Advertisement

Obesity Surgery

, Volume 30, Issue 1, pp 127–138 | Cite as

Internalizing, Externalizing, and Interpersonal Components of the MMPI-2-RF in Predicting Weight Change After Bariatric Surgery

  • Nickolas A. DasherEmail author
  • Allison Sylvia
  • Kristen L. Votruba
Original Contributions
  • 79 Downloads

Abstract

Background

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is commonly used to assess psychological factors that may adversely impact weight loss. Research is limited on the specific MMPI-2-RF scales that may predict poor postoperative outcomes following bariatric surgery. The current study compared preoperative MMPI-2-RF profiles associated with postoperative weight change to novel component scores in a bariatric surgery sample.

Methods

One hundred twenty-seven patients completed a preoperative medical evaluation, a test of reading ability, and the MMPI-2-RF. Percent weight loss was obtained postoperatively at 6 and 12 months.

Results

Principal components analysis (PCA) generated five novel subcomponents from within the internalizing, externalizing, and interpersonal substantive scales of the MMPI-2-RF. Among these components, higher externalizing and social conflict scores at baseline were predictive of less percent weight change postoperatively at 6 months. A similar trend was observed with higher insecurity scores predicting less weight loss at 6 months postoperatively. At 12-month follow-up, higher insecurity scores at baseline remained predictive of lower percentage weight loss, while social conflict trended toward significance in the same direction. Model comparisons of traditional MMPI-2-RF scales were found to be more sensitive than the novel subcomponents. Specifically, demoralization (RCd), antisocial behavior (RC4), hypomanic activation (RC9), family problems (FML), and shyness (SHY) significantly predicted weight change after surgery.

Conclusion

Results suggested that specific problems scales were not more effectively differentiated into more sensitive and specific component scores, but demonstrated supportive evidence that the traditional MMPI-2-RF scales indicating higher degrees of behavioral dysregulation, poor self-efficacy, and lower social support predict reduced postoperative weight loss.

