Long-term health and psychosocial outcomes from surgically induced weight loss: results obtained in patients not attending protocolled follow-up visits

Abstract

Objective: Obesity management is focused at weight loss to obtain health, psychological and social benefits. Outcomes from controlled trials, however, do not reflect the everyday routine practice. Therefore, we aimed to investigate the results from surgically induced weight loss in patients devoid of a protocol-wise follow-up, who were visited at home. Patients and methods: Patients who underwent a vertical banded gastroplasty or a gastric bypass between 1980 and 1997 were eligible. Body weight and height were measured. Patients filled out questionnaires on health status (Nottingham Health Profile (NHP)), psychological symptoms (Symptom Check List (SCL-90-R)), personality traits (Dutch Personality Questionnaire (DPQ)) and eating behaviour (Dutch Eating Behaviour Questionnaire (DEBQ)). Results: Out of 451 operated patients the addresses of 313 subjects could be traced and 236 (75%) agreed to participate. They maintained a mean (s.d.) loss of 32.1 (22.6) kg and 45.2 (29.3) % of excess weight, 8.2 (4.5) years after the operation, about two-third of the largest weight loss they achieved after 17 months postoperatively. The NHP and SCL-90-R conformed to norm values in males except for energy, sleep and emotional reactions. Females differed from norm values in every aspect and even women achieving a BMIo30 kg/m 2 did not catch up to norm values. Weight loss was inversely related to physical immobility and pain. Personality traits (DPQ) showed a higher grievance and dominance and a lower rigidity and self-esteem compared to norm values. Females scored higher in inadequacy and lower in social inadequacy. Eating patterns (DEBQ) showed mainly emotional eating and restrained eating. Effect sizes of X0.8 s.d. were chosen to reflect the clinical relevance of statistically significant findings. Pain, disturbances in sleep, energy and mobility and emotional and restrained eating proved to be clinically relevant. In subjects operated 45 years ago, a higher sensitivity, a higher inadequacy and a lower social inadequacy were observed compared to more recently operated subjects. A more restrained eating pattern was related to an operation of recent date. Conclusions: Surgically induced weight losses are satisfactory in the long-term, even in patients not attending a strict follow-up protocol. Health, psychological symptoms, personality traits and eating behaviour were related to weight loss and time lapse since the operation and did not return to reference normal-weight subject values.

Does Surgically Induced Weight Loss Improve Daytime Sleepiness?

“…Overall, we found statistically significant improvements in all quality of life measures at 24 months. Others have also noted statistically significant and clinically relevant improvements in healthrelated quality of life measures after surgically induced weight loss [24,[73][74][75][76]. However, few have assessed the relationship between weight loss, subjective sleepiness, and health-related quality of life [24].…”

An Assessment of Patient Behavioral Requirements Pre- and Post-Surgery at Accredited Weight Loss Surgical Centers

“…For data collection and analyses, specific categories were determined and a spreadsheet created in order to record observations. Categories were generated based on the current research questions as well as previous research and best-practice recommendations; for instance, research shows that regular follow-up and attendance at support groups are associated with improved outcomes [23][24][25]. Categories included psychological assessment, pre-and post-surgical behavioral requirements, support groups, follow-up protocol, and staffing.…”

Preoperative Predictors of Weight Loss Following Bariatric Surgery: Systematic Review

“…Of the 14 studies analyzing the association between personality disorders and postoperative weight loss (n=3,360 patients), 7 reported a negative association [27,49,51,62,103,131,132], 3 reported no association [54,109,133], and 4 reported a positive association [48,52,134,135]. Tsushima et al [62] reported that patients with ≥50% EWL compared to those with <50% EWL at 12 months had a significantly lower incidence of personality disorder subscales including phobia and paranoia, using the MMPI-2 [119].…”

“…Mathus-Vliegen et al used The Dutch Eating Behaviour Questionnaire [113], which assesses eating behaviors such as emotional eating and conscious restriction of intake, and reported a significant inverse relationship between weight change and emotional eating scores [109]. Gentry et al used the Eating Behavior Questionnaires II (series of open-ended questions about patient's history of obesity) and III (structured interview regarding food and activity patterns) and found that patients who ate in response to stress lost less weight after surgery compared to patients who ate in response to pleasant feelings or a sense of accomplishment (P<0.005) [110].…”

“…Emotional eating was found to have either a negative association (three studies) [108][109][110] or no association (three studies) [45,111,112] with postoperative weight loss (n= 612 patients). Mathus-Vliegen et al used The Dutch Eating Behaviour Questionnaire [113], which assesses eating behaviors such as emotional eating and conscious restriction of intake, and reported a significant inverse relationship between weight change and emotional eating scores [109].…”