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Pre- and Postbariatric Subtypes and Their Predictive Value for Health-Related Outcomes Measured 3 Years After Surgery

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Abstract

Background

Although bariatric surgery is the most effective treatment for severe obesity, a subgroup of patients shows insufficient postbariatric outcomes. Differences may at least in part result from heterogeneous patient profiles regarding reactive and regulative temperament, emotion dysregulation, and disinhibited eating. This study aims to subtype patients based on these aspects before and 2 years after bariatric surgery and tests the predictive value of identified subtypes for health-related outcomes 3 years after surgery.

Methods

Within a prospective multicenter patient registry, N = 229 bariatric patients were examined before bariatric surgery, 2 and 3 years postoperatively via clinical interviews and self-report questionnaires. Pre- and postbariatric subtypes were differentiated by temperament, emotion dysregulation, and disinhibited eating using latent profile analyses (LPA). The predictive value of pre- and postbariatric subtypes for surgery outcomes measured 3 years postoperatively was tested via linear regression analyses.

Results

LPA resulted in five prebariatric and three postbariatric subtypes which were significantly associated with different levels of general and eating disorder psychopathology. Post- versus prebariatric subtypes explained more variance regarding eating disorder psychopathology, depression, and quality of life assessed 3 years postoperatively, whereas neither pre- nor postbariatric subtypes predicted postbariatric weight loss. Patients with prebariatric deficits in self- and emotional control had an increased risk for showing these deficits postoperatively.

Conclusions

A re-evaluation of patients’ psychological status after bariatric surgery is recommended to detect patients with potential risk for adverse psychological surgery outcomes in the long term.

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References

  1. Burgmer R, Legenbauer T, Müller A, et al. Psychological outcome 4 years after restrictive bariatric surgery. Obes Surg. 2014;24(10):1670–8.

    Article  Google Scholar 

  2. Puzziferri N, Roshek TB, Mayo HG, et al. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014;312(9):934–42.

    Article  CAS  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310(22):2416–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Magro DO, Geloneza B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648–51.

    Article  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. Claes L, Müller A. Temperament and personality in bariatric surgery – resisting temptations? Eur Eat Disord Rev. 2015;23(6):435–41.

    Article  Google Scholar 

  8. García-Ruiz-de-Gordejuela A, Agüera Z, Granero R, et al. Weight loss trajectories in bariatric surgery patients and psychopathological correlates. Eur Eat Disord Rev. 2017;25(6):586–94.

    Article  Google Scholar 

  9. 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.

    Article  Google Scholar 

  10. Sheets CS, Peat CM, Berg KC, et al. Post-operative psychosocial predictors of outcome in bariatric surgery. Obes Surg. 2015;25(2):330–45.

    Article  Google Scholar 

  11. Wimmelmann CL, Dela F, Mortensen EL. Psychosocial predictors of weight loss after bariatric surgery: a review of the recent research. Obes Res Clin Pract. 2014;8(4):e299–313.

    Article  Google Scholar 

  12. Gray JA. The psychology of fear and stress. Cambridge: Cambridge University Press; 1987.

    Google Scholar 

  13. Müller A, Claes L, Wilderjans TF, et al. Temperament subtypes in treatment seeking obese individuals: a latent profile analysis. Eur Eat Disord Rev. 2014;22(4):260–6.

    Article  Google Scholar 

  14. 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;12(3):514–21.

    Article  Google Scholar 

  15. 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 using the Minnesota multiphasic personality Inventory-2 restructured form (MMPI-2-RF). Obes Surg. 2014;24(4):631–9.

    Article  Google Scholar 

  16. Claes L, Vandereycken W, Vandeputte A, et al. Personality subtypes in female pre-bariatric obese patients: do they differ in eating disorder symptoms, psychological complaints and coping behaviour? Eur Eat Disord Rev. 2013;21(1):72–7.

    Article  Google Scholar 

  17. Kulendran M, Borovoi L, Purkayastha S, et al. Impulsivity predicts weight loss after obesity surgery. Surg Obes Relat Dis. 2017;13(6):1033–40.

    Article  Google Scholar 

  18. Schag K, Mack I, Giel KE, et al. The impact of impulsivity on weight loss four years after bariatric surgery. Nutrients. 2016;8(11):E721.

    Article  Google Scholar 

  19. Peterhänsel C, Linde K, Wagner B, et al. Subtypes of personality and ‘locus of control’ in bariatric patients and their effect on weight loss, eating disorder and depressive symptoms, and quality of life. Eur Eat Disord Rev. 2017;25(5):397–405.

    Article  Google Scholar 

  20. Giel KE, Teufel M, Junne F, et al. Food-related impulsivity in obesity and binge eating disorder – a systematic update of the evidence. Nutrients. 2017;9(11):E1170.

    Article  Google Scholar 

  21. Leehr EJ, Krohmer K, Schag K, et al. Emotion regulation model in binge eating disorder and obesity – a systematic review. Neurosci Biobehav Rev. 2015;49:125–34.

    Article  Google Scholar 

  22. Schäfer L, Hübner C, Carus T, et al. Identifying prebariatric subtypes based on temperament traits, emotion dysregulation, and disinhibited eating: a latent profile analysis. Int J Eat Disord. 2017;50(10):1172–82.

    Article  Google Scholar 

  23. Meany G, Conceição E, Mitchell JE. Binge eating, binge eating disorder and loss of control eating: effects on weight outcomes after bariatric surgery. Eur Eat Disord Rev. 2014;22(2):87–91.

    Article  Google Scholar 

  24. Baldofski S, Tigges W, Herbig B, et al. Nonnormative eating behavior and psychopathology in prebariatric patients with binge-eating disorder and night eating syndrome. Surg Obes Relat Dis. 2015;11(3):621–6.

