting list for RYGB and SL at Køge hospital, Denmark. Pre-surgery and 1.5, 6 and 18 months after surgery we assessed various endpoints spanning multiple domains. Endpoints were selected on basis of previous studies and include: physiological measures: anthropometrics, vital signs, biochemical measures and appetite hormones, genetics, gut microbiota, appetite sensation, food and taste preferences, neural sensitivity, sensory perception and movement behaviors; psychological measures: general psychiatric symptom-load, depression, eating disorders, ADHD, personality disorder, impulsivity, emotion regulation, attachment pattern, general self-efficacy, alexithymia, internalization of weight bias, addiction, quality of life and trauma; and sociological and anthropological measures: sociodemographic measures, eating behavior, weight control practices and psycho-social factors. Joining these many endpoints and methodologies from different scientific disciplines and creating a multi-dimensional predictive model has not previously been attempted. Data on the primary endpoint are expected to be published in 2018. Trial registration Clinicaltrials. gov ID NCT02070081.
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Affiliation(s)
- Bodil Just Christensen
- Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Denmark
| | - Julie Berg Schmidt
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | - Mette Søndergaard Nielsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark.,The Danish Diabetes Academy, Denmark
| | - Louise Tækker
- Department of Psychology, Faculty of Social Science, University of Copenhagen, Denmark
| | - Lotte Holm
- Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Denmark
| | - Susanne Lunn
- Department of Psychology, Faculty of Social Science, University of Copenhagen, Denmark
| | - Wender L P Bredie
- Department of Food Science, Faculty of Science, University of Copenhagen, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | - Jens Juul Holst
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Denmark
| | - Torben Hansen
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Anja Hilbert
- Universitätsmedizin Leipzig, Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology, Germany
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland
| | - Oliver J Hulme
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Denmark
| | - Hartwig Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Tobias Morville
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Denmark
| | - Lars Naver
- Bariatric Clinic, Køge Hospital, Denmark
| | | | - Anders Sjödin
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
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van-der Hofstadt Román CJ, Costa CL, González ST, Rodríguez MG, Martínez EP, Rodríguez-Marín J. Predictors of Anxiety and Depression Symptoms in Bariatric Surgery Candidates. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2016.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Carlos Javier van-der Hofstadt Román
- Clinical Health Psychology Unit, Alicante University General Hospital, Alicante, Spain
- Department of Health Psychology, Universidad Miguel Hernández, Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL - FISABIO Foundation), Alicante, Spain
| | - César Leal Costa
- Faculty of Nursing, Universidad Católica de Murcia, Murcia, Spain
| | - Sonia Tirado González
- Department of Health Psychology, Universidad Miguel Hernández, Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL - FISABIO Foundation), Alicante, Spain
| | | | - Enrique Pérez Martínez
- Alicante Institute for Health and Biomedical Research (ISABIAL - FISABIO Foundation), Alicante, Spain
- Psychiatry Service, Alicante University General Hospital, Alicante, Spain
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Elche, Spain
| | - Jesús Rodríguez-Marín
- Clinical Health Psychology Unit, Alicante University General Hospital, Alicante, Spain
- Department of Health Psychology, Universidad Miguel Hernández, Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL - FISABIO Foundation), Alicante, Spain
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Thiara G, Yanofksy R, Abdul-Kader S, Santiago VA, Cassin S, Okrainec A, Jackson T, Hawa R, Sockalingam S. Toronto Bariatric Interprofessional Psychosocial Assessment Suitability Scale: Evaluating A New Clinical Assessment Tool for Bariatric Surgery Candidates. PSYCHOSOMATICS 2016; 57:165-73. [DOI: 10.1016/j.psym.2015.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/30/2015] [Accepted: 12/02/2015] [Indexed: 01/01/2023]
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Edwards-Hampton SA, Wedin S. Preoperative psychological assessment of patients seeking weight-loss surgery: identifying challenges and solutions. Psychol Res Behav Manag 2015; 8:263-72. [PMID: 26604844 PMCID: PMC4639515 DOI: 10.2147/prbm.s69132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Preoperative psychosocial assessment is the standard of care for patients seeking weight-loss surgery (WLS). However, the assessment procedure varies widely by surgery site. Comprehensive assessments can provide a wealth of information that assists both the patient and the treatment team, anticipate and prepare for challenges associated with extensive behavioral and lifestyle changes that are required postsurgery. In this review, we provide an overview of the purpose of the preoperative psychosocial assessment and domains to be included. Challenges commonly identified in the assessment are discussed, including maladaptive eating behaviors, psychiatric comorbidities, and alcohol use. Potential solutions and approaches to these challenges are provided. Additionally, patient populations requiring special consideration are presented to include adolescents, those with cognitive vulnerabilities, and aging adults.
