The Bariatric Interprofessional Psychosocial Assessment of Suitability Scale (BIPASS): Predictive Validity for Outcomes 1 and 2 Years Following Bariatric Surgery

Abstract

Bariatric surgery is the most effective intervention for severe obesity; however, many patients demonstrate insufficient and/or unsustained weight loss, and unsatisfactory psychosocial functioning in the longer-term. Although it is well established that attendance at postsurgical follow-up appointments is integral to sustained weight loss, nonadherence to follow-up is common. Consequently, presurgical psychosocial evaluations are conducted in order to identify patients at high risk of poor outcomes. Yet, no consensus has been established regarding a standardized protocol for the assessment of variables relevant to surgical outcomes, and bariatric programs vary widely in their interpretation of psychosocial risk. In addition, there is a paucity of research examining the predictive utility of psychosocial evaluations. The Bariatric Interprofessional Psychosocial Assessment of Suitability Scale (BIPASSTM), a novel psychosocial evaluation tool, was developed to address these issues. The purpose of the present study was to contribute to the validation of the BIPASS tool via two aims: 1) by examining the psychometric properties of the BIPASS, and; 2) by examining the ability of the BIPASS tool to predict outcomes 1 and 2 years following bariatric surgery, including weight loss and weight regain, quality of life, psychiatric symptoms, and adherence to postsurgical follow-up appointments. The BIPASS was applied retrospectively to the charts of 200 consecutively referred patients of the Toronto Western Hospital Bariatric Surgery Program (TWH-BSP). Factor analysis of BIPASS items revealed a two-factor structure, reflecting “Mental Health” and “Patient Readiness” subscales. Internal consistency for the BIPASS Total and subscale scores ranged from poor to good, and inter-rater reliability was excellent. Higher BIPASS scores significantly predicted higher binge eating symptomatology, and lower physical and mental health-related quality of life at 1 year postsurgery. The BIPASS did not predict any outcome variables at 2 years postsurgery, or adherence to postsurgical follow-up appointments. Findings suggest that the BIPASS can be used to identify patients at increased risk of problematic eating and poor health-related quality of life early in the postsurgical course, thereby facilitating appropriate interventions.