Psychological factors prevent patients completing surgery
14 January 2015
I thought this was an interesting study that looked at factors that prevented people who qualified for bariatric surgery from actually going ahead with it. Psychological factors are well known to play a part but few studies have actually tried to quantify the effects. I'm sure these factors ring a few bells with some people ie being scared of undergoing major surgery or feeling convinced that they ar able to lose weight themselves with diet and exercise. I suspect that the fact that you are reading this means that you are thinking about Bariatric Surgery as a solution for your own weight problems and I would hate to think that surgery fear would prevent people from being able to take a step that is likely to change your life significantly and for the better! It is likely that more information may be part of the stepping stones to help you make this type of decision more objectively. Take a read and let me know what you think. Steph Ulmer
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.
“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.”
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.
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.
“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.
The real reason New Year diets fail
4 January 2015
Happy New Year! This seems to be a standard entry for New Zealand Herald in the first few days of the new year... a comment on diets and resolutions! This I found particularly interesting though. These categories of eating behaviours rings very true to me. I do seem to get one of these three descriptions from people when we are talking through their relationship with food and eating during the initial consultation. I have never seen it spelt out quite so simply though. Take a read and see if you agree. Which category sounds like you? The take home message however is a little misleading as we do have research evidence that sys that diets are successful in the short term but generally fail in the weight regain area for up to 95% of people at 3 years. A horrible statistic but true - and probably a lot of you are nodding your heads. Best wishes for the new year! Steph Ulmer
11:00 AM Thursday Jan 1, 2015
Oxbridge scientists say they have unlocked the secret to a successful New Year diet.
Researchers believe no diet is perfect for everyone, and the key to picking the right one depends on hormones, genes and psychology.
Each plays a key role in our relationship with food - and why some of us tend to eat too much.
Scientists identified three broad groups: "feasters" who keep on eating because they never feel full; "constant cravers" who can't stop thinking about food; and "emotional eaters" who raid the biscuit tin in times of trouble.
According to the team, which included Government nutrition advisor Professor Susan Jebb, from Oxford University, and Cambridge geneticist Dr Giles Yeo, each group responds differently to different diets.
They tested their theories on 75 volunteers - 25 from each group - over three months last summer.
Dr Chris van Tulleken said feasters don't release enough of a hormone known as GLP1, which tells your brain you are full.
"If you are someone who goes to an all-you-can-eat buffet and never feels full, then chances are you are a feaster.
"Secondly, we know that some people have a genetic risk factor for being overweight. It isn't one gene - there are many. Some of them are about personality, some are about appetite, and some about willpower. Those with lots of these 'obesity genes' are the constant cravers."
Chefs and "foodies" are likely to fall into this category, he said.
"Finally, we noticed some people self-medicate with food. They eat when they are unhappy. We call them the emotional eaters."
Having identified the groups, the researchers created different diets for each.
"Feasters" were given a diet designed to stimulate gut hormone levels with high-protein foods such as meat, fish and pulses, and cut out 'high-GI' carbohydrates such as white bread and potatoes.
"Constant cravers" were put on a version of the 5:2 diet, eating no more than 800 calories for two days every week. They could eat what they liked for the other five.
"Emotional eaters" were enrolled in Weight Watchers-style classes, on the theory that what they really needed was social support to prevent them turning to food.
Dr van Tulleken hopes the work will help people understand what causes their weight problems and "spell an end to fad diets".
Surgery induced weight loss improves brain function
7 November 2014
This is an unexpected finding! I always tell people who come to me to find out more about Bariatric Surgery that obesity affects every organ system. However, if you had asked me how it affected the brain I wouldn't have been able to give you a specific example. But now here it is! PET scans look at metabolic activity of the body or how rapidly cells are working in specific organs. It is very sensitive and allows visual evidence that enables you to compare one part of the body with another. They found that the metabolic activity in obese brains had areas of abnormally increased metabolism but it was very heartening to see that the brain can regain normal activity following surgery for weight loss (gastric bypass in this example) and improvements in cognitive functioning were measurable. Another upside to significant and longterm weight loss with Bariatric surgery!
Bariatric surgery can lead to changes in brain activity associated with obesity and improve cognitive function involved in planning, strategising and organising, according to a study published in the Journal of Clinical Endocrinology & Metabolism.
"When we studied obese women prior to bariatric surgery, we found some areas of their brains metabolised sugars at a higher rate than normal weight women," said one of the study's authors, Dr Cintia Cercato from the University of São Paolo in São Paolo, Brazil. "In particular, obesity led to altered activity in a part of the brain linked to the development of Alzheimer's disease, the posterior cingulate gyrus. Since bariatric surgery reversed this activity, we suspect the procedure may contribute to a reduced risk of Alzheimer's disease and other forms of dementia."
The longitudinal study examined the effect of bypass surgery on the brain function of 17 obese women and the researchers used positron emission tomography (PET) scans and neuropsychological tests to assess brain function and activity, in the participants prior to surgery and six months after the procedure. The same tests also were run once on a control group of 16 lean women.
Before they underwent surgery, the obese women had higher rates of metabolism in certain areas of the brain, including the posterior cingulate gyrus.
Following surgery, there was no evidence of this exacerbated brain activity and their brain metabolism rates were comparable to the activity seen in normal weight women. After surgery, the obese women also performed better on a test measuring executive function (the brain's ability to connect past experience and present action) than they did before the procedures
Five other neuropsychological tests measuring various aspects of memory and cognitive function showed no change following the surgery.
"Our findings suggest the brain is another organ that benefits from weight loss induced by surgery," Cercato said. "The increased brain activity the obese women exhibited before undergoing surgery did not result in improved cognitive performance, which suggests obesity may force the brain to work harder to achieve the same level of cognition."
“It seems that metabolic and inflammatory properties associated with obesity in young adults are accompanied by changes in the cerebral metabolism capable of being reversed with weight loss,” the authors conclude. “Further studies are required to improve the understanding of the pathogenesis of the cognitive dysfunction related to obesity and the effects of weight loss on the occurrence of dementia.”