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Affiliation(s)
- Shenelle A Edwards-Hampton
- Department of General Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Sharlene Wedin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Rummell CM, Heinberg LJ. Assessing marijuana use in bariatric surgery candidates: should it be a contraindication? Obes Surg 2015; 24:1764-70. [PMID: 24913244 DOI: 10.1007/s11695-014-1315-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Research has demonstrated negative effects of both alcohol and tobacco use after bariatric surgery. However, no research to date has examined effects of cannabis use after bariatric surgery, even though cannabis is the most commonly used illicit drug in the USA. Literature review reveals that many practitioners generalize from data regarding alcohol abuse to all substances. Further, many screening protocols fail to differentiate between varying levels of cannabis use. The current report aims to (1) review the relevant literature on marijuana use and its potential consequences among bariatric patients, (2) discuss relevant problems and gaps in this literature, and (3) make preliminary recommendations regarding the assessment and treatment planning of bariatric candidates who disclose marijuana use.
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Affiliation(s)
- Christina M Rummell
- Bariatric and Metabolic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/M61, Cleveland, OH, 44195, USA,
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19
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Rouleau CR, Rash JA, Mothersill KJ. Ethical issues in the psychosocial assessment of bariatric surgery candidates. J Health Psychol 2014; 21:1457-71. [DOI: 10.1177/1359105314556160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Psychosocial evaluation is recommended prior to bariatric surgery. Practice guidelines have been published on assessment methods for bariatric surgery candidates, but they have not emphasized ethical issues with this population. This review outlines ethical and professional considerations for behavioral healthcare providers who conduct pre-surgical assessments of bariatric surgery candidates by merging ethical principles for mental health professionals with current practices in pre-surgical assessments. Issues discussed include the following: (a) establishing and maintaining competence, (b) obtaining informed consent, (c) respecting confidentiality, (d) avoiding bias and discrimination, (e) avoiding and addressing dual roles, (f) selecting and using psychological tests, and (g) acknowledging limitations of psychosocial assessments.
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20
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Ratcliffe D, Ali R, Ellison N, Khatun M, Poole J, Coffey C. Bariatric psychology in the UK National Health Service: input across the patient pathway. BMC OBESITY 2014; 1:20. [PMID: 26217507 PMCID: PMC4510897 DOI: 10.1186/s40608-014-0020-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 08/21/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Providers of bariatric surgery within the National Health Service (NHS) are required to provide psychological assessment and intervention, yet operational definitions regarding the purpose and scope of this input are lacking. This has led to significant variation in the provision of psychology, with some providing an assessment-only service and others providing a more comprehensive package of intervention throughout the patient pathway. The aims of this paper are to document the current psychology provision and service models of National Health Service (NHS) bariatric surgery services in the UK. Psychologists belonging to a bariatric psychology forum completed a survey. This focused on provision of psychological assessment and intervention throughout the bariatric pathway as well as the ratio between psychology resources and number of bariatric procedures per year. We obtained information from 22 NHS services which provide 3691 procedures per year. RESULTS There is significant variation in the ratio between psychology resources and number of bariatric procedures undertaken per service. Whilst all services offer pre-surgery psychology assessments, less than one-third routinely assess all potential bariatric surgery candidates. Over 90% of services offer pre-surgery individual interventions and 41% offer pre-surgery groups. None of the services routinely offer post-surgery assessments but 68% offer post-surgery assessment and intervention following referral. None offered post-operative structured psychological group interventions. CONCLUSION There are significant disparities and inconsistencies in the provision of psychology resources in relation to surgery volume in the NHS. Most of these resources are directed at pre-surgery assessment and this raises issues regarding the function of these assessments. Rather than focusing on assessing psychological (un)suitability for surgery, an evidence-based approach involves psychologists offering pre-operative interventions to improve readiness for surgery and post-operative interventions to address recurring or emerging difficulties which impact on outcomes.
