title: Using the presurgical psychological evaluation to predict 5-year weight loss outcomes in bariatric surgery patients.
abstract: BACKGROUND
  Psychosocial factors contribute to poorer weight loss outcomes following bariatric surgery; however, findings on associations between preoperative psychiatric diagnoses, psychological testing, and weight loss are inconsistent.
  
  
  OBJECTIVE
  Examine associations between presurgical psychiatric diagnoses derived from a semi-structured clinical interview and test scores from the Minnesota Multiphasic Personality-Inventory-2 - Restructured Form (MMPI-2-RF) and 5-year Body Mass Index (BMI) outcomes.
  
  
  METHODS
  Cleveland Clinic Bariatric and Metabolic Institute METHODS: 446 consecutively consented patients who underwent a Roux-en-Y gastric bypass (RYGB) at least 5 years prior were included in the study. A majority were women (74.2%) and Caucasian (66.2%). Patients' mean presurgical BMI was 49.14 kg/m2[SD = 9.50 kg/m2]. Psychiatric diagnoses were obtained from a presurgical, semi-structured clinical interview and all participants were administered the MMPI-2-RF at their presurgical evaluations. BMIs were collected at 4 postoperative time points across a 5-year trajectory. This prospective design utilized latent growth curve modeling.
  
  
  RESULTS
  Older patients evidenced a slower rate of BMI reduction over time. A presurgical diagnosis of Binge Eating Disorder predicted higher BMIs at the 5-year outcome. Scores on MMPI-2-RF measures of emotional and behavioral dysfunction domains incrementally predicted poorer weight loss outcomes.
  
  
  CONCLUSIONS
  Preoperative indicators of psychopathology, notably indicators that are dimensional in nature, are important in predicting postoperative outcomes. Closer follow-up with patients who evidence presurgical psychological factors, both before and after surgery, may help improve outcomes.
authors.affiliation: Department of Psychological Sciences, Kent State University, Kent, OH. Electronic address: rmarek1@kent.edu.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Marek
authors.affiliation: Department of Psychological Sciences, Kent State University, Kent, OH.
authors.forename: Yossef S
authors.initials: YS
authors.lastname: Ben-Porath
authors.affiliation: Department of Psychological Sciences, Kent State University, Kent, OH.
authors.forename: Manfred H M van
authors.initials: MHMV
authors.lastname: Dulmen
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Cleveland, OH.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ashton
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Cleveland, OH.
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Heinberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D056912:Binge-Eating Disorder / Q000150:complications / Q000175:diagnosis; D005260:Female; D015390:Gastric Bypass / Q000523:psychology*; D006801:Humans; D008950:MMPI; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000523:psychology / Q000601:surgery; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*; D055815:Young Adult
keywords: Assessment; Bariatric surgery; Obesity; Outcome; Psychology; Weight loss