Psychological factors relating to postoperative outcome to gastric bypass surgery for morbid obesity

This investigation marked the initial phase of a longer-term research study of patients undergoing a gastric bypass for morbid obesity. The purpose was for the enhanced understanding of the problem of morbid obesity and identifying the psychological factors relating to postoperative outcome to gastric surgery. A sample of 44 consecutive patients of the Obesity Consult Center at Tufts-New England Medical Center, were evaluated preoperatively with 39 patients ultimately having the surgery. The contribution of psychological factors was examined with the Millon Behavioral Health Inventory, (MBHI), and a semistructured interview (SI), specifically designed for the study and for the initial intake interview. Patients were classified based on characteristic coping styles with the MBHI. Extensive demographic data, weight history, eating behaviors and self reported reasons for overeating, as well as their expectations for amount of weight loss and for life changes via the weight loss were examined with the SI. The sample was mostly women, demographically mixed, with an average age of 36 years old, and preoperative weight of 306 pounds. Most were employed, with at least a high school education. The results demonstrated that patients lost an average of 35 percent of their total body weight after two years and attended follow-up appointments for at least one year. Greater percent weight change (all patients lost weight) was related to the following variables: patients who were not expecting major changes in their physical activity, patients who described themselves as average weight entering kindergarten, patients who had utilized behavior modification to lose weight in the past, patients who weighed less preoperatively and patients who scored high on the MBHI-5: Confident Style scale. Greater compliance with follow-up appointments (CFA) was found for those patients scoring high on the following MBHI scales: Cooperative and Respectful. Better CFA was also found for patients who: did not indicate they were having surgery to avoid future medical disability, were expecting improvement in their self-concept, did not indicate boredom was a reason for their overeating and who had previously attempted psychotherapy to lose weight. The relative importance of these findings along with limitations of the study are discussed