Analyzing the Effects of Psychotherapy on Weight Loss after Laparoscopic Gastric Bypass or Laparoscopic Adjustable Gastric Banding in Patients with Borderline Personality Disorder: A Prospective Study

Abstract

Background and Aims: Personality disorders are frequently associated with eating disorders in obese patients and may negatively affect weight loss and maintenance after bariatric surgery. This non-randomized study aimed to assess the effects of different psychotherapeutic interventions on weight loss in a sample of patients with borderline personality disorder who underwent laparoscopic gastric bypass or laparoscopic adjustable gastric banding.Materials and Methods: A total of 153 bariatric patients meeting borderline personality disorder criteria were chosen voluntarily and consecutively to undergo an interpersonal individual treatment (n = 50), a dialectical behavioral group treatment (n = 50), or treatment as usual (n = 53) for a year after surgery. Their body mass index was measured before and at the end of each treatment.Results and Conclusion: A total of 12 patients (7.8%) dropped out of the study. Significantly higher body mass index reductions were registered in both experimental groups (−14.2 and −9.4 kg/m 2 , respectively) compared with the treatment as usual group (−2.1 kg/m 2 ; p < 0.01). Treated patients who underwent laparoscopic gastric bypass (total n = 94) showed better outcomes than those who underwent laparoscopic adjustable gastric banding (total n = 45), while no differences were observed in untreated patients. This study demonstrates the role of pre-operative psychological assessment and post-operative psychotherapeutic support in improving weight loss among bariatric patients with borderline personality disorder. A randomized controlled trial is needed to confirm these preliminary findings.

Preoperative and post‐operative psychosocial interventions for bariatric surgery patients: A systematic review

“…Numerous studies identified certain “high risk” groups to participate in psychosocial interventions, including seven studies identifying patients with maladaptive eating patterns, one study identifying individuals with body dissatisfaction despite substantial weight loss, six studies identifying individuals with psychosocial difficulties, three studies identifying individuals with lack of physical activity, four studies identifying patients with a past history of weight plateau or regain after weight loss attempts, and one study with patients presently deemed unsuitable to undergo surgery…”

“…Of the studies reviewed, 16 focused on preoperative interventions and 24 on post‐operative interventions . One study offered the intervention either before or after surgery, and three studies examined interventions delivered at time points both before and after surgery …”

“…Of the reviewed articles, 13 studies examined a cognitive‐behavioural intervention, and 13 examined behavioural modification techniques . Many selected studies examined a cognitive, cognitive‐behavioural, or behavioural modification intervention in conjunction with various other approaches, including motivational techniques, mindfulness‐based approaches, acceptance‐based treatments, dialectical behavioural therapy (DBT), virtual reality, dynamic guidance psychotherapy, exercise programmes, and meal delivery programmes …”

“…Of the selected studies, 24 conducted group‐based interventions, and 16 conducted the interventions individually . Galle et al offered participants DBT, which included both individual and group therapy components . Kalarchian et al offered individual follow‐up phone calls subsequent to a group intervention …”

“…The least intensive treatments consisted of four 90‐minute group sessions or six 60‐minute individual sessions . The treatment dose could not be calculated for 14 studies …”