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Affiliation(s)
- Denise Ratcliffe
- />Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK
- />Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK
- />Department of Clinical, Educational & Health Psychology, University College London, London, UK
- />Phoenix Health, Chester, UK
| | - Rukshana Ali
- />Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK
- />Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Nell Ellison
- />Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK
- />Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK
- />Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Mahbuba Khatun
- />Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK
- />Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Jolyon Poole
- />Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK
- />Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Caroline Coffey
- />Psychological Medicine Unit, CNWL NHS Foundation Trust, 1 Nightingale Place, London, SW10 9NG UK
- />Bariatric Surgery Service, Chelsea & Westminster NHS Foundation Trust, London, UK
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Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres A, Weiner R, Yashkov Y, Frühbeck G. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg 2014; 24:42-55. [PMID: 24081459 DOI: 10.1007/s11695-013-1079-8] [Citation(s) in RCA: 395] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In 2012, an expert panel composed of presidents of each of the societies, the European Chapter of the International Federation for the Surgery of Obesity (IFSO-EC), and of the European Association for the Study of Obesity (EASO), as well as of the chair of EASO Obesity Management Task Force (EASO OMTF) and other key representatives from IFSO-EC and EASO, devoted the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery in advance of the 2013 European Congress on Obesity held in Liverpool. This meeting was prompted by the extraordinary advancement made in the field of metabolic and bariatric surgery during the past decade. It was agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced by focusing in particular on the evidence gathered in relation to the effects on diabetes and the changes in the recommendations of patient eligibility criteria. The expert panel allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.
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Affiliation(s)
- M Fried
- Center for Treatment of Obesity and Metabolic Disorders, OB Klinika, Prague, Czech Republic,
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Pitzul KB, Jackson T, Crawford S, Kwong JCH, Sockalingam S, Hawa R, Urbach D, Okrainec A. Understanding disposition after referral for bariatric surgery: when and why patients referred do not undergo surgery. Obes Surg 2014; 24:134-40. [PMID: 24122658 DOI: 10.1007/s11695-013-1083-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bariatric surgery is an effective long-term solution for weight loss in the severely obese. Prevalence of bariatric surgery has increased over the recent years; however, the attrition rate of those referred who actually undergo surgery is high. The purpose of this study was to examine patients' attrition rates after referral for bariatric surgery at an academic tertiary care institution. When and why patients who were referred for bariatric surgery did not ultimately undergo surgical treatment was examined. METHODS Charts of 1,237 patients referred to the Toronto Western Hospital Bariatric Program from program inception to February 2011 were retrospectively reviewed. Patient demographics, appointment dates, no shows and cancellations, and when and why patients did not undergo surgery were summarized. RESULTS Patients' mean age was 47. Most patients were female, and the mean body mass index was 47. Half (50.6 %) of the total persons referred left the program prior to being seen by a health-care professional, and only 36.2 % underwent surgical treatment. Only 2.75 % of persons were ineligible for surgery. A total of 60.6 % of persons self-removed from our program. Reasons for self-removal varied, with the most common reason for leaving the program recorded as "unknown." CONCLUSIONS Our multidisciplinary program with in-hospital psychosocial resources resulted in very few persons being excluded from receiving surgical treatment. However, less than half of those referred underwent surgery as most persons self-removed from our program for unknown reasons. Further investigation is required to determine which patient, administrative, and system factors play a role in the patients' decision to not undergo bariatric surgical treatment.
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Aarts F, Hinnen C, Gerdes VEA, Acherman Y, Brandjes DPM. Psychologists’ Evaluation of Bariatric Surgery Candidates Influenced by Patients’ Attachment Representations and Symptoms of Depression and Anxiety. J Clin Psychol Med Settings 2014; 21:116-23. [DOI: 10.1007/s10880-014-9385-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Singh A, Tipton K. Preoperative Evaluation of the Obese Patient. Bariatr Surg Pract Patient Care 2013. [DOI: 10.1089/bari.2013.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Arvinpal Singh
- Medical Director, Emory Bariatric Center, Emory University Hospital Midtown, Department of Surgery, Atlanta, Georgia
| | - Katie Tipton
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Martínez EP, González ST, Vicente MM, van-der Hofstadt Román CJ, Rodríguez-Marín J. Psychopathology in a sample of candidate patients for bariatric surgery. Int J Psychiatry Clin Pract 2013; 17:197-205. [PMID: 22746988 DOI: 10.3109/13651501.2012.704383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The prevalence of morbid obesity and the popularity of bariatric surgery have grown in recent years. Many surgical protocols require that the candidates undergo a pre-operative psychological evaluation. We describe the psychopathological characteristics of both clinical syndromes (Axis I of the DSM-IV), as well as personality disorders (Axis II of the DSM-IV), in a sample of morbidly obese patients accepted as bariatric surgery candidates and who participate in a specific surgery preparatory programme, and we analyze its relationship with personality clusters. METHODS The Millon Clinical Multiaxial Inventory-III (MCMI-III) scores from 50 patients attending for bariatric surgery were cluster analyzed in hopes of identifying clinical subgroups corresponding to typical personality profiles. RESULTS With regard to personality disorders, the highest prevalence was found in the histrionic disorder, followed by obsessive- compulsive disorder. Cluster analysis revealed three personality profiles, which were validated by examining demographics, morphological variables, scores on anxiety and depression psychometric scales, and MCMI-III clinical scales scores. Groups were different in virtually all the MCMI-III clinical scores, as well as in depression and trait anxiety, with Cluster 3 presenting the worst scores. CONCLUSIONS These findings suggest that morbidly obese patients are heterogeneous in their psychological profiles, highlighting Cluster C disorders.