Keywords

MMPI-2-RF Bariatric surgery Weight loss Preoperative assessment 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief. 2017;288:1–8.Google Scholar
  2. 2.
    Ogden CL, Carroll MD, Kit BK, et al. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806–14.  https://doi.org/10.1001/jama.2014.732.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Maleckas A, Gudaitytė R, Petereit R, et al. Weight regain after gastric bypass: etiology and treatment options. Gland Surg. 2016;5(6):617–24.  https://doi.org/10.21037/gs.2016.12.02. ReviewCrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Brolin RE, Kenler HA, Gorman RC, et al. The dilemma of outcome assessment after operations for morbid obesity. Surgery. 1989;105(3):337–46.PubMedGoogle Scholar
  5. 5.
    Coleman KJ, Huang YC, Hendee F, et al. Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system. Surg Obes Relat Dis. 2014;10(3):396–403.  https://doi.org/10.1016/j.soard.2014.02.044.CrossRefPubMedGoogle Scholar
  6. 6.
    Vidal P, Ramón JM, Goday A, et al. Lack of adherence to follow-up visits after bariatric surgery: reasons and outcome. Obes Surg. 2014;24(2):179–83.  https://doi.org/10.1007/s11695-013-1094-9.CrossRefPubMedGoogle Scholar
  7. 7.
    Conceição EM, Utzinger LM, Pisetsky EM. Eating disorders and problematic eating behaviours before and after bariatric surgery: characterization, assessment and association with treatment outcomes. Eur Eat Disord Rev. 2015;23(6):417–25.  https://doi.org/10.1002/erv.2397.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Chao AM, Wadden TA, Faulconbridge LF, et al. Binge-eating disorder and the outcome of bariatric surgery in a prospective, observational study: two-year results. Obesity (Silver Spring). 2016;24(11):2327–33.  https://doi.org/10.1002/oby.21648.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Gerlach G, Herpertz S, Loeber S. Personality traits and obesity: a systematic review. Obes Rev. 2015;16(1):32–63.  https://doi.org/10.1111/obr.12235. ReviewCrossRefPubMedGoogle Scholar
  10. 10.
    Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88.  https://doi.org/10.1186/1471-2458-9-88. ReviewCrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Endocr Pract. 2013;19(2):337–72.  https://doi.org/10.4158/EP12437.GL.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Melissas J. IFSO guidelines for safety, quality, and excellence in bariatric surgery. Obes Surg. 2008;18(5):497–500.  https://doi.org/10.1007/s11695-007-9375-9.CrossRefPubMedGoogle Scholar
  13. 13.
    Votruba K, Marshall D, Finks J, et al. Neuropsychological factors and bariatric surgery: a review. Curr Psychiatry Rep. 2014;16(6):448.  https://doi.org/10.1007/s11920-014-0448-x. ReviewCrossRefPubMedGoogle Scholar
  14. 14.
    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.  https://doi.org/10.1016/j.jad.2011.03.025.CrossRefPubMedGoogle Scholar
  15. 15.
    Gordon PC, Sallet JA, Sallet PC. The impact of temperament and character inventory personality traits on long-term outcome of Roux-en-Y gastric bypass. Obes Surg. 2014;24(10):1647–55.  https://doi.org/10.1007/s11695-014-1229-7.CrossRefPubMedGoogle Scholar
  16. 16.
    Kalarchian MA, King WC, Devlin MJ, et al. Psychiatric disorders and weight change in a prospective study of bariatric surgery patients: a 3-year follow-up. Psychosom Med. 2016;78(3):373–81.  https://doi.org/10.1097/PSY.0000000000000277.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Marek RJ, Ben-Porath YS, Heinberg LJ. Understanding the role of psychopathology in bariatric surgery outcomes. Obes Rev. 2016;17(2):126–41.  https://doi.org/10.1111/obr.12356. ReviewCrossRefPubMedGoogle Scholar
  18. 18.
    Marek RJ, Ben-Porath YS, Dulmen MHMV, et al. Using the presurgical psychological evaluation to predict 5-year weight loss outcomes in bariatric surgery patients. Surg Obes Relat Dis. 2017;13(3):514–21.  https://doi.org/10.1016/j.soard.2016.11.008.CrossRefPubMedGoogle Scholar
  19. 19.
    Marek RJ, Ben-Porath YS, Merrell J, et al. Predicting one and three month postoperative somatic concerns, psychological distress, and maladaptive eating behaviors in bariatric surgery candidates with the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). Obes Surg. 2014;24(4):631–9.  https://doi.org/10.1007/s11695-013-1149-y. Erratum in: Obes Surg 2014 Apr;24(4):640–2CrossRefPubMedGoogle Scholar
