title: Who is adherent with preoperative psychological treatment recommendations among weight loss surgery candidates?
abstract: BACKGROUND
  Adherence to treatment regimens is critical for success with weight loss surgery. Weight loss surgery patients commonly undergo a psychological evaluation before surgery. When indicated, patients are provided with preoperative behavioral recommendations; yet, little is known about the adherence to these recommendations. In this study, we evaluated the following: (1) level of adherence to behavioral treatment plans; (2) characteristics that differentiate adherent patients from nonadherent patients; and (3) the weight loss of delayed-adherent patients compared with those whose surgery was not delayed.
  
  
  METHODS
  We performed a case review of psychological evaluations, preoperative behavioral treatment plans, and subsequent adherence rates.
  
  
  RESULTS
  Of the 837 patients evaluated, 68 (8%) had significant psychosocial issues and were given behavioral treatment recommendations before surgery. Of these 68 patients, 38 (56%) were adherent and subsequently underwent surgery, and 30 (46%) were nonadherent and were not offered surgery in our program. Adherence did not differ relative to body mass index, age, education, race, marital status, depression, anxiety, or rate of eating disorders. Adherence did differ by gender: 31% percent of the men were adherent to recommendations while 62% of the women were adherent. Individuals with complex treatment plans were less likely to be adherent than those with less complex recommendations. Additionally, increased hostility reduced the adherence rates. Patients adherent to the psychological recommendations had weight loss within 2 years, which was similar to that of patients who did not require behavioral treatment recommendations.
  
  
  CONCLUSIONS
  The results of this study have provided information regarding adherence to preoperative psychological treatment recommendations. Although most patients are psychologically suitable for weight loss surgery at the initial evaluation, a better understanding of the factors influencing the adherence with preoperative behavioral programs could improve care for those with major psychosocial issues.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Weight Loss Surgery Program, Duke University Medical Center, Durham, North Carolina 27704, USA. fried019@mc.duke.edu
authors.forename: Kelli E
authors.initials: KE
authors.lastname: Friedman
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Applegate
authors.forename: John
authors.initials: J
authors.lastname: Grant
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000523:psychology*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology* / Q000601:surgery; D010349:Patient Compliance; D011300:Preoperative Care / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D012307:Risk Factors