Psychosocial Outcome of Gastric Bypass Surgery for Patients With and Without Binge Eating

Background: There is limited data on the prevalence of eating disorder pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGBP) and the degree to which this may affect surgical outcome. The present study examined surgical outcome between 2 groups of patients undergoing RYGBP: those with pre-surgical binge eating (BE) and those without pre-surgical binge eating (NBE). Methods: This study tested the hypothesis that the BE group would demonstrate greater pathology on measures of eating pathology, psychological wellbeing, and quality of life than the NBE group both pre- and post-surgery. Results: Compared with the NBE group, the BE group had significantly higher levels of disinhibited eating, and hunger, and significantly lower levels of social functioning at pre-surgery and 6 months post-surgery. The BE group had a significantly lower percentage of excess weight lost than the NBE group at 6 months post-surgery. Conclusions: These findings indicate a less successful outcome for the BE patients compared with the NBE patients. While there were more distinct differences between the BE and NBE groups before surgery, they were largely impossible to differentiate on psychosocial measures at post-surgery.     

Binge Eating,Quality of Life and Physical Activity Improve after Roux-en-Y Gastric Bypass for Morbid Obesity

Background: Severe obesity has been associated with disordered eating, impaired quality of life (QoL), and decreased physical activity.This study examines changes in these variables 6 months after Roux-en-Y gastric bypass (RYGBP). Methods: 40 morbidly obese patients were evaluated at baseline and at 6 months after RYGBP on the following measures: Binge Eating Scale, Three Factor Eating Questionnaire, Impact of Weight on Quality of Life-Lite (IWQoL-Lite), and the Baseline Questionnaire of Activity. Results: 6 months after RYGBP, weight loss averaged 26.7%, and scores on measures of disordered eating, weight-related QoL, and physical activity showed statistically significant improvement from baseline. At the time of follow-up, 100% of participants achieved a score on the Binge Eating Scale that indicated no binge eating problems, and weight-related QoL scores approached those obtained by a reference sample of community volunteers. There were also improvements in the level of self-reported physical activity and television watching behavior. Conclusions: RYGBP resulted in significant improvements in disordered eating, weight-related QoL, and physical activity in addition to weight loss.     

Quality of Life in Morbidly Obese Patients after Surgical Weight Loss

Background Laparoscopic adjustable gastric banding (LAGB) is seen as a safe surgical procedure in individuals with morbid obesity, with satisfactory weight loss and significant postoperative improvement in quality of life (QoL). The present study investigates the predictive value of various parameters such as age, gender, weight loss, and preoperative psychiatric disorders with regard to QoL after LAGB. Methods 300 obesity surgery patients were sent questionnaires to assess a variety of personal parameters. QoL was assessed using the Ardelt-Moorehead Quality of Life Questionnaire. Questionnaires were completed by 140 (63%) female patients and 36 (45%) male patients. Results Average weight loss in both sexes was 14.7 kg/m²; however, not all patients successfully lost weight. No difference was seen in satisfaction with weight loss among the age groups. Some correlations were seen between the amount of weight loss and QoL scores in females, but not in males. Greater weight loss showed a statistically significant positive correlation to self-esteem, physical activity, social relationships, sexuality, and eating pattern. Obese females with no preoperative psychiatric diagnosis had better self-esteem, more physical activity, and more satisfying social and sexual relationships than those with psychiatric diagnoses at follow-up. Conclusion A majority of morbidly obese patients show psychological and interpersonal improvement after surgery. However, some obese patients, particularly those having a preoperative psychiatric or personality disorder, need more individual strategies for psychosocial intervention than do obese individuals with no psychiatric disorder.     

