Obesity Surgery

, Volume 25, Issue 2, pp 330–345 | Cite as

Post-operative Psychosocial Predictors of Outcome in Bariatric Surgery

  • Carrie S. Sheets
  • Christine M. Peat
  • Kelly C. Berg
  • Emily K. White
  • Lindsey Bocchieri-Ricciardi
  • Eunice Y. Chen
  • James E. Mitchell
Review Article


Although there are several recent reviews of the pre-operative factors that influence treatment outcome for bariatric surgery, commensurate efforts to identify and review the predictive validity of post-operative variables are lacking. This review describes the post-operative psychosocial predictors of weight loss in bariatric surgery. Results suggest empirical support for post-operative binge eating, uncontrolled eating/grazing, and presence of a depressive disorder as negative predictors of weight loss outcomes; whereas, adherence to dietary and physical activity guidelines emerged as positive predictors of weight loss. With the exception of depression, psychological comorbidities were not consistently associated with weight loss outcomes. Results highlight the need for post-operative assessment of disordered eating and depressive disorder, further research on the predictive value of post-operative psychosocial factors, and development of targeted interventions.


Bariatric surgery Post-operative Psychopathology Psychosocial Weight loss 



We would like to thank Janna B. Howard, BS, and Elise C. Hartley for their contributions to this manuscript.

Conflict of Interest

Christine M. Peat, PhD, reports grants from Shire Pharmaceuticals, outside the submitted work. All other authors have no conflict of interest to declare.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the original studies reviewed here.

Statement of Human and Animal Rights

Procedures followed in the original studies reviewed here were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000.


