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Perceived social support before and after bariatric surgery: association with depression, problematic eating behaviors, and weight outcomes

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Abstract

Purpose

Engaging in a healthy lifestyle after bariatric surgery is essential to optimize and sustain weight loss in the long term. There is promising evidence that social support of patients who undergo bariatric surgery plays an important role in promoting a better quality of life and adherence to the required behavioral changes and medical appointments. This study sought to investigate: (a) if post-operative patients experience different levels of perceived social support compared to pre-operative patients; (b) correlations between perceived social support, depression, disordered eating, and weight outcomes; (c) if social support is a moderator between psychological distress, and disordered eating behavior and weight outcomes.

Methods

A group of 65 patients assessed pre-surgery and another group of 65 patients assessed post-surgery (M = 26.12; SD 7.97 months since surgery) responded to a set of self-report measures assessing social support, eating disorder psychopathology, disordered eating, and depression.

Results

Greater social support was associated with lower depression, emotional eating, weight and shape concerns, and greater weight loss in pre- and post-surgery groups. Social support was found to be a moderator between different psychological/weight variables but only for the post-surgery group: the relation between depression and eating disorder psychopathology or weight loss was significant for patients scoring medium to high level is social support; the relation between grazing and weight regain was significant for patients scoring medium to low levels of social support.

Conclusions

The associations found between perceived social support and depression, disordered eating and weight outcomes highlight the importance of considering and working with the social support network of patients undergoing bariatric surgery to optimize treatment outcomes.

Level of Evidence  Level III: case-control study.

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References

  1. Courcoulas AP, King WC, Belle SH, Berk P, Flum DR, Garcia L et al (2017) Seven-year weight trajectories and health outcomes in the longitudinal assessment of bariatric surgery (LABS) Study. JAMA Surg 15213:1–8

    Google Scholar 

  2. Conceição EM, Mitchell JE, Pinto-Bastos A, Arrojado F, Brandão I, Machado PPP (2017) Stability of problematic eating behaviors and weight loss trajectories after bariatric surgery: a longitudinal observational study. Surg Obes Relat Dis 13(6):1063–1070. https://doi.org/10.1016/j.soard.2016.12.006

    Article  PubMed  Google Scholar 

  3. Mitchell JE, Christian NJ, Flum DR, Pomp A, Pories WJ, Wolfe BM et al (2016) Postoperative behavioral variables and weight change 3 years after bariatric surgery. JAMA Surg 151(8):752–757. https://doi.org/10.1001/jamasurg.2016.0395

    Article  PubMed  PubMed Central  Google Scholar 

  4. Galioto R, Gunstad J, Heinberg LJ, Spitznagel MB (2013) Adherence and weight loss outcomes in bariatric surgery: does cognitive function play a role? Obes Surg 23(10):1703–1710. https://doi.org/10.1007/s11695-013-1060-6

    Article  PubMed  Google Scholar 

  5. Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff K (1990) Psychometric characteristics of the multidimensional scale of perceived social support. J Pers Assess 55(3–4):610–617. https://doi.org/10.1207/s15327752jpa5503&%23x0026;4_17

    Article  CAS  PubMed  Google Scholar 

  6. Pereira MG, Faria S, Lopes H. Quality of life one year after bariatric surgery: the moderator role of spirituality. Obeity Surg. 2019;1–9. https://doi.org/10.1007/s11695-018-03669-4

    Article  PubMed  Google Scholar 

  7. Sharman M, Hensher M, Wilkinson S, Williams D, Palmer A, Venn A et al (2017) What are the support experiences and needs of patients who have received bariatric surgery? Heal Expect 20(1):35–46. https://doi.org/10.1111/hex.12423

    Article  Google Scholar 

  8. Valley V, Grace DM (1987) Psychosocial risk factors in gastric surgery for obesity: identifying guidelines for screening. Int J Obes 11(2):105–113

    CAS  PubMed  Google Scholar 

  9. Sabbioni MEE, Dickson MH, Eychmuller S, Francke D, Goetz S, Hurny C et al (2002) Intermediate results of health related quality of life after vertical banded gastroplasty. Int J Obes 26:277–280. https://doi.org/10.1038/sj/ijo/0801879

    Article  CAS  Google Scholar 

  10. Koball AM, Jester DJ, Domoff SE, Kallies KJ, Grothe KB, Kothari SN (2017) Examination of bariatric surgery Facebook support groups: a content analysis. Surg Obes Relat Dis 13(8):1369–1375. https://doi.org/10.1016/J.SOARD.2017.04.025

    Article  PubMed  Google Scholar 

  11. Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A et al (2011) Is social support associated with greater weight loss after bariatric surgery?: a systematic review. Obes Rev 12:142–148. https://doi.org/10.1111/j.1467-789X.2010.00720.x

    Article  CAS  PubMed  Google Scholar 

  12. Ray EC, Nickels MW, Sayeed S, Sax HC, Matthews JB, Maher JW et al (2003) Predicting success after gastric bypass: the role of psychosocial and behavioral factors. Surgery 134(4):555–564. https://doi.org/10.1016/S0039-6060(03)00279-4