Emotional Eating in a Morbidly Obese Bariatric Surgery-Seeking Population

Background The impact of presurgical eating patterns on postoperative outcomes is poorly understood. The results of previous studies are mixed regarding the impact of presurgical binge eating on weight loss after surgery. However, many patients describe other maladaptive eating patterns prior to surgery, such as eating in response to emotions.The goals of this study were to describe presurgical emotional eating patterns in morbidly obese individuals, determine whether these individuals were binge eaters, and assess the effect of this eating behavior on weight loss after surgery. Methods Prior to surgery, 144 Roux-en-Y gastric bypass (RYGBP) patients completed the Questionnaire of Eating and Weight Patterns (QEWP) or QEWPRevised (QEWP-R) and the Emotional Eating Scale to assess eating patterns prior to surgery. Their eating behavior, levels of depression, and weight were assessed after surgery. Results High emotional eaters tended to have higher levels of depression, binge eating, and eating in response to external cues than low emotional eaters prior to surgery.However, there appeared to be a distinct group of individuals who were high emotional eaters but who did not engage in binge eating. At a mean of 8 months after surgery, High Emotional Eaters and Low Emotional Eaters were indistinguishable on these subscales and there were no differences in weight lost. Conclusions RYGBP has an equally positive impact on eating behavior and weight loss for both High Emotional Eaters and Low Emotional Eaters. Further replication is needed with longer follow-up times and larger samples.     

MMPI-2 Scores in the Outcome Prediction of Gastric Bypass Surgery

Background: A psychological assessment is critical for morbidly obese patients seeking Roux-en-Y gastric bypass (RYGBP) surgery. The Minnesota Multiphasic Personality Inventory (MMPI) has been widely used in past psychological studies of bariatric surgery patients, but, to date, there is no published research on the more recent version of the MMPI, the Minnesota Multiphasic Personality Inventory-2 (MMPI2), and its relation to RYGBP outcome.This investigation was designed to evaluate the predictive validity of the MMPI-2 with respect to outcome of RYGBP for morbid obesity. Methods: The research involved a retrospective analysis of MMPI-2 scores of 2 groups of patients 1 year following RYGBP: 1) those who lost ≥ 50% of their excess weight and 2) those who lost <50% of their excess weight. Subjects were 52 morbidly obese patients (mean age 44 years, mean BMI 56 kg/m2).The measurement of psychological variables consisted of the MMPI-2 scores of 3 validity scales, 10 clinical scales, and 3 Content Scales, and BMI. Results: Those who lost <50% excess weight scored significantly higher than those who lost >50% excess weight on the F,Hysteria, Paranoia, and Health Concerns scales of the MMPI-2, and significantly lower on the Masculinity-femininity scale. Stepwise regression analysis found that a combination of the Health Concerns and Masculinity-femininity scales was the most accurate predictor model for 1-year post-surgery weight loss. Conclusion: A standard personality measure, the MMPI-2, appears to be associated with weight loss outcome 1 year after RYGBP. Psychological traits such as anxiety and excessive health concerns are likely to influence bariatric surgical outcome.     

Eating Behavior as a Prognostic Factor for Weight Loss after Gastric Bypass

BACKGROUND: Binge-eating disorder (BED) may be associated with unsatisfactory weight loss in obese patients submitted to bariatric procedures. This study aims to investigate whether the presence of binge eating before Roux-en-Y gastric bypass (RYGBP) influences weight outcomes. METHODS: In a prospective design, 216 obese patients (37 males, 178 females, BMI=45.9 +/- 6.0 kg/m2) were assessed for the lifetime prevalence of BED and classified at structured interview into 3 subgroups: no binge eating (NBE=43), sub-threshold binge eating (SBE=129), and binge-eating disorder (BED=44). All patients were encouraged to take part in a multidisciplinary program following surgery, and weight loss at follow-up was used as the outcome variable. RESULTS: At 1-year follow-up, NBE patients (n=41) showed percent excess BMI loss (%EBL) significantly higher than SBE patients (n=112) (P=0.027), although this effect was not significantly different between NBE and BED patients (n=44). At 2-year follow-up, NBE patients (n=33) showed %EBL higher than SBE (n=64) (P=-0.003) and BED patients (n=34) (P<0.001). Nevertheless, we found no significant weight loss differences between SBE (subclinical) and BED (full criteria) patients at any period of follow-up. Preliminary results at 3-year follow-up suggest that such an effect may be enduring. CONCLUSION: The presence of a history of binge eating prior to treatment is associated with poorer weight loss in obese patients submitted to RYGBP. Because BED is highly prevalent in obese patients seeking bariatric surgery, its early recognition and treatment may be of important clinical value.     

