Cognitive function is linked to adherence to bariatric postoperative guidelines

Abstract

Background Impairment in cognitive function is found in a significant subset of individuals undergoing bariatric surgery and recent work shows this impairment is associated with smaller postoperative weight loss. Reduced cognitive function could contribute to poorer adherence to postoperative guidelines, though this has not been previously examined. Objectives The current study examined the relationship between cognitive function and adherence to bariatric postoperative guidelines. We expected that higher cognitive function would be associated with better adherence to postoperative guidelines. Setting Data were collected through the bariatric service of a major medical center. Methods Thirty-seven bariatric surgery patients completed cognitive testing and a self-report measure of adherence to postoperative bariatric guidelines during their 4–6 week postoperative appointment. Results Strong correlations were observed between adherence to postoperative guidelines and cognitive indices of attention, executive function, and memory. Conclusions Results demonstrate that cognitive performance is strongly associated with adherence to postoperative guidelines shortly after bariatric surgery. Further work is needed to clarify if this relationship is present at later postoperative stages, and the degree to which this relationship mediates postoperative weight loss outcomes.

Using presurgical psychological testing to predict 1-year appointment adherence and weight loss in bariatric surgery patients: predictive validity and methodological considerations

“…Statistically significant RRRs indicate that patients who produce elevated scores at cut-offs ranging from 55T to 65T on some of the externalizing scales are up to twice as likely to have suboptimal weight loss. Thus, the findings of this investigation are consistent with studies indicating that problems associated with externalizing psychopathology, namely, poor executive functioning [7,8], loss of control eating [9,10,54], alcohol use [11], and nonadherence [8], contribute to suboptimal weight loss after bariatric surgery. Based on the findings of this study, if high scores are evidenced on the BXD scales of the MMPI-2-RF, pre-and/or postoperative interventions should include a focus on enhancing patient's self-control.…”

“…candidates than among the normative population [2][3][4], and psychopathology persists following surgery [5][6][7][8][9][10][11][12][13]. Measures associated with externalizing psychopathology (a construct that encompasses under-controlled behaviors, such as impulsivity, substance use, aggression, etc.…”

“…For example, studies using neuropsychological assessment instruments suggest that poor executive functioning (associated with impulsivity, poor planning, etc.) is positively associated with suboptimal weight loss and nonadherence to postoperative guidelines [7,8]. Poor executive functioning is associated with an increased risk of externalizing psychopathology owing to deficits in disinhibition.…”

Physical Activity, Decision-Making Abilities, and Eating Disturbances in Pre- and Postbariatric Surgery Patients

“…Support for this assumption was found in 37 bariatric surgery patients, indicating a strong association between cognitive performance and adherence to postoperative guidelines shortly after surgery [28]. In this context, the model proposed by Joseph et al [29] seems important.…”

Physical activity is unrelated to cognitive performance in pre-bariatric surgery patients

“…In fact, inferior performance on aspects of cognitive function was associated with lower rates of reported adherence in bariatric surgery patients (35). Hence, the supposed relationship between low PA and cognitive dysfunction in obesity has implications for designing effective weight loss, weight loss maintenance, and prevention strategies.…”