title: A closer look at the nature of anxiety in weight loss surgery candidates.
abstract: OBJECTIVE
  Depression among weight loss surgery (WLS) candidates is common. Anxiety in this population is less studied. Untreated anxiety persists post-surgery and is associated with poor surgical outcomes. The current study sought to explore the nature of anxiety in WLS candidates. Given shared symptoms of anxiety and obesity, we hypothesized that physiological symptoms of anxiety would be most common.
  
  
  METHODS
  In this retrospective study, the medical records of 174 pre-WLS candidates at a large medical center were reviewed. Each completed a comprehensive medical, surgical, and psychological evaluation as part of standard of care. Data from these evaluations were abstracted. One hundred forty-three candidates completed the Beck Anxiety Inventory (BAI). A Principal Components Analysis (PCA) with varimax rotation was used to identify the factor structure of the BAI.
  
  
  RESULTS
  The sample consisted of primarily middle-aged (46.0 ± 13.24 years), married (60.8%), Caucasian (65.7%), females (79%) with Class III obesity (Body Mass Index = 50.1 ± 10.68) and mild anxiety (8.86 ± 8.70). Forty-four percent of the sample endorsed clinically significant anxiety. PCA revealed a four-factor structure that explained 56.28% of the variance in the BAI. The four factors were: 1) cognitive-emotional distress, 2) autonomic hyperarousal, 3) neurophysiologic concerns, and 4) body temperature.
  
  
  CONCLUSIONS
  Clinically significant anxiety is common among WLS candidates. Cognitive-emotional clustering of anxiety symptoms was more common than hypothesized. This is notable given the overlap of physiological symptoms of anxiety and obesity. Findings lend support for the utility of psychotherapeutic approaches tailored to address maladaptive thoughts to address anxiety and potentially improve WLS outcomes.
authors.affiliation: Wake Forest Health Sciences, Winston-Salem, North Carolina.
authors.forename: Shenelle A
authors.initials: SA
authors.lastname: Edwards-Hampton
authors.affiliation: The Menninger Clinic and Baylor College of Medicine, Houston, Texas.
authors.forename: Alok
authors.initials: A
authors.lastname: Madan
authors.affiliation: Medical University of South Carolina, Charleston.
authors.forename: Sharlene
authors.initials: S
authors.lastname: Wedin
authors.affiliation: Medical University of South Carolina, Charleston.
authors.forename: Jeffery J
authors.initials: JJ
authors.lastname: Borckardt
authors.affiliation: Medical University of South Carolina, Charleston.
authors.forename: Nina
authors.initials: N
authors.lastname: Crowley
authors.affiliation: Medical University of South Carolina, Charleston.
authors.forename: Karl T
authors.initials: KT
authors.lastname: Byrne
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology*; D050110:Bariatric Surgery / Q000523:psychology*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis* / Q000523:psychology*; D011594:Psychometrics; D012189:Retrospective Studies; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology
keywords: anxiety; bariatric surgery; body mass index; gastric bypass; obesity; preoperative care; psychosocial; weight loss