Gastric Bypass in a Japanese Man with Prader-Willi Syndrome and Morbid Obesity

Background: In Prader-Willi syndrome (PrWS), marked obesity is the most serious and common complication, contributing significantly to morbidity and mortality. Because of the associated psychosocial difficulties, bariatric surgery appears to be the only effective treatment. Case Report: A 30-year-old man with PrWS weighing 108 kg (BMI 50 kg/m²), underwent Roux-en-Y gastric bypass (RYGBP). 3 months before the RYGBP, he weighed 146 kg (BMI 68.5), partly because of heart failure. 18 months after RYGBP, he weighed 92.4 kg (BMI 43.3), with no postoperative complications. Moreover, he showed considerable increase in serum HDL-cholesterol levels with reciprocal reduction in LDL-cholesterol after the surgery. Conclusion: RYGBP resulted in satisfactory weight loss and improvement in serum lipid profile in a Japanese morbidly obese patient with PrWS.     

Predictors of psychological symptoms in morbidly obese patients after gastric bypass surgery

BackgroundMorbid obesity is associated with debilitating psychosocial consequences, such as depression, anxiety, and low self-esteem. One of the main goals of bariatric surgery should not only be reducing weight and counteracting co-morbid conditions, but also improving postoperative psychosocial functioning. The objective of our study was to determine the preoperative variables that could predict the psychological symptoms 6 and 12 months after surgery to improve the clinical outcome of morbidly obese patients undergoing bariatric surgery. The setting was a university hospital in Spain.MethodsThe study group consisted of 60 morbidly obese patients (46 women and 14 men) who had undergone gastric bypass surgery for weight reduction and had ≥1 year of follow-up. The patients were evaluated using different questionnaires (Symptom Checklist-90-Revised, Body Shape Questionnaire, Rosenberg Self-Esteem Questionnaire, COPE, Medical Outcomes Study Social Support Survey) at 3 points: before surgery, at 6 months postoperatively, and at 1 year postoperatively. To determine the influence of preoperative variables on long-term psychological status, a step-by-step multivariate linear regression analysis was performed, taking P < .05 as statistically significant.ResultsThe variables of self-esteem, instrumental support, and coping focused in the emotions were the main preoperative predictors for psychological symptoms 6 months after surgery. Preoperative drug abuse as a strategy of problem solving and mainly body image significantly predicted most of the psychological disorders 1 year after surgery.ConclusionThe study of different psychosocial variables in patients before bariatric surgery is an important aid to predict postoperative psychological functioning. Self-esteem and body image were the most influential factors in the postoperative psychological outcome of morbidly obese patients in our study.     

Psychosocial Predictors of Weight Loss after Bariatric Surgery

Background: The authors investigated the predictive value of various parameters such as age, preoperative weight, eating behavior, psychiatric disorders, adverse childhood experiences and self-efficacy with regard to weight loss after gastric restrictive surgery. Methods: After a minimum follow-up of 30 months (median follow-up 50 months; range 30-84 months), a questionnaire concerning extent of, satisfaction with, and consequences of weight loss was mailed to 220 morbidly obese female patients following laparoscopic Swedish adjustable gastric banding (SAGB). Results: Questionnaires were completed and returned by 140 patients (63%). Average BMI loss was 14.6 kg/m². Most patients (85%) were happy with the extent of weight loss. Satisfaction with weight loss showed a significant correlation with extent of weight loss. BMI loss was greatest in the obese with an atypical eating disorder (20.0 kg/m²), and BMI loss was least in the obese with no eating-disordered behavior before surgery (13.4 kg/m²). Obese patients with two or more psychiatric disorders showed significantly less weight loss than did obese patients with one or no psychiatric disorder (BMI units 10.8 vs 14.0 vs 16.1; P=.047). Conclusions: The findings indicate a less successful outcome for obese patients with psychiatric disorders (particularly adjustment disorders, depression and/or personality disorders), compared to patients not mentally ill. An eating disorder preceding surgery, however, was not a negative predictor of success following bariatric surgery. To improve outcome of bariatric surgery in obese patients with psychiatric disorders, more individual psychosocial intervention strategies are necessary.     