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Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring) 2013; 21 Suppl 1:S1-27. [PMID: 23529939 PMCID: PMC4142593 DOI: 10.1002/oby.20461] [Citation(s) in RCA: 740] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 12/27/2012] [Indexed: 02/06/2023]
Abstract
The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
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Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Endocr Pract 2013; 19:337-72. [PMID: 23529351 PMCID: PMC4140628 DOI: 10.4158/ep12437.gl] [Citation(s) in RCA: 276] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
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Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis 2013; 9:159-91. [PMID: 23537696 DOI: 10.1016/j.soard.2012.12.010] [Citation(s) in RCA: 426] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 12/27/2012] [Indexed: 02/06/2023]
Abstract
The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
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Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres AJ, Weiner R, Yashkov Y, Frühbeck G. Interdisciplinary European Guidelines on metabolic and bariatric surgery. Obes Facts 2013; 6:449-68. [PMID: 24135948 PMCID: PMC5644681 DOI: 10.1159/000355480] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/09/2013] [Indexed: 12/12/2022] Open
Abstract
In 2012, an outstanding expert panel derived from IFSO-EC (International Federation for the Surgery of Obesity-European Chapter) and EASO (European Association for the Study of Obesity), composed by key representatives of both Societies including past and present presidents together with EASO's OMTF (Obesity Management Task Force) chair, agreed to devote the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery as a pre-satellite of the 2013 European Congress on Obesity (ECO) to be held in Liverpool given the extraordinarily advancement made specifically in this field during the past years. It was further agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced in cooperation of both Societies by focusing in particular on the evidence gathered in relation to the effects on diabetes during this lustrum and the subsequent changes that have taken place in patient eligibility criteria. The expert panel composition allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.
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Affiliation(s)
- Martin Fried
- OB Klinika, Centre for Treatment of Obesity and Metabolic Disorders, 1st Faculty of Medicine, Charles University, Prague, Czech Republic, Istanbul, Turkey
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Jean-Michel Oppert
- Department of Nutrition, Heart and Metabolism Division, Pitie Salpetriere University Hospital (AP-HP) University Pierre et Marie Curie-Paris 6, Institute of Cardiometabolism and Nutrition (ICAN) Paris, France
| | | | - Antonio J. Torres
- Department of Surgery Complutense University of Madrid, Hospital Clinico ‘San Carlos’, Madrid, Spain
| | - Rudolf Weiner
- Sachsenhausen Hospital and Centre for Minimally Invasive Surgery, Johan Wolfgang Goethe University, Frankfurt/M., Germany, Spain
| | - Yuri Yashkov
- Obesity Surgery Service, Centre of Endosurgery and Lithotripsy Moscow, Russia, Spain
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, CIBERobn, Instituto de Salud Carlos III, Pamplona, Spain
- *Gema Frühbeck, R Nutr MD PhD, Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, CIBERobn, Instituto de Salud Carlos III, Avda. Pio XII, 36, 31008 Pamplona (Spain),
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Adams CE, Gabriele JM, Baillie LE, Dubbert PM. Tobacco use and substance use disorders as predictors of postoperative weight loss 2 years after bariatric surgery. J Behav Health Serv Res 2012; 39:462-71. [PMID: 22374227 DOI: 10.1007/s11414-012-9277-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Although evaluations of tobacco and substance use disorders (SUDs) are required before bariatric surgery, the impact of these factors on postsurgical outcomes is unclear. This study describes (1) the prevalence of tobacco and SUDs in 61 veterans undergoing bariatric surgery, (2) associations between presurgical tobacco use and postsurgical weight loss, and (3) relationships between presurgical SUDs and postsurgical weight loss. Height, weight, tobacco, and SUDs were assessed from medical charts at presurgery and 6, 12, and 24 months postsurgery. Thirty-three patients (55%) were former or recent tobacco users; eight (13%) had history of SUDs. All patients who quit smoking within 6 months before surgery resumed after surgery, which was associated with increased weight loss at 6 and 12 months. Presurgical SUDs were related to marginally worse weight loss at 12 and 24 months. Bariatric surgery candidates with history of smoking and/or SUDs might benefit from additional services to improve postsurgical outcomes.