  1. 1.
    Ostman J, Britton M, Jonsson E. Treating and preventing obesity: an evidence based review. Wiley, editor. Weinheim, Germany, 2004.Google Scholar
  2. 2.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. J Am Med Assoc. 2004;292(14):1724–37. PubMed PMID: 15479938.CrossRefGoogle Scholar
  3. 3.
    Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59. PubMed PMID: 15809466.PubMedCrossRefGoogle Scholar
  4. 4.
    Karlsson J, Taft C, Ryden A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31(8):1248–61. PubMed PMID: 17356530.CrossRefGoogle Scholar
  5. 5.
    Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA J Am Med Assoc. 2008;299(3):316–23. PubMed PMID: 18212316.CrossRefGoogle Scholar
  6. 6.
    NIH, editor. NIH conference: Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Annals of Internal Medicine; 1991 Dec 15.Google Scholar
  7. 7.
    Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;19:1605–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Chevallier JM, Paita M, Rodde-Dunet MH, et al. Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behavior. Ann Surg. 2007;246(6):1034–9. PubMed PMID: 18043107.PubMedCrossRefGoogle Scholar
  9. 9.
    Anwar M, Collins J, Kow L, et al. Long-term efficacy of a low-pressure adjustable gastric band in the treatment of obesity. Ann Surg. 2008;247:771–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Benotti PN, Forse RA. The role of gastric surgery in the multidisciplinary management of severe obesity. Am J Surg. 1995;169:361–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Powers PS, Rosemurgy A, Boyd F, et al. Outcome of gastric restriction procedures: weight, psychiatric diagnoses, and satisfaction. Obes Surg. 1997;7(6):471–7. PubMed PMID: 9730503.PubMedCrossRefGoogle Scholar
  12. 12.
    Devlin MJ, Goldfein JA, Flancbaum L, et al. Surgical management of obese patients with eating disorders: a survey of current practice. Obes Surg. 2004;14(9):1252–7. PubMed PMID: 15527644.PubMedCrossRefGoogle Scholar
  13. 13.
    Bauchowitz AU, Gonder-Frederick LA, Olbrisch ME, et al. Psychosocial evaluation of bariatric surgery candidates: a survey of present practices. Psychosom Med. 2005;67(5):825–32. PubMed PMID: 16204445.PubMedCrossRefGoogle Scholar
  14. 14.
    Santry HP, Chin MH, Cagney KA, et al. The use of multidisciplinary teams to evaluate bariatric surgery patients: results from a national survey in the U.S.A. Obes Surg. 2006;16(1):59–66. PubMed PMID: 16417760.PubMedCrossRefGoogle Scholar
  15. 15.
    Marcus MD, Kalarchian MA, Courcoulas AP. Psychiatric evaluation and follow-up of bariatric surgery patients. Am J Psychiatry. 2009;166(3):285–91. PubMed PMID: 19255051.PubMedCrossRefGoogle Scholar
  16. 16.
    Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13(4):639–48. PubMed PMID: 15897471.PubMedCrossRefGoogle Scholar
  17. 17.
    Herpertz S, Kielmann R, Wolf AM, et al. Do psychosocial variables predict weight loss or mental health after obesity surgery? A systematic review. Obes Res. 2004;12(10):1554–69. PubMed PMID: 15536219.PubMedCrossRefGoogle Scholar
  18. 18.
    van Hout GC, Verschure SK, van Heck GL. Psychosocial predictors of success following bariatric surgery. Obes Surg. 2005;15(4):552–60. PubMed PMID: 15946437.PubMedCrossRefGoogle Scholar
  19. 19.
    Pull CB. Current psychological assessment practices in obesity surgery programs: what to assess and why. Curr Opin Psychiatry. 2010;23(1):30–6. PubMed PMID: 19926994.PubMedCrossRefGoogle Scholar
  20. 20.
    Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22(1):70–89.PubMedCrossRefGoogle Scholar
  21. 21.
    Iacovino JM, Gredysa DM, Altman M, et al. Psychological treatments for binge eating disorder. Curr Psychiatry Rep. 2012;14(4):432–46. doi: 10.1007/s11920-012-0277-8.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Miller WR, Rollnick S. Motivational interviewing: preparing people for change. 2nd ed. New York: Guilford Press; 2002. 428 p.Google Scholar
  23. 23.
    Larsen JK, van Ramshorst B, Geenen R, et al. Binge eating and its relationship to outcome after laparoscopic adjustable gastric banding. Obes Surg. 2004;14(8):1111–7. PubMed PMID: 15479602.PubMedCrossRefGoogle Scholar
  24. 24.
    Scholtz S, Bidlake L, Morgan J, et al. Long-term outcomes following laparoscopic adjustable gastric banding: post-operative psychological sequelae predict outcome at 5-year follow-up. Obes Surg. 2007;17(9):1220–5. PubMed PMID: 18074498.PubMedCrossRefGoogle Scholar