Long-Term Health-Related Quality of Life Following Gastric Bypass: Influence of Depression

Background: Severe obesity has been associated with impaired quality of life (QoL). We evaluated the long-term health-related quality of life (HRQoL) after gastric bypass. Methods: A cross-sectional study was conducted on 50 morbidly obese patients >5 years after gastric bypass and on a control group of 78 non-operated morbidly obese patients. Both groups were evaluated for the EuroQol 5D measure and the Goldberg General Health Questionnaire. In addition, the Bariatric Analysis of Reporting Outcome System (BAROS) was applied to the surgical group. Depression and severe life events were included in the analysis. Logistic Regresion Model was used, and age was included in the analysis. Results: Groups were similar except for mean age (lower in the surgical group: 40.5±9.0 vs 46.1±8.8 years, P=0.026). 86.5% of patients had >50% Excess Weight Loss. 85.7% showed an improvement in co-morbid conditions. BAROS Global score: 22% excellent, 56% very good, 18% good, 2% fair and 2% failure. After surgery, significant improvements were reported in self-esteem (94%), work conditions (72.6%), physical activity (66.7%), and sexual interest/activity (50.9%). The control group showed poorer results for the EuroQol 5D in mobility (55% vs 21.6%, P=0.005), difficulty with daily activity (55% vs 13.7%, P=0.005) and self-evaluation of well-being (59.2% vs 78.1%, P=0.005). Patients with depression or insufficient weight loss following surgery presented poorer global evaluation in HRQoL. Conclusion: Gastric bypass resulted in significant long-term improvements in co-morbidities, sustained weight loss and increased HRQoL. Depression and insufficient weight loss were associated with poorer HRQoL in surgical patients.     

Expectations and Outcomes with Gastric Bypass Surgery

Background: Bariatric surgery is widely accepted as the effective treatment option for morbid obesity. However, the extant literature does not provide mental health clinicians with consistent guidance for evaluating candidates for surgery, nor for preparing patients for postsurgical adjustment. Among both bariatric clinicians and patients, there are commonly endorsed expectations about who will do well postoperatively and what the psychosocial impact of the surgery and weight loss will be. The current study surveyed our patient population regarding the accuracy of these expectations. Methods: Medical charts were reviewed and surveys mailed to all 194 patients who had undergone the Roux-en-Y gastric bypass (RYGBP) at University of New Mexico Hospital prior to April 2003. Surveys explored patients' expectations and actual experiences with RYGBP and the subsequent changes in their physical and psychosocial status. Results: Completed surveys received from 47.9% of the patients reported significant improvements in physical health, emotional status, and binge eating. These improvements were seen across the entire sample, regardless of the presence of preoperative psychological distress, and were unrelated to the degree of weight loss. Professional and non-romantic relationships benefited from the impact of weight loss, but romantic relationships appeared unaffected. There were no significant changes in occupational status. Conclusion: The impact of bariatric surgery appears sufficiently potent to negate whatever preoperative differences might otherwise affect weight management. It may be time for the field to cease its search for surgical outcome predictors and focus instead on improving postoperative support.     

