Using presurgical psychological testing to predict 1-year appointment adherence and weight loss in bariatric surgery patients: predictive validity and methodological considerations
Abstract
Background Previous studies suggest that presurgical psychopathology accounts for some of the variance in suboptimal weight loss outcomes among Roux-en-Y gastric bypass (RYGB) patients, but research has been equivocal.Objectives The present study seeks to extend the past literature by examining associations between presurgical scale scores on the broadband Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and suboptimal weight loss and poor adherence to follow-up 1 year postoperatively after accounting for several methodologic considerations.Setting Cleveland Clinic Bariatric and Metabolic Institute, Cleveland, Ohio, USA.Methods The sample consisted of 498 RYGB patients, who produced a valid presurgical MMPI-2-RF protocol at program intake. The sample was primarily female (72.9%), Caucasian (64.9%), and middle-aged (mean = 46.4 years old; standard deviation [SD] = 11.6). The mean presurgical body mass index (BMI) was 47.4 kg/m(2) (SD = 8.2) and mean percent weight loss (%WL) at 1 year postoperatively was 31.18 %WL (SD = 8.44).Results As expected, scales from the Behavioral/Externalizing Dysfunction (BXD) domain of the MMPI-2-RF were associated with worse weight loss outcomes and poor adherence to follow-up, particularly after accounting for range restriction due to underreporting. Individuals producing elevated scores on these scales were at greater risk for achieving suboptimal weight loss (<50% excess weight loss) and not following up with their appointment compared with those who scored below cut-offs.Conclusions Patients who are more likely to engage in undercontrolled behavior (e.g., poor impulse control), as indicated by presurgical MMPI-2-RF findings, are at greater risk for suboptimal weight loss and poor adherence to follow-up following RYGB. Objective psychological assessments should also be conducted postoperatively to ensure that intervention is administered in a timely manner. Future research in the area of presurgical psychological screening should consider the impact of underreporting and other discussed methodologic issues in predictive analyses.
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Pre-operative behavioral problems (e.g., antisocial behaviors and substance use) were associated with poorer follow-up appointment attendance 1 year after surgery.
“Pre‐operative behavioral problems (e.g., antisocial behaviors and substance use) were associated with poorer follow‐up appointment attendance 1 year after surgery. 24”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [24]
Pre-operative emotional/internalizing dysfunction was not significantly related to follow-up appointment adherence.
“In contrast, pre‐operative emotional/internalizing dysfunction, 24 hostility, interpersonal sensitivity, alexithymia, 20 and maladaptive eating attitudes and habits 23 were not significantly related to follow‐up appointment adherence.”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [24]
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Recommendations for the Presurgical Psychosocial Evaluation of Bariatric Surgery Patients
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“24 In contrast, pre ‐ operative emotional/inter-nalizing dysfunction, 24 hostility, interpersonal sensitivity, alex-ithymia, 20 and maladaptive eating attitudes and habits 23 were not significantly related to follow ‐ up appointment adherence.”
Background
- Authors
- Marek, R. J., Tarescavage, A. M., Ben-Porath, Y. S., Ashton, K., Merrell Rish, J., & Heinberg, L. J.
- Affiliations
- Kent State University (US)
- Cleveland Clinic Lerner College of Medicine (US)
- Corresponding author
- Marek, Ryan J.
- Venue
- Surgery for Obesity and Related Diseases
- Publisher
- Elsevier BV
- Published
- 2015-09
- Volume
- 11
- Issue
- 5
- Pages
- 1171-1181
- ISSN
- 1550-7289 (ISSN-L)
- OpenAlex
- W1964233535
- Cited by
- 69
- References
- 57
- Citations by year
- 2026: 1 · 2024: 5 · 2023: 8 · 2022: 5 · 2021: 7 · 2020: 8 · 2019: 10 · 2018: 5 · 2017: 7 · 2016: 12 · 2015: 1
- FWCI
- 8.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Surgery for Obesity and Related Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Keywords
- bariatric surgery, Roux-en-Y gastric bypass
- MeSH terms
- Academic Medical Centers, Adult, Appointments and Schedules, Female, Follow-Up Studies, Humans, Male, Middle Aged, MMPI, Obesity, Morbid, Patient Compliance, Predictive Value of Tests, Preoperative Care, Prospective Studies, Psychological Tests, Time Factors, United States, Cohort Studies, Gastric Bypass, Weight Loss, Health Behavior, Body Mass Index, Treatment Outcome, Risk Assessment, Propensity Score
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