  25. 25.
    de Zwaan M, Hilbert A, Swan-Kremeier L, et al. Comprehensive interview assessment of eating behavior 18–35 months after gastric bypass surgery for morbid obesity. Surg Obes Relat Dis. 2010;6(1):79–85.PubMedCrossRefGoogle Scholar
  26. 26.
    Kofman MD, Lent MR, Swencionis C. Maladaptive eating patterns, quality of life, and weight outcomes following gastric bypass: results of an internet survey. Obesity. 2010;18(10):1938–43.PubMedCrossRefGoogle Scholar
  27. 27.
    Beck NN, Mehlsen M, Støving RK. Psychological characteristics and associations with weight outcomes two years after gastric bypass surgery: post-operative eating disorder symptoms are associated with weight loss outcomes. Eat Behav. 2012;13(4):394–7. doi: 10.1016/j.eatbeh.2012.06.001.PubMedCrossRefGoogle Scholar
  28. 28.
    Sioka E, Tzovaras G, Oikonomou K, et al. Influence of eating profile on the outcome of laparoscopic sleeve gastrectomy. Obes Surg. 2013;23(4):501–8. doi: 10.1007/s11695-012-0831-9.PubMedCrossRefGoogle Scholar
  29. 29.
    White MA, Kalarchian MA, Masheb RM, et al. Loss of control over eating predicts outcomes in bariatric surgery patients: a prospective, 24-month follow-up study. J Clin Psychiatry. 2010;71(2):175–84. PubMed PMID: 19852902.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Colles SL, Dixon JB, O’Brien PE. Grazing and loss of control related to eating: two high-risk factors following bariatric surgery. Obesity. 2008;16(3):615–22.PubMedCrossRefGoogle Scholar
  31. 31.
    Wolfe B, Terry M. Expectations and outcomes with gastric bypass surgery. Obes Surg. 2006;16(12):1622–9.PubMedCrossRefGoogle Scholar
  32. 32.
    de Man Lapidoth J, Ghaderi A, Norring C. Binge eating in surgical weight-loss treatments: long-term associations with weight loss, health related quality of life (HRQL), and psychopathology. Eat Weight Disord. 2011;16(4):e263–9. PubMed PMID: 2012-11367-006. PMID: 22526131.PubMedCrossRefGoogle Scholar
  33. 33.
    Latner JD, Wetzler S, Goodman ER, et al. Gastric bypass in a low-income, inner-city population: eating disturbances and weight loss. Obes Res. 2004;12(6):956–61. PubMed PMID: 15229335.PubMedCrossRefGoogle Scholar
  34. 34.
    Wadden TA, Faulconbridge LF, Jones-Corneille LR, et al. Binge eating disorder and the outcome of bariatric surgery at one year: a prospective, observational study. Obesity. 2011;19(6):1220–8. doi: 10.1038/oby.2010.336.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Faria SL, de Oliveira Kelly E, Faria OP, et al. Snack-eating patients experience lesser weight loss after Roux-en-Y gastric bypass surgery. Obes Surg. 2009;19(9):1293–6.CrossRefGoogle Scholar
  36. 36.
    Colles SL, Dixon JB, O’Brien PE. Hunger control and regular physical activity facilitate weight loss after laparoscopic adjustable gastric banding. Obes Surg. 2008;18(7):833–40.PubMedCrossRefGoogle Scholar
  37. 37.
    Silver HJ, Torquati A, Jensen GL, et al. Weight, dietary and physical activity behaviors two years after gastric bypass. Obes Surg. 2006;16(7):859–64. PubMed PMID: 16839483.PubMedCrossRefGoogle Scholar
  38. 38.
    Bueter M, Thalheimer A, Lager C, et al. Who benefits from gastric banding? Obes Surg. 2007;17(12):1608–13.PubMedCrossRefGoogle Scholar
  39. 39.
    Lanyon RI, Maxwell BM, Kraft AJ. Prediction of long-term outcome after gastric bypass surgery. Obes Surg. 2009;19(4):439–45.PubMedCrossRefGoogle Scholar
  40. 40.
    Colles SL, Dixon JB. Night eating syndrome: impact on bariatric surgery. Obes Surg. 2006;16(7):811–20. PubMed PMID: 16839476.PubMedCrossRefGoogle Scholar
  41. 41.
    Kinzl JF, Schrattenecker M, Traweger C, et al. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;16(12):1609–14. PubMed PMID: 17217637.PubMedCrossRefGoogle Scholar
  42. 42.
    Laurenius A, Larsson I, Bueter M, et al. Changes in eating behaviour and meal pattern following Roux-en-Y gastric bypass. Int J Obes. 2012;36(3):348–55. doi: 10.1038/ijo.2011.217. PubMed PMID: 2012-07688-004. PMID: 22124454.CrossRefGoogle Scholar
  43. 43.
    van Strien T. Dutch Eating Behavior Questionnaire. Suffolk: Thames Valley Test Company Limited; 2002.Google Scholar
  44. 44.
    van Hout GCM, Jakimowicz JJ, Fortuin FAM, et al. Weight loss and eating behavior following vertical banded gastroplasty. Obes Surg. 2007;17(9):1226–34. doi: 10.1007/s11695-007-9205-0.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Burgmer R, Grigutsch K, Zipfel S, et al. The influence of eating behavior and eating pathology on weight loss after gastric restriction operations. Obes Surg. 2005;15(5):684–91. PubMed PMID: 15946461.PubMedCrossRefGoogle Scholar
