Bariatric Surgery Evaluation Predictors and Their Functional Outcome

The following is an abstract for research conducted by Dr. Samuel Bledsoe, with the help of Dr. Vincent Escandell and Dr. Richard Elder.

Background:

A 10-year review of bariatric surgery literature demonstrated varied results for the predictive value of psychological assessments and bariatric surgery success (>50% EBWL). Results of psychological scores on bariatric patient assessments differed when psychological variables were viewed separately. In order to assess psychological predictions and their interaction effects, the Allied Health Sciences Section Ad Hoc Behavioral Health Committee (AHSSAHBHC) for Pre-Surgical psychological assessment of bariatric surgery candidates presented specific categories for assessment. Our objective was to develop and evaluate predictive ability of psychological tests to assess each AHSSAHBHC category: behavioral, cognitive/emotional, developmental, current life situation, motivation, and expectation factors.

Methods:

This study documented weight/BMI and psychological test results on 155 patients in preoperative evaluation. Weight/BMI results were recorded upon each successive post operation follow-up. Initial analysis of patients involved a regression analysis predicting > 50%EBWL. Tests included: Bariatric Structured interview, the Alcohol Use Disorders Identification Test (AUDIT), Beck Depression Inventory-II, WAIS-IV Coding Subtest, Obsessive Compulsive Disorder Screening Questions, Three Factor Eating Questionnaire, Eating Attitudes Test-26, Patient Health Questionnaire, Shipley-2, and WRAT-4Reading Recognition subtest, Quality of Life inventory, patient’s desired weight, and pain scales. The most significant variable was used with next 50 bariatric surgical patients to validate its predictive value.

Results:

A total of 155 patients underwent weight loss surgery at Christus St. Francis Cabrini Hospital in Alexandria, Louisiana (mean age 47, average education 12 years, 71% females, 93% Caucasian, average weight 275 lbs, height and mean body mass index 43.88). A regression analysis revealed the patients’ post surgical desired weight, the coding subtest of the WAIS-4 (a measure of cognitive efficiency), and the AUDIT were most significant in predicting maximal excess body weight loss upon the first two post surgical visits. The patients’ specific stated goal for post-surgical desired weight was the best predictor of significant trend toward 50%EBWL, followed by cognitive efficiency, and substance abuse at the second and subsequent visits. The patients’ weight loss goal plus pain scores were the best predictors of weight loss from the pre surgical visit. The next fifty patients who completed bariatric surgery were analyzed by the same psychological tests for prediction of >50% excess weight loss. Again, the patients’ preoperative stated post-surgical desired weight was the best predictor of significant trend toward >50%EBWL.

Conclusion:

Patients with specific stated desired weight had significant trend toward > 50%EBWL from their preoperative evaluation and each follow-up assessment. Absence of pain was predictive of significant trend toward %50 EBWL preoperatively. The addition of a cognitive efficiency measure (Coding subtest) and positive substance abuse significantly added to predictive values. A positive psychological history including any psychiatric/psychological care /use of psychoactive medication was negatively correlated but added nothing significant to predictive value. The QOL and developmental/trauma factors did not add predictive value. The desired weight goal is being validated on new sample and appears as most significant predictor, >50%EBWL.

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