title: The Impact of Impulsivity on Weight Loss Four Years after Bariatric Surgery.
abstract: Bariatric surgery has serious implications on metabolic health. The reasons for a failure of bariatric surgery, i.e., limited weight loss, are multifactorial and include psychological factors. We established a theoretical model of howimpulsivityis related to weight loss outcome. We propose that depressive symptoms act as a mediator between impulsivity andpathological eating behavior, and that pathological eating behavior has a direct impact on weight loss outcome. We calculatedexcessive weight loss(%EWL) and assessed self-reported impulsivity (using the Baratt Impulsiveness Scale (BIS-15) total score), depressive symptoms (the Patient Health Questionnaire (PHQ-9) score), and pathological eating behavior (the Eating Disorder Inventory 2 (EDI-2) total score) in 65 patients four years after laparoscopic sleeve gastrectomy. Regression and mediation analyses were computed to validate the theoretical model. The BIS-15, PHQ-9, and EDI-2 have medium to high correlations between each other, and EDI-2 correlated with %EWL. The mediation analysis yielded that the PHQ-9 represents a significant mediator between BIS-15 and EDI-2. The regression model between EDI-2 and %EWL was also significant. These results support our theoretical model, i.e., suggest that impulsivity has an indirect impact on weight loss outcome after bariatric surgery, mediated by depression and transferred through pathological eating behavior. Thus, the underlying psychological factors should be addressed in post-operative care to optimize weight loss outcome.
authors.affiliation: Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany. kathrin.schag@med.uni-tuebingen.de.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Schag
authors.affiliation: Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany. isabelle.mack@medizin.uni-tuebingen.de.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Mack
authors.affiliation: Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany. katrin.giel@med.uni-tuebingen.de.
authors.forename: Katrin E
authors.initials: KE
authors.lastname: Giel
authors.affiliation: Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany. sabrina.oelschlaeger@student.uni-tuebingen.de.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Ölschläger
authors.affiliation: Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany. eva-maria.skoda@med.uni-tuebingen.de.
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Skoda
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Tübingen, 72076 Tübingen, Germany. maximilian.feilitzsch@med.uni-tuebingen.de.
authors.forename: Maximilian
authors.initials: M
authors.lastname: von Feilitzsch
authors.affiliation: Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany. stephan.zipfel@med.uni-tuebingen.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.affiliation: Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany. martin.teufel@med.uni-tuebingen.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Teufel
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000523:psychology; D003863:Depression; D004435:Eating / Q000523:psychology; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012043:Regression, Psychology; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
keywords: bariatric surgery; depression; eating behavior; impulsivity; weight loss