Correlates of Body Image Dissatisfaction in Extremely Obese Female Bariatric Surgery Candidates

Background: This study investigated correlates of body image dissatisfaction in 131 extremely obese female bariatric surgery candidates. Methods: Female gastric bypass surgery candidates participating in a comprehensive psychiatric evaluation completed a battery of established self-report measures of body image and psychosocial functioning. Nine predictors of body image dissatisfaction were considered: body mass index (BMI), ethnicity, childhood onset of obesity, childhood teasing about weight, binge eating, depression, self-esteem, shame, and perfectionism. Results: Stepwise multiple regression analysis revealed that the nine variables jointly accounted for 48% of the variance; three variables, depression, self-esteem and perfectionism, made significant independent contributions. Conclusion: Our findings highlight the importance of adult psychological functioning (depression, self-esteem and perfectionism) for predicting body image dissatisfaction in extremely obese female bariatric surgery candidates.     

Amiodarone-induced Hyperthyroidism during Massive Weight Loss Following Gastric Bypass

Gastric bypass is increasingly used in morbidly obese patients to achieve significant reduction of body weight and fat mass and concurrent improvement in co-morbidities. We report the case of a 53-year-old male patient (141 kg, BMI 50 kg/m2), successfully treated by amiodarone for supraventricular arrythmia, who underwent Roux-en-Y gastric bypass (RYGBP). 6 months after surgery, he had lost 45% of his preoperative weight (44.8% of weight loss was lean mass) and developed amiodarone-induced subclinical hyperthyroidism. We hypothesize the following sequence of events: weight loss after RYGBP, therefore fat loss, decrease in distribution volume of amiodarone inducing iodine overload and hyperthyroidism, reinforcing weight loss and particularly loss of lean mass. This report emphasizes the importance of careful monitoring of weight and body composition changes after RYGBP. In this situation, checking thyroid status is recommended, especially when there is a history of thyroid disease or potentially toxic thyroid medication.     

Outcome of Esophageal Function and 24-hour Esophageal pH Monitoring after Vertical Banded Gastroplasty and Roux-en-Y Gastric Bypass

Background: One of the co-morbidities frequently associated with morbid obesity is gastro-esophageal reflux disease (GERD), present in >50 % of morbidly obese individuals. We compared the anti-reflux effect of vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGBP), and their effect on esophageal function. Methods: 10 patients underwent VBG and 40 patients underwent RYGBP. Anthropometric parameters, symptomatology of GERD, esophageal manometry (EM), isotopic esophageal emptying (IEE) and 24hr esophageal pH monitoring were recorded in all patients preoperatively, and at 3 months and 1 year postoperatively. Results: Preoperatively, there was a high prevalence of GERD, symptomatic and pH-metric in both groups (57% and 80% respectively). The preoperative values of EM and IEE parameters were within the normal range in most patients. After surgery, there was an improvement at 3 months postoperatively in both groups. 1 year after surgery, the VBG group presented symptomatic GERD in 30% and pH-metric reflux in 60% of patients while the RYGBP group presented symptomatic GERD and pH-metric reflux in 12.5% and 15% of patients, respectively. There was an increase in postoperative sensation of dysphagia in both groups (70% VBG, 30% RYGBP) one year after operation. After surgery, differences in all EM parameters were minimal, and never reached statistical significance for any group (VBG and RYGBP). The IEE showed a significantly higher percentage of esophageal retention after surgery, but this retention was always within the normal range. Both groups had an improvement in anthropometric parameters, but 1 year after surgery the results were significantly better in RYGBP patients (70% excess weight loss) than in VBG patients (46% excess weight loss). Conclusion: >50% of morbidly obese individuals suffer from GERD. We did not find changes in esophageal function of morbidly obese patients to explain their gastroesophageal reflux preoperatively and postoperatively. EM and IEE studies are not indicated as standard preoperative tests, except in patients with significant symptoms of gastroesophageal reflux. RYGBP is significantly better than VBG as an anti-reflux procedure, and had better weight loss.     