  46. 46.
    Batsis JA, Lopez-Jimenez F, Collazo-Clavell ML, et al. Quality of life after bariatric surgery: a population-based cohort study. Am J Med. 2009;122(11):1055.e1–e10.CrossRefGoogle Scholar
  47. 47.
    Toussi R, Fujioka K, Coleman KJ. Pre- and post-surgery behavioral compliance, patient health, and post-bariatric surgical weight loss. Obesity. 2009;17(5):996–1002. PubMed PMID: 19165167.PubMedCrossRefGoogle Scholar
  48. 48.
    El Chaar M, McDeavitt K, Richardson S, et al. Does patient compliance with pre-operative bariatric office visits affect post-operative excess weight loss? Surg Obes Relat Dis. 2011;7(6):743–8. doi: 10.1016/j.soard.2010.10.020.PubMedCrossRefGoogle Scholar
  49. 49.
    Sarwer DB, Wadden TA, Moore RH, et al. Pre-operative eating behavior, post-operative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2008;4(5):640–6. PubMed PMID: 18586571.PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    Welch G, Wesolowski C, Piepul B, et al. Physical activity predicts weight loss following gastric bypass surgery: findings from a support group survey. Obes Surg. 2008;18(5):517–24. PubMed PMID: 18365295.PubMedCrossRefGoogle Scholar
  51. 51.
    Bond DS, Phelan S, Wolfe LG, et al. Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Obesity. 2009;17(1):78–83. PubMed PMID: 18997679.PubMedCrossRefGoogle Scholar
  52. 52.
    Pontiroli AE, Fossati A, Vedani P, et al. Post-surgery adherence to scheduled visits and compliance, more than personality disorders, predict outcome of bariatric restrictive surgery in morbidly obese patients. Obes Surg. 2007;17(11):1492–7. PubMed PMID: 18219777.PubMedCrossRefGoogle Scholar
  53. 53.
    Kruseman M, Leimgruber A, Zumbach F, et al. Dietary, weight, and psychological changes among patients with obesity, 8 years after gastric bypass. J Am Diet Assoc. 2010;110:527–34.PubMedCrossRefGoogle Scholar
  54. 54.
    Livhits M, Mercado C, Yermilov I, et al. Exercise following bariatric surgery: systematic review. Obes Surg. 2010;20(5):657–65. PubMed PMID: 20180039.PubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    Jacobi D, Ciangura C, Couet C, et al. Physical activity and weight loss following bariatric surgery. Obes Rev. 2011;12(5):366–77.PubMedCrossRefGoogle Scholar
  56. 56.
    Bond DS, Evans RK, Wolfe LG, et al. Impact of self-reported physical activity participation on proportion of excess weight loss and BMI among gastric bypass surgery patients. Am Surg. 2004;70(9):811–4. PubMed PMID: 15481300.PubMedGoogle Scholar
  57. 57.
    Metcalf B, Rabkin R, Rabkin J, et al. Weight loss composition: the effects of exercise following obesity surgery as measured by bioelectrical impedance analysis. Obes Surg. 2005;15(2):183–6.PubMedCrossRefGoogle Scholar
  58. 58.
    Larsen JK, Geenen R, van Ramshorst B, et al. Binge eating and exercise behavior after surgery for severe obesity: a structural equation model. Int J Eat Disord. 2006;39(5):369–75.PubMedCrossRefGoogle Scholar
  59. 59.
    Evans RK, Bond DS, Wolfe LG, et al. Participation in 150 min/wk of moderate or higher intensity physical activity yields greater weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2007;3(5):526–30.PubMedCrossRefGoogle Scholar
  60. 60.
    Coleman KJ, Toussi R, Fujioka K. Do gastric bypass patient characteristics, behavior, and health differ depending upon how successful weight loss is defined? Obes Surg. 2010;20(10):1385–92. doi: 10.1007/s11695-010-0223-y.PubMedCrossRefGoogle Scholar
  61. 61.
    Forbush S, Nof L, Echternach J, et al. Influence of activity levels and energy intake on percent excess weight loss after Roux-en-Y gastric bypass. Obes Surg. 2011;21(11):1731–8. doi: 10.1007/s11695-011-0450-x. PubMed PMID: WOS:000297128700016.PubMedCrossRefGoogle Scholar
  62. 62.
    Josbeno DA, Kalarchian M, Sparto PJ, et al. Physical activity and physical function in individuals post-bariatric surgery. Obes Surg. 2011;21(8):1243–9. doi: 10.1007/s11695-010-0327-4. PubMed PMID: WOS:000293402600674.PubMedCrossRefGoogle Scholar
  63. 63.
    Rosenberger PH, Henderson KE, White MA, et al. Physical activity in gastric bypass patients: associations with weight loss and psychosocial functioning at 12-month follow-up. Obes Surg. 2011;21(10):1564–9. doi: 10.1007/s11695-010-0283-z. PubMed PMID: WOS:000295175700013.PubMedCentralPubMedCrossRefGoogle Scholar
