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Psychological factors

Psychological factors prevent patients completing surgery

Those patients who had surgery were more comfortable with surgical risks, had less confidence in their ability to lose weight on their own
Candidates for surgery may benefit from additional education about the severity and potential lethality of their co-morbid conditions, as well as the safety and benefits of bariatric surgery
Future studies to assess why so many obese individuals that are eligible for bariatric surgery do not even seek out the procedure

Many bariatric surgery candidates often drop out of the surgical process because they experience surgical anxiety and/or they believe that they can lose weight on their own, without surgery, according to research by investigators led by Dr David Mahony from PsyBari, Brooklyn, New York, US. Although these obese patients present with co-morbidities, these conditions do not sufficiently motivate patients to complete the surgical process.

 “Conversely, factors that are not traditionally assessed in the pre-surgical workup, such as their level of surgical anxiety and their beliefs about their ability to lose weight without surgery, may lead them to decide against surgery.”

The paper, ‘Psychological predictors of bariatric surgery attrition’, published in the open access journal Research, states that an estimated 49-69 percent to that patients who are enrolled in a bariatric surgery programme have the procedure. Previous research has outlined several factors for this high drop-out rate including financial, medical and/or psychological concerns. 

David Mahony

“Given that considerable time, effort, and expense are devoted to pre-surgical screenings, the cost-effectiveness of these screenings may be improved by advancing our understanding of the psychological factors that predict surgical attrition,” write the authors. “Furthermore, if psychological barriers that impede surgical completion can be identified, interventions to manage these barriers could be implemented so that a greater number of patients could receive the benefits of bariatric surgery.”

Study

A total of 123 patients agreed to take part in the study; 105 females (85.4%) and 18 males (14.6%). Of these, 90 (73.2%) identified themselves as Caucasian, 24 (19.5%) as African-American, 7 (5.7%) as Latino, and 2 (1.6%) as “other” race. They had a mean BMI (±SD) of 47.7 (±7.31) and mean age (±SD) of 48.82 (±11.45), when they enrolled in the programme.

The patients were interviewed via a semi-structured clinical telephone interview and their demographic, psychological and medical factors were assessed. All patients were asked about their anxiety about surgical risks, history of weight loss attempts, confidence in their ability to lose weight on their own, presence of obesity related co-morbidities, and their psychological status. Items were responded to with yes/no or rated on a 7 point Likert scale. 

Outcomes

From 122 patients (one patient had missing data), 70 (57.7%) completed bariatric surgery compared with 52 (42.3%) dropped out and did not receive surgery. Of the 70 patients that completed surgery, 31 (44.3%) received the gastric band, 28 (40.0%) received the gastric bypass, five (7.1%) received the sleeve gastrectomy, and 6 (8.6%) received another procedure.

The authors report that those patients who had surgery were more comfortable with surgical risks, had less confidence in their ability to lose weight on their own, felt as though they were less able to control their weight and were more likely to believe that bariatric surgery was the only way for them to lose weight (Figure 1). 

Figure 1. Attrition due to psychological variables (all variables measured on a 7-point Likert Scale and all comparisons p<0.05)

They also had more previous weight loss attempts and were more likely to have experienced weight re-gain after dieting, in the past. No significant differences were found for completers vs. non-completers on medical and/or psychological co-morbidities including type 2 diabetes, hypertension, hypercholesterolemia, sleep apnea, asthma, back pain, heart disease and depression. 

Conclusion

“Overall, these findings offer insights into some of the psychological factors involved in determining whether or not a bariatric surgery candidate completes surgery. Most importantly, the results show that the motivators that patients usually report as their primary reasons for seeking bariatric surgery, such as medical co-morbidities, are not sufficient, the authors conclude. “Conversely, factors that are not traditionally assessed in the pre-surgical workup, such as their level of surgical anxiety and their beliefs about their ability to lose weight without surgery, may lead them to decide against surgery.”

The researchers added that candidates for surgery may benefit from additional education about the severity and potential lethality of their co-morbid conditions, as well as the safety and benefits of bariatric surgery.

The authors also call for future studies to determine whether these barriers are also the reason why so many obese individuals that are eligible for bariatric surgery do not even seek out the procedure.

This study was supported by Ethicon Endo-Surgery. 

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