  20. 20.
    Wimmelmann CL, Dela F, Mortensen EL. Psychological predictors of weight loss after bariatric surgery: a review of the recent research. Obes Res Clin Pract. 2014;8(4):e299–313.  https://doi.org/10.1016/j.orcp.2013.09.003. ReviewCrossRefPubMedGoogle Scholar
  21. 21.
    Fuchs HF, Laughter V, Harnsberger CR, et al. Patients with psychiatric comorbidity can safely undergo bariatric surgery with equivalent success. Surg Endosc. 2016;30(1):251–8.  https://doi.org/10.1007/s00464-015-4196-8.CrossRefPubMedGoogle Scholar
  22. 22.
    Morseth MS, Hanvold SE, Rø Ø, et al. Self-reported eating disorder symptoms before and after gastric bypass and duodenal switch for super obesity—a 5-year follow-up study. Obes Surg. 2016;26(3):588–94.  https://doi.org/10.1007/s11695-015-1790-8.CrossRefPubMedGoogle Scholar
  23. 23.
    Wise ES, Hocking KM, Kavic SM. Prediction of excess weight loss after laparoscopic Roux-en-Y gastric bypass: data from an artificial neural network. Surg Endosc. 2016;30(2):480–8.  https://doi.org/10.1007/s00464-015-4225-7.CrossRefPubMedGoogle Scholar
  24. 24.
    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.  https://doi.org/10.4088/JCP.08m04328blu.CrossRefPubMedGoogle Scholar
  25. 25.
    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 (Silver Spring). 2011;19(6):1220–8.  https://doi.org/10.1038/oby.2010.336. Erratum in: Obesity (Silver Spring). 2016 Jan;24(1):267CrossRefPubMedCentralGoogle Scholar
  26. 26.
    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. ReviewCrossRefGoogle Scholar
  27. 27.
    Ben-Porath YS, Tellegen A. MMPI-2-RF user’s guide for reports. Minneapolis: University of Minnesota Press; 2008.Google Scholar
  28. 28.
    Butcher JN, Graham JR, Ben-Porath YS, et al. Minnesota multiphasic personality inventory–2 (MMPI-2): manual for administration and scoring. Minneapolis: University of Minnesota Press; 2011.Google Scholar
  29. 29.
    Marek RJ, Ben-Porath YS, Windover A, et al. Assessing psychosocial functioning of bariatric surgery candidates with the Minnesota multiphasic personality inventory-2 restructured form (MMPI-2-RF). Obes Surg. 2013;23(11):1864–73.  https://doi.org/10.1007/s11695-013-1024-x.CrossRefPubMedGoogle Scholar
  30. 30.
    Tarescavage AM, Wygant DB, Boutacoff LI, et al. Reliability, validity, and utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in assessments of bariatric surgery candidates. Psychol Assess. 2013;25(4):1179–94.  https://doi.org/10.1037/a0033694.CrossRefPubMedGoogle Scholar
  31. 31.
    Marek RJ, Tarescavage AM, Ben-Porath YS, et al. Using presurgical psychological testing to predict 1-year appointment adherence and weight loss in bariatric surgery patients: predictive validity and methodological considerations. Surg Obes Relat Dis. 2015;11(5):1171–81.  https://doi.org/10.1016/j.soard.2015.03.020.CrossRefPubMedGoogle Scholar
  32. 32.
    Livhits M, Mercado C, Yermilov I, et al. Is social support associated with greater weight loss after bariatric surgery?: a systematic review. Obes Rev. 2011;12(2):142–8.  https://doi.org/10.1111/j.1467-789X.2010.00720.x. ReviewCrossRefPubMedGoogle Scholar
  33. 33.
    Tellegen A, Ben-Porath YS. MMPI-2-RF: technical manual. Minneapolis: University of Minnesota Press; 2008.Google Scholar
  34. 34.
    Wilkinson GS, Robertson GJ. Wide range achievement test – 4 (WRAT4). Lutz: PAR (Psychological Assessment Resources); 2006.Google Scholar
  35. 35.
    Mullen CM, Fouty HE. Comparison of the WRAT4 reading subtest and the WTAR for estimating premorbid ability level. Appl Neuropsychol Adult. 2014;21(1):69–72.  https://doi.org/10.1080/09084282.2012.727111.CrossRefPubMedGoogle Scholar
  36. 36.
    Ambwani S, Boeka AG, Brown JD, et al. Socially desirable responding by bariatric surgery candidates during psychological assessment. Surg Obes Relat Dis. 2013;9(2):300–5.  https://doi.org/10.1016/j.soard.2011.06.019.CrossRefPubMedGoogle Scholar
  37. 37.
    Bordignon S, Aparício MJG, Bertoletti J, et al. Personality characteristics and bariatric surgery outcomes: a systematic review. Trends Psychiatry Psychother. 2017;39(2):124–34.  https://doi.org/10.1590/2237-6089-2016-0016. ReviewCrossRefPubMedGoogle Scholar