A Prospective Comparison of Vertical Banded Gastroplasty and Roux-en-Y Gastric Bypass in a Non-Superobese Population

Background: In the non-superobese population, consensus is currently unavailable in bariatric surgery. We report the results of a prospective comparison of vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGBP) in a non-superobese population. Methods: From 1994 to 2000, 179 patients with clinically severe obesity underwent various surgical procedures in our department. During this time a prospective study was undertaken in order to compare VBG with RYGBP in morbidly obese patients with a BMI <50 kg/m². Based on specific criteria including eating behavior, 68 patients were selected to undergo RYGBP and 35 VBG. All patients have undergone complete follow-up evaluation at 1, 3, 6, and 12 months postoperatively and every year thereafter. Results: All patients have now completed their 5th postoperative year. Mean follow-up period to date is 96.5±12.2 months for VBG and 67.6±11.3 months for RYGBP. 3 patients (8.6%) in the VBG group and 9 patients (13.2%) in the RYGBP group are lost to follow-up. Mean excess weight loss (EWL) was always better in the RYGBP group (P=0.0013). The percentage of failure, defined as EWL <25%, was not significantly different between the two procedures. No statistically significant differences were observed between the 2 groups in the total number of non-metabolic complications, and the only statistically significant difference observed in metabolic complications was vitamin B₁₂ deficiency after RYGBP. Frequency of vomiting was significantly less and quality of eating significantly better in RYGBP than in VBG patients. Conclusion: This prospective long-term study, with nearly complete follow-up, suggests that in the non-superobese population, preoperative eating habits may play a role in choosing the most appropriate bariatric operation for each patient. Although RYGBP is associated with better mean weight loss outcomes, the percentage of patients who achieved and maintained ≥50% EWL after VBG in this pre-selected patient population was not significantly different. Each type of operation has advantages and disadvantages, and, if properly chosen, a purely restrictive procedure can be successful for some patients. Therefore, it can be said that the decision regarding which bariatric procedure to perform in non-superobese patients must be based on in-depth preoperative evaluation as well as the patients' own preferences and outcome expectations.     

Outcome following Gastric Bypass Surgery: Impact of Past Sexual Abuse

Background: This study examined gastric bypass (GBP) outcome in 2 groups of morbidly obese females: those with a history of sexual abuse (SA) and those without a history of sexual abuse (NSA). Methods: Subjects were assessed preoperatively and at one of two time points following surgery: either 5 to 9 months or 10 to 14 months. Outcome measures included BMI, level of depression as measured through the Beck Depression Inventory (BDI), and level of self-esteem as measured through the Rosenberg Self-Esteem Scale (RSE).T-tests were conducted for pre and post scores between the 2 groups on each of the variables. Results: Of the 12 tests conducted, the only statistically significant difference was on BDI scores for the 5 to 9 month post-surgery groups, with the SA groups showing a significantly higher level of depression than the NSA group. Conclusions:The results suggest that females with a history of sexual abuse are as successful with weight loss following GBP as those without a history of abuse.While females with a history of sexual abuse show significantly more depression 5 to 9 months after surgery, they are indistinguishable from those without a history of abuse 1 year following GBP.Thus, sexual abuse does not appear to be a negative prognostic indicator for GBP.     

Psychopathological Status and Interpersonal Functioning Following Weight Loss in Morbidly Obese Patients Undergoing Bariatric Surgery