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Affiliation(s)
- Claire E Adams
- Department of Health Disparities Research-Unit 1440, University of Texas MD Anderson Cancer Center, PO Box 301402, Houston, TX 77230-1402, USA.
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Psychiatric Predictors of Surgery Non-completion Following Suitability Assessment for Bariatric Surgery. Obes Surg 2012; 23:205-11. [DOI: 10.1007/s11695-012-0762-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Heinberg LJ, Ashton K, Coughlin J. Alcohol and bariatric surgery: review and suggested recommendations for assessment and management. Surg Obes Relat Dis 2012; 8:357-63. [DOI: 10.1016/j.soard.2012.01.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 01/20/2012] [Accepted: 01/24/2012] [Indexed: 11/29/2022]
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Merrell J, Ashton K, Windover A, Heinberg L. Psychological risk may influence drop-out prior to bariatric surgery. Surg Obes Relat Dis 2012; 8:463-9. [PMID: 22465088 DOI: 10.1016/j.soard.2012.01.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Factors necessitating a delay before psychological clearance for bariatric surgery have been previously identified; however, research has not examined why patients who begin the preoperative evaluation fail to complete surgery or drop-out of bariatric programs. This study sought to explore the potential psychosocial reasons for a failure to reach bariatric surgery. The setting was an academic medical center. METHODS Data were analyzed from 129 patients psychologically evaluated for bariatric surgery who had failed to reach surgery after 15 months. Medical records were reviewed for demographics, body mass index, and psychiatric variables. RESULTS The most common reasons for not reaching surgery included withdrawal from the program, outstanding program requirements, self-canceled surgery, moving out of the area, insurance denial, switching to non-surgical weight management, or death. Patients with outstanding program requirements were psychosocially different from patients who had not achieved surgery for other reasons. They were significantly more likely to be involved in outpatient behavioral health treatment (chi-square = 12.90, P < .05), to be taking psychotropic medications (chi-square = 15.17, P < .05), and to have met the criteria for current or past alcohol abuse/dependence (chi-square = 23.70, P < .01), and there was a trend for previous inpatient hospitalizations (chi-square = 11.59, P < .07). CONCLUSION Patients who failed to complete outstanding program requirements often had significant psychiatric and/or substance abuse/dependence issues that required additional treatment. It is possible that these patients drop-out of the program due to unwillingness to complete psychiatric treatment recommendations. Continued screening of high-risk patients and the education of patients on the importance of managing these risks is indicated. However, patients may choose to leave programs once education has been provided or treatment mandated.
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Affiliation(s)
- Julie Merrell
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Heinberg LJ, Ashton K, Windover A, Merrell J. Older bariatric surgery candidates: is there greater psychological risk than for young and midlife candidates? Surg Obes Relat Dis 2011; 8:616-22; discussion 622-4. [PMID: 22197385 DOI: 10.1016/j.soard.2011.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/07/2011] [Accepted: 11/07/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although severe obesity is dramatically increasing in older adults, many bariatric programs use age cutoffs due to concerns about greater perioperative morbidity and mortality risks. More recently, surgical outcomes have been reported in older adults. However, a paucity of data is available on the psychological risks of older bariatric candidates. Our objective is to examine psychiatric risk factors and weight loss outcomes in older (≥65 yr) versus midlife (40-55 yr) versus young adult (18-29 yr) patients. METHODS Older, midlife, and young adults (n = 608) who underwent weight loss surgery (74.6% women, 75.6% white, mean body mass index 48.07 ± 9.61 kg/m2) at the Cleveland Clinic Bariatric and Metabolic Institute completed a psychiatric diagnostic interview, and the Minnesota multiphasic personality inventory-2-restructured form, binge eating scale, and Cleveland Clinic behavioral rating scale before surgery. The data gathered from follow-up visits and weight loss outcomes at 1, 3, 6, 9, 12, and 18 months after surgery were measured. RESULTS Young adults had a greater reduction in excess body mass index than those at midlife in the first 6 months but no age differences were noted in the following year. Older patients were less likely to have a suicide history but the groups were equivalent on other psychiatric variables and self-report measures. Psychologist evaluators rated older adults less favorably on the capacity to consent and realistic nature of expectations. CONCLUSION Although medical risks may cause concern, older adults do not demonstrate any increased psychological risk factors compared with midlife or young adult surgical candidates and evidenced equivalent weight loss. However, concerns with lower ratings on consent and expectations warrant additional research.
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Affiliation(s)
- Leslie J Heinberg
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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