    Article  Google Scholar 

  25. Carver CS, White TL. Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: the BIS/BAS scales. J Pers Soc Psychol. 1994;67(2):319–33.

    Article  Google Scholar 

  26. Derryberry D, Rothbart MK. Arousal, affect, and attention as components of temperament. J Pers Soc Psychol. 1988;55(6):958–66.

    Article  CAS  Google Scholar 

  27. Gratz K, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26(1):41–54.

    Article  Google Scholar 

  28. Van Strien T, Frijters JER, Bergers GPA, et al. The Dutch eating behavior questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. Int J Eat Disord. 1986;5(2):295–315.

    Article  Google Scholar 

  29. Grunert SC. Ein Inventar zur Erfassung von Selbstaussagen zum Ernährungsverhalten [an inventory of the assessment of self-reported eating behavior]. Diagnostica. 1989;35:167–79.

    Google Scholar 

  30. Tanofsky-Kraff M, Ranzenhofer LM, Yanovski SZ, et al. Psychometric properties of a new questionnaire to assess eating in the absence of hunger in children and adolescents. Appetite. 2008;51(1):148–55.

    Article  Google Scholar 

  31. Goldschmidt AB, Conceição EM, Thomas JG, et al. Conceptualizing and studying binge and loss of control eating in bariatric surgery patients-time for a paradigm shift? Surg Obes Relat Dis. 2016;12(8):1622–5.

    Article  Google Scholar 

  32. Fairburn CG, Cooper Z, O’Connor M. Eating disorder examination (17.0D). New York: Guilford Press; 2014.

    Google Scholar 

  33. Fairburn CG, Beglin SJ. Eating disorder examination questionnaire (6.0). In: Fairburn CG, editor. Cognitive behavior therapy and eating disorders. New York: Guilford Press; 2008. p. 309–14.

    Google Scholar 

  34. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 1999;282(18):1737–44.

    Article  CAS  Google Scholar 

  35. Kolotkin RL, Crosby RD. Psychometric evaluation of the impact of weight on quality of life-Lite questionnaire (IWQOL-LITE) in a community sample. Qual Life Res. 2002;11(2):157–71.

    Article  Google Scholar 

  36. Vermount JK, Madison J. Latent GOLD 4.0 User’s Guide. Belmont: Statistical Innovations Inc; 2005.

    Google Scholar 

  37. Schwarz G. Estimating the dimension of a model. Ann Stat. 1978;6(2):461–4.

    Article  Google Scholar 

  38. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Erlbaum; 1988.

    Google Scholar 

  39. Conceição EM, Mitchell JE, Pinto-Bastos A, et al. Stability of problematic eating behaviors and weight loss trajectories after bariatric surgery: a longitudinal observational study. Surg Obes Relat Dis. 2017;13(6):1063–70.

    Article  Google Scholar 

  40. Giel KE, Rieber N, Enck P, et al. Effects of laparoscopic sleeve gastrectomy on attentional processing of food-related information: evidence from eye-tracking. Surg Obes Relat Dis. 2014;10(2):277–82.

    Article  Google Scholar 

  41. Buchwald H, Buchwald JN, McGlennon TW. Systematic review and meta-analysis of medium-term outcomes after banded Roux-en-Y gastric bypass. Obes Surg. 2014;24(9):1536–51.

    Article  CAS  Google Scholar 

  42. Lynch A. “When the honeymoon is over, the real work begins:” gastric bypass patients’ weight loss trajectories and dietary change experiences. Soc Sci Med. 2016;151:241–9.

    Article  Google Scholar 

  43. Paul L, van der Heiden C, Hoek HW. Cognitive behavioral therapy and predictors of weight loss in bariatric surgery patients. Curr Opin Psychiatry. 2017;30(6):474–9.

    Article  Google Scholar 

  44. Wild B, Hünnemeyer K, Sauer H, et al. Psychotherapeutic interventions following bariatric surgery. Implications from the BaSE study. Psychotherapeut. 2017;62:222–9.

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank Christine Stroh, M.D.; Wolfgang Tigges, M.D.; Christian Jurowich, M.D.; Sabrina Baldofski; Kathrin Hohl; Martina Pabst, M.D.; Petra Börner; Yvonne Sockolowsky; Marlen Schmidt; and Sylvia Lellwitz for their support in data collection at the study centers, and Ricarda Schmidt, Ph.D., for her editing of the manuscript.

Funding

This work was supported by the Federal Ministry of Education and Research (BMBF), Germany, FKZ: 01EO1501.

Author information

Authors and Affiliations

  1. Integrated Research and Treatment Center Adiposity Diseases, Departments of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany

    Lisa Schäfer, Claudia Hübner & Anja Hilbert

  2. Department of General Surgery, Asklepios Clinic, Hamburg, Germany

    Thomas Carus

  3. Schön Klinik Hamburg Eilbek Bariatric Clinic, Hamburg, Germany

    Beate Herbig

  4. Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany

    Florian Seyfried

  5. Department of Visceral, Pediatric and Vascular Surgery, Hospital Konstanz, Constance, Germany

    Stefan Kaiser

  6. Department of Surgery, Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany

    Arne Dietrich

Authors
  1. Lisa Schäfer
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  2. Claudia Hübner
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  3. Thomas Carus
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  4. Beate Herbig
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  5. Florian Seyfried
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  6. Stefan Kaiser
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  8. Anja Hilbert
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Corresponding author

Correspondence to Lisa Schäfer.

Ethics declarations

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Schäfer, L., Hübner, C., Carus, T. et al. Pre- and Postbariatric Subtypes and Their Predictive Value for Health-Related Outcomes Measured 3 Years After Surgery. OBES SURG 29, 230–238 (2019). https://doi.org/10.1007/s11695-018-3524-1

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