    Article  PubMed  Google Scholar 

  13. Funk LM, Grubber JM, Mcvay MA, Olsen MK, Yancy WS, Voils CI et al (2018) Patient predictors of weight loss following a behavioral weight management intervention among US Veterans with severe obesity. Eat Weight Disord Stud Anorexia Bulim Obes 23(5):587–595. https://doi.org/10.1007/s40519-017-0425-6

    Article  Google Scholar 

  14. Treiber FA, Baranowski T, Braden DS, Strong WB, Levy M, Knox W (1991 Nov) Social support for exercise: relationship to physical activity in young adults. Prev Med (Baltim) 20(6):737–750. https://doi.org/10.1016/0091-7435(91)90068-F

    Article  CAS  Google Scholar 

  15. Lent MR, Bailey-Davis L, Irving BA, Wood GC, Cook AM, Hirsch AG et al (2016) Bariatric surgery patients and their families: health, physical activity, and social support. Obes Surg 26(12):2981–2988. https://doi.org/10.1007/s11695-016-2228-7

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mehta A, Hutfless S, Blair AB, Karcher M, Nasatka S, Schweitzer M et al (2017) Outcomes of partnered individuals undergoing bariatric surgery together: a single institution case series. Obes Surg 27(8):2207–2210. https://doi.org/10.1007/s11695-017-2728-0

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ter Braak UBJM, Hinnen C, De Jong MMC, Van De Laar A (2018) Perceived postoperative support differentiates responders from non-responders 3 years after laparoscopic Roux-en-Y gastric bypass. Obes Surg 28:415–520. https://doi.org/10.1007/s11695-017-2852-x

    Article  PubMed  Google Scholar 

  18. Ferriby M, Pratt KJ, Balk E, Feister K, Noria S, Needleman B (2015) Marriage and weight loss surgery: a narrative review of patient and spousal outcomes. Obes Surg 25:2436–42. https://doi.org/10.1007/s11695-015-1893-2

    Article  PubMed  Google Scholar 

  19. Wallwork A, Tremblay L, Chi M, Sockalingam S (2017) Exploring partners’ experiences in living with patients who undergo bariatric surgery. Obes Surg 27(8):1973–1981. https://doi.org/10.1007/s11695-017-2594-9

    Article  PubMed  Google Scholar 

  20. Lutfi R, Torquati A, Sekhar N, Richards WO (2006) Predictors of success after laparoscopic gastric bypass: a multivariate analysis of socioeconomic factors. Endosc Other Interv Tech 20(6):864–867. https://doi.org/10.1007/s00464-005-0115-8

    Article  CAS  Google Scholar 

  21. Wheeler E, Prettyman A, Lenhard MJ, Tran K (2008) Adherence to outpatient program postoperative appointments after bariatric surgery. Surg Obes Relat Dis 4(4):515–20. https://doi.org/10.1016/J.SOARD.2008.01.013

    Article  PubMed  Google Scholar 

  22. Nasirzadeh Y, Kantarovich K, Wnuk S, Okrainec A, Cassin SE, Hawa R et al (2018) Binge eating, loss of control over eating, emotional eating, and night eating after bariatric surgery: results from the Toronto Bari-PSYCH Cohort Study. Obes Surg. https://doi.org/10.1007/s11695-018-3137-8

    Article  PubMed  Google Scholar 

  23. Fischer S, Chen E, Katterman S, Roerhig M, Bochierri-Ricciardi L, Munoz D et al (2007) Emotional eating in a morbidly obese bariatric surgery-seeking population. Obes Surg 17(6):778–784. https://doi.org/10.1007/s11695-007-9143-x

    Article  PubMed  Google Scholar 

  24. Conceição E, Mitchell J, Machado P, Vaz A, Pinto-Bastos A, Ramalho S et al (2017) Repetitive eating questionnaire [Rep(eat)-Q]: enlightening the concept of grazing and psychometric properties in a Portuguese sample. Appetite 117:351–358. https://doi.org/10.1016/j.appet.2017.07.012

    Article  PubMed  Google Scholar 

  25. Carvalho S, Pimentel P, Maia D, Mota-pereira J (2011) Características psicométricas da versão portuguesa da Escala Multidimensional de Suporte Social Percebido. Psychologica 54:309–358

    Google Scholar 

  26. Fairburn CG, Cooper Z, O’Connor M (2014) The eating disorder examination (edition 17.0)

  27. Machado PP, Martins C, Vaz A, Conceição E, Bastos AP, Gonçalves S (2014) Eating disorder examination questionnaire (EDE-Q): psychometric properties and norms for the portuguese population. Eur Eat Disord Rev 22(6):448–453. https://doi.org/10.1002/erv.2318

    Article  PubMed  Google Scholar 

  28. Cappelleri J, Bushmakin A, Gerber R, Leidy N, Sexton C, Lowe M et al (2009) Psychometric analysis of the Three-Factor Eating Questionnaire-R21: Results from a large diverse sample of obese and non-obese participants. Int J Obes 33(6):611–620. https://doi.org/10.1038/ijo.2009.74