Background: We questioned whether differences in psychopathological status and interpersonal relations exist in a group of morbidly obese patients 18 months after bariatric surgery,as related to extent of weight loss. Methods: The study group consisted of 100 morbidly obese patients (85 female, 15 male) who had undergone surgical treatment (vertical banded gastroplasty) for weight reduction. Each patient completed the Lancashire Quality of Life Profile - European version, the Eating Disorder Inventory,the Symptom Check List-90-Revised, and the Millon Clinical Multiaxial Inventory-II. The sample was divided into 2 groups according to the percentage of excess weight loss 18 months after surgery: a greater weight loss group (weight loss >30%) and a lesser weight loss group (weight loss <30%). Results: Significant differences were found between the 2 groups in percentage of weight loss (P<0.0001), negative self-esteem (P<0.001), drive for thinness (P<0.001), body dissatisfaction (P<0.001), global EDI (P<0.002), anxiety (P<0.003), GSI (P<0.002), avoidant (P<0.001), borderline (P<0.0001), and passive-aggressive (P<0.002). Conclusion: Greater weight loss strongly correlates with improved quality of life, less disturbed eating behavior, and lower psychopathology. These results justify the clinical use of surgical procedures and demonstrate that weight loss has powerful psychological and psychosocial implications.     

Laparoscopic Adjustable Gastric Banding in a Morbidly Obese 18-year-old with Hypertrophic Cardiomyopathy

In this case report, we present an 18-year-old morbidly obese male with complicating hypertensive cardiomyopathy who underwent laparoscopic adjustable gastric band surgery. The patient had multiple comorbidities associated with his obesity, including obstructive sleep apnea, systemic hypertension, asthma, and depression. Given the severity of his underlying cardiac pathology and multiple previously unsuccessful attempts at weight loss with conventional medical and behavioral therapy, the patient opted to proceed with surgical intervention. We present this laparoscopic adjustable gastric banding surgical case to demonstrate the impact of surgical weight reduction on cardiac risk factors in a morbidly obese adolescent, highlighting the viability of this surgery for patients with existing cardiac dysfunction.     

The relationship between weight loss and psychosocial functioning among bariatric surgery patients

Background

Success after bariatric surgery should also reflect improvement in psychosocial functioning. The objective of this study was to assess the relationships between both mental health and eating disorders and weight loss in morbidly obese patients 2 years after gastric bypass.

Methods

Forty-three obese women (mean age, 39.3 ± 1.4 years; mean body mass index, 44.7 ± 0.4 kg/m²) were evaluated before and 1 and 2 years after gastric bypass. The Beck Depression Inventory and the Hospital Anxiety and Depression Scale were used for depression and anxiety evaluation and the Eating Disorder Inventory for eating disorder assessment.

Results

Decreases in depression (P <.01), anxiety (P <.05), and eating disorder (P <.01) scores were measured 2 years after surgery. Both excess weight loss and change in body mass index were associated with improvements in all measured psychologic outcomes 2 years after surgery.

Conclusions

The importance of weight loss is in relation to mental health 2 years after bariatric surgery. Psychologic outcomes and eating disorders did not predict weight loss 2 years after gastric bypass. However, these factors improved significantly after weight loss.     

The Effects of Roux-en-Y Gastric Bypass Surgery on Body Image

Background: Numerous studies examine the physical effects of Roux-en-Y gastric bypass (RYGBP) surgery on morbid obesity. However, the effects of this surgery on psychosocial issues such as body image have not been extensively studied. Methods: This pilot study used a cross-sectional design to examine the effects of RYGBP surgery on patients' perceived body image. Four groups (n=20) were assessed for perceived change in body image at 4 time intervals.These included pre-surgery,1 to 3 weeks post-surgery, 6-months post-surgery, and 1- year post-surgery,with two measures of body image. One-way ANOVA was applied, with body image measures as the dependent variables, and time since surgery (group) as the independent variable. Planned post-hoc t-tests were applied to assess the differences between specific groups (pre vs. 1 week, pre vs. 6 months post, 6 months post vs. 1 year post). Results: Results of the one-way ANOVAs revealed significant improvement on perceptions of body image over time following surgery. Follow-up t-tests revealed that the most significant improvement occurred between pre-surgery and 6 months postsurgery. Although smaller, the change between 6 months post-surgery and 1 year post-surgery was also significant. Conclusion: While RYGBP results in numerous medical and physical benefits, this study reveals that there are also dramatic improvements in perceived body image, demonstrating the impact of this surgery on a patient's psychosocial health.