  64. 64.
    Shen R, Dugay G, Rajaram K, et al. Impact of patient follow-up on weight loss after bariatric surgery. Obes Surg. 2004;14(4):514–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Dixon JB, Laurie CP, Anderson ML, et al. Motivation, readiness to change, and weight loss following adjustable gastric band surgery. Obesity. 2009;17(4):698–705. PubMed PMID: 19148126.PubMedCrossRefGoogle Scholar
  66. 66.
    Gould JC, Beverstein G, Reinhardt S, et al. Impact of routine and long-term follow-up on weight loss after laparoscopic gastric bypass. Surg Obes Relat Dis. 2007;3(6):627–30.PubMedCrossRefGoogle Scholar
  67. 67.
    Kaiser KA, Franks SF, Smith AB. The positive relationship between support group attendance and one year post-operative weight loss in gastric banding patients. Surg Obes Relat Disord. 2011;7(1):89–93. doi: 10.1016/j.soard.2010.07.013.CrossRefGoogle Scholar
  68. 68.
    Elakkary E, Elhorr A, Aziz F, et al. Do support groups play a role in weight loss after laparoscopic adjustable gastric banding? Obes Surg. 2006;16:331–4.PubMedCrossRefGoogle Scholar
  69. 69.
    Orth W, Madan A, Taddeucci R, et al. Support group meeting attendance is associated with better weight loss. Obes Surg. 2008;18(4):391–4. doi: 10.1007/s11695-008-9444-8.PubMedCrossRefGoogle Scholar
  70. 70.
    de Zwaan M, Enderle J, Wagner S, et al. Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. J Affect Disord. 2011;133(1–2):61–8. doi: 10.1016/j.jad.2011.03.025.PubMedCrossRefGoogle Scholar
  71. 71.
    Ware JE, Kosinski M, Dewey JE. How to score version two of the SF-36 health survey. Lincoln: QualityMetric, Incorporated; 2000.Google Scholar
  72. 72.
    Shiri S, Gurevich T, Feintuch U, et al. Positive psychological impact of bariatric surgery. Obes Surg. 2007;17(5):663–8. doi: 10.1007/s11695-007-9111-5.PubMedCrossRefGoogle Scholar
  73. 73.
    Hayden MJ, Murphy KD, Brown WA, et al. Axis I disorders in adjustable gastric band patients: the relationship between psychopathology and weight loss. Obes Surg. 2014. doi: 10.1007/s11695-014-1207-0.Google Scholar
  74. 74.
    King WC, Chen J-Y, Mitchell JE, et al. Prevalence of alcohol use disorders before and after bariatric surgery. JAMA J Am Med Assoc. 2012;307(23):2516–25. PubMed PMID: 2012-33481-003. PMID: 22710289.CrossRefGoogle Scholar
  75. 75.
    Raebel MA, Newcomer SR, Reifler LM, et al. Chronic use of opioid medications before and after bariatric surgery. JAMA. 2013;310(13):1369–76. doi: 10.1001/jama.2013.278344.PubMedCrossRefGoogle Scholar
  76. 76.
    Odom J, Zalesin K, Washington T, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20(3):349–56. doi: 10.1007/s11695-009-9895-6.PubMedCrossRefGoogle Scholar
  77. 77.
    Kinzl JF, Schrattenecker M, Traweger C, et al. Quality of life in morbidly obese patients after surgical weight loss. Obes Surg. 2007;17:229–35.PubMedCrossRefGoogle Scholar
  78. 78.
    Myers VH, Adams CE, Barbera BL, et al. Medical and psychosocial outcomes of laparoscopic Roux-en-Y gastric bypass: cross-sectional findings at 4-year follow-up. Obes Surg. 2012;22:230–9. PubMed Central PMCID: PMC21136302.PubMedCrossRefGoogle Scholar
  79. 79.
    Frydrych AM, Davies GR, McDermott BM. Eating disorders and oral health: a review of the literature. Aust Dent J. 2005;50:6–15.PubMedCrossRefGoogle Scholar
  80. 80.
    Hayden MJ, Dixon JB, Dixon ME, et al. Characterization of the improvement in depressive symptoms following bariatric surgery. Obes Surg. 2011;21(3):328–35. doi: 10.1007/s11695-010-0215-y.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Carrie S. Sheets
    • 1
  • Christine M. Peat
    • 2
  • Kelly C. Berg
    • 3
  • Emily K. White
    • 4
  • Lindsey Bocchieri-Ricciardi
    • 5
  • Eunice Y. Chen
    • 6
  • James E. Mitchell
    • 7
    • 8
  1. 1.InSight Counseling, LLCOverland ParkUSA
  2. 2.Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of PsychiatryUniversity of MinnesotaMinneapolisUSA
  4. 4.Department of PsychologyUniversity of Nevada, Las VegasLas VegasUSA
  5. 5.Center for Emotional HealthLas VegasUSA
  6. 6.Department of PsychologyTemple UniversityPhiladelphiaUSA
  7. 7.Neuropsychiatric Research InstituteFargoUSA
  8. 8.Department of Clinical Neuroscience, School of Medicine and Health SciencesUniversity of North DakotaFargoUSA

Personalised recommendations