Preoperative Predictors of Weight Loss Following Bariatric Surgery: Systematic Review

Abstract

Background

Obesity affects 32% of adults in the USA. Surgery generates substantial weight loss, but 20–30% fails to achieve successful weight loss. Our objective was to identify preoperative psychosocial factors associated with weight loss following bariatric surgery.

Methods

We performed a literature search of PubMed® and the Cochrane Database of Reviews of Effectiveness between 1988 and April 2010. Articles were screened for bariatric surgery and weight loss if they included a preoperative predictor of weight loss: body mass index (BMI), preoperative weight loss, eating disorders, or psychiatric disorder/substance abuse. One thousand seven titles were reviewed, 534 articles screened, and 115 included in the review.

Results

Factors that may be positively associated with weight loss after surgery include mandatory preoperative weight loss (7 of 14 studies with positive association). Factors that may be negatively associated with weight loss include preoperative BMI (37 out of 62 studies with negative association), super-obesity (24 out of 33 studies), and personality disorders (7 out of 14 studies). Meta-analysis revealed a decrease of 10.1% excess weight loss (EWL) for super-obese patients (95% confidence interval (CI) [3.7–16.5%]), though there was significant heterogeneity in the meta-analysis, and an increase of 5.9% EWL for patients with binge eating at 12 months after surgery (95% CI [1.9–9.8%]).

Conclusions

Further studies are necessary to investigate whether preoperative factors can predict a clinically meaningful difference in weight loss after bariatric surgery. The identification of predictive factors may improve patient selection and help develop interventions targeting specific needs of patients.

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Acknowledgments

We would like to acknowledge the generous contribution of Paul G. Shekelle to the design of our project and critical review of the analysis. The VA Department of Surgery provided support for Dr. Livhits and Dr. Gibbons. Dr. Gibbons’s time was supported in part by a grant from the Robert Wood Johnson Physician Faculty Scholars program.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Correspondence to Masha Livhits.

Appendices

Appendix 1. MEDLINE Search Terms

Preoperative Weight Loss

(1/1/1988 to 2/13/2008 and 2/14/2008 to 4/22/2010)

“Bariatric Surgery” [Mesh:NoExp] OR “weight loss surgery” OR “obesity surgery” OR “weight reduction surgery” OR “Biliopancreatic Diversion” [Mesh] OR “laparoscopic band” OR “lap band” OR “gastric band” OR “Gastric Bypass” [Mesh] OR “Gastroplasty” [Mesh] OR “gastric sleeve” OR “sleeve gastrectomy” AND “Obesity” [Mesh] and (“preoperative weight loss” or “pre-operative weight loss” or “preoperative weight” or “pre-operative weight”)

Maladaptive Eating

(1/1/1988 to 2/11/2008 and 2/12/2008 to 4/22/2010)

“Bariatric Surgery” [Mesh:NoExp] OR “weight loss surgery” OR “obesity surgery” OR “weight reduction surgery” OR “Biliopancreatic Diversion” [Mesh] OR “duodenal switch” OR “laparoscopic band” OR “lap band” OR “gastric band” OR “Gastric Bypass” [Mesh] OR “Gastroplasty” [Mesh] OR “gastric sleeve” OR “sleeve gastrectomy” AND “Obesity” [Mesh] AND “Feeding Behavior” [Mesh] OR “Eating Disorders” [Mesh] OR “Bulimia Nervosa” [Mesh] OR “Adaptation, Psychological” [Mesh] OR “Self Efficacy” [Mesh] OR “Bulimia” [Mesh] OR “Serotonin Uptake Inhibitors” [Mesh] OR “Volume Eater” OR “Maladaptive Eating” OR “Binge Eating” OR “ Sweet Eater” OR “Portion Size”

Psychiatric Disorders

(1/1/1988 to 2/13/2008 and 2/14/2008 to 2/18/2010)

“Bariatric Surgery” [Mesh:NoExp] OR “weight loss surgery” OR “obesity surgery” OR “weight reduction surgery” OR “Biliopancreatic Diversion” [Mesh] OR “Duodenal switch” OR “laparoscopic band” OR “lap band” OR “gastric band” OR “Gastric Bypass” [Mesh] OR “Gastroplasty” [Mesh] OR “gastric sleeve” OR “sleeve gastrectomy” AND “Obesity” [Mesh] AND “Depressive Disorder” [Mesh] OR “Depression” [Mesh] OR “Depressive Disorder, Major” [Mesh] OR “Depression, Chemical” [Mesh] OR “Bipolar Disorder” [Mesh] OR “Adjustment Disorders” [Mesh] OR “Dysthymic Disorder” [Mesh] OR “Seasonal Affective Disorder” [Mesh] OR “Affective Disorders, Psychotic” [Mesh] OR “Psychiatric Counseling” OR “counseling” OR “Psychiatric evaluation”

Appendix 2

Table 6 Description of studies included in the review

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Livhits, M., Mercado, C., Yermilov, I. et al. Preoperative Predictors of Weight Loss Following Bariatric Surgery: Systematic Review. OBES SURG 22, 70–89 (2012). https://doi.org/10.1007/s11695-011-0472-4

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Keywords

  • Bariatric surgery
  • Predictors
  • Weight loss
  • Preoperative
  • Outcomes