    Article  CAS  Google Scholar 

  29. Moreira P, Almeida L, Sampaio D, Almeida MD (1997) Escala para avaliação do comportamento alimentar: Adaptação portuguesa em jovens universitários saudáveis. In: Gonçalves M, Ribeiro I, Araujo S, Al E (eds) Avaliação psicológica: Formas e contextos. V. Apport, Braga, pp 641–658

    Google Scholar 

  30. Lovibond SH, Lovibond PF (1995) Manual for the depression anxiety stress scales, 2nd edn. Psychology Foundation, Sydney

    Google Scholar 

  31. Pais-Ribeiro J, Honrado A, Leal I (2004) Contribuição Para O Estudo Da Adaptação Portuguesa Das Escalas De Ansiedade, Depressão E Stress (Eads) De 21 Itens De Lovibond E Lovibond. Psicol Saúde Doenças 5(2):229–239. https://doi.org/10.1080/13548500500524088

    Article  Google Scholar 

  32. Hayes AF (2013) Introduction to mediation, moderation, and conditional process analysis. A regression-based approach. Guilford, New York, pp 79–81

    Google Scholar 

  33. Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191. https://doi.org/10.3758/BF03193146

    Article  PubMed  Google Scholar 

  34. Ficaro I (2018) Surgical weight loss as a life-changing transition: the impact of interpersonal relationships on post bariatric women. Appl Nurs Res 40(2017):7–12. https://doi.org/10.1016/j.apnr.2017.12.003

    Article  PubMed  Google Scholar 

  35. Conceição EM, Utzinger LM, Pisetsky EM (2015) Eating disorders and problematic eating behaviours before and after bariatric surgery: characterization, assessment and association with treatment outcomes. Eur Eat Disord Rev 23:417–425. https://doi.org/10.1002/erv.2397

    Article  PubMed  PubMed Central  Google Scholar 

  36. Mitchell J, King W, Chen J, Devlin M, Flum D, Garcia L et al (2014) Course of depressive symptoms and treatment in the longitudinal assessment of bariatric surgery (LABS-2) study. Obesity 22(8):1799–1806. https://doi.org/10.1001/jamasurg.2016.0395

    Article  PubMed  Google Scholar 

  37. Conceição E, Orcutt M, Mitchell J, Engel S, Lahaise K, Jorgensen M et al (2013) Eating disorders after bariatric surgery: a case series. Int J Eat Disord 46(3):274–279. https://doi.org/10.1002/eat.22074

    Article  PubMed  Google Scholar 

  38. Pona AA, Heinberg LJ, Lavery M, Ben-Porath YS, Rish JM (2016 Jan) Psychological predictors of body image concerns 3 months after bariatric surgery. Surg Obes Relat Dis 12(1):188–193. https://doi.org/10.1007/s11695-018-03669-4

    Article  PubMed  Google Scholar 

  39. Ramalho S, Pinto-Bastos A, Silva C, Vaz A, Brandão I, Machado P et al (2015) Excessive skin and sexual function: relationship with psychological variables and weight regain in women after bariatric surgery. Obes Surg 25(7):1149–1154. https://doi.org/10.1007/s11695-014-1514-5

    Article  PubMed  Google Scholar 

  40. Conceição E, Vaz A, Pinto-Bastos A, Ramos A, Machado P (2013) The development of eating disorders after bariatric surgery. Eat Disord 21(3):275–282. https://doi.org/10.1080/10640266.2013.779193

    Article  PubMed  Google Scholar 

  41. Tymoszuk U, Kumari M, Batterham R, Stafford M (2018) Social support and trajectories of body mass index and waist to hip ratio from mid-adulthood to old age. J Epidemiol Community Health 73(2):1–6. https://doi.org/10.1136/jech-2018-210525

    Article  Google Scholar 

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Acknowledgements

The authors wish to acknowledge Dr. Isabel Brandão and the AMTCO group (Avaliação Multidisciplinar do Tratamento Cirúrgico da Obesidade) at the Hospital of São João, Porto, for facilitating access to the patients and conducting the multidisciplinary treatment as usual of the participants of this study.

Funding

This study was partially conducted at Psychology Research Centre (PSI/01662), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds, and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653), by the following grants to Eva Conceição (IF/01219/2014 and POCI-01-0145-FEDER-028209), and doctoral scholarship to Ana Pinto-Bastos (SFRH/BD/104159/2014) and to Sofia Ramalho (SFRH/BD/104182/2014), and post-doctoral grant to Ana R. Vaz (SFRH/BPD/94490/2013). The funding body had no role in the design, collection, analysis, and interpretation of data; the writing of the manuscript; or the decision to submit the manuscript for publication.

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Correspondence to Eva M. Conceição.

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Conceição, E.M., Fernandes, M., de Lourdes, M. et al. Perceived social support before and after bariatric surgery: association with depression, problematic eating behaviors, and weight outcomes. Eat Weight Disord 25, 679–692 (2020). https://doi.org/10.1007/s40519-019-00671-2

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