  38. 38.
    Hays LM, Finch EA, Saha C, et al. Effect of self-efficacy on weight loss: a psychosocial analysis of a community-based adaptation of the diabetes prevention program lifestyle intervention. Diabetes Spectr. 2014;27(4):270–5.  https://doi.org/10.2337/diaspect.27.4.270.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Brembo EA, Kapstad H, Van Dulmen S, et al. Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study. Health Qual Life Outcomes. 2017;15(1):68.  https://doi.org/10.1186/s12955-017-0649-1.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Magklara E, Burton CR, Morrison V. Does self-efficacy influence recovery and well-being in osteoarthritis patients undergoing joint replacement? A systematic review. Clin Rehabil. 2014;28(9):835–46.  https://doi.org/10.1177/0269215514527843. ReviewCrossRefPubMedGoogle Scholar
  41. 41.
    Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA Surg. 2016;151(11):1046–55.  https://doi.org/10.1001/jamasurg.2016.2317.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Yen YC, Huang CK, Tai CM. Psychiatric aspects of bariatric surgery. Curr Opin Psychiatry. 2014;27(5):374–9.  https://doi.org/10.1097/YCO.0000000000000085. ReviewCrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Ikossi DG, Maldonado JR, Hernandez-Boussard T, et al. Post-traumatic stress disorder (PTSD) is not a contraindication to gastric bypass in veterans with morbid obesity. Surg Endosc. 2010;24(8):1892–7.  https://doi.org/10.1007/s00464-009-0866-8.CrossRefPubMedGoogle Scholar
  44. 44.
    Mirijello A, D'Angelo C, Iaconelli A, et al. Social phobia and quality of life in morbidly obese patients before and after bariatric surgery. J Affect Disord. 2015;179:95–100.  https://doi.org/10.1016/j.jad.2015.03.030.CrossRefPubMedGoogle Scholar
  45. 45.
    Robinson AH, Adler S, Stevens HB, et al. What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year? Surg Obes Relat Dis. 2014;10(4):697–704.  https://doi.org/10.1016/j.soard.2014.01.030.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Glinski J, Wetzler S, Goodman E. The psychology of gastric bypass surgery. Obes Surg. 2001;11(5):581–8. ReviewCrossRefGoogle Scholar
  47. 47.
    Marek RJ, Ben-Porath YS, Ashton K, et al. Minnesota multiphasic personality inventory-2 restructured form (MMPI-2-RF) scale score differences in bariatric surgery candidates diagnosed with binge eating disorder versus BMI-matched controls. Int J Eat Disord. 2014;47(3):315–9.  https://doi.org/10.1002/eat.22194.CrossRefPubMedGoogle Scholar
  48. 48.
    Ruchinskas RA, Combs CJ, Riley KC, et al. Defensive responding on the MMPI-2 in pre-surgical candidates. J Clin Psychol Med Settings. 2006;13:435–9.  https://doi.org/10.1007/s10880-006-9044-5.CrossRefGoogle Scholar
  49. 49.
    Fabricatore AN, Sarwer DB, Wadden TA, et al. Impression management or real change? Reports of depressive symptoms before and after the preoperative psychological evaluation for bariatric surgery. Obes Surg. 2007;17(9):1213–9.CrossRefGoogle Scholar
  50. 50.
    McGrice M, Don PK. Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions. Diabetes Metab Syndr Obes. 2015;8:263–74.  https://doi.org/10.2147/DMSO.S57054.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Beck NN, Mehlsen M, Støving RK. Psychological characteristics and associations with weight outcomes two years after gastric bypass surgery: postoperative eating disorder symptoms are associated with weight loss outcomes. Eat Behav. 2012;13(4):394–7.  https://doi.org/10.1016/j.eatbeh.2012.06.001.CrossRefPubMedGoogle Scholar
  52. 52.
    Pratt GM, Learn CA, Hughes GD, et al. Demographics and outcomes at American Society for Metabolic and Bariatric Surgery Centers of Excellence. Surg Endosc. 2009;23(4):795–9.  https://doi.org/10.1007/s00464-008-0077-8.CrossRefPubMedGoogle Scholar
  53. 53.
    Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg. 2011;21(11):1650–6.  https://doi.org/10.1007/s11695-011-0479-x.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Rehabilitation MedicineUniversity of Washington Medical CenterSeattleUSA
  2. 2.Department of PsychologyUniversity of CincinnatiCincinnatiUSA
  3. 3.Department of Psychiatry, Neuropsychology SectionUniversity of MichiganAnn ArborUSA

Personalised recommendations