How Psychological Characteristics Affect Outcome & Success

A comparison of behavioural and psychological characteristics of patients opting for surgical and conservative treatment for morbid obesity

Patients use choose bariatric surgery compared to conservative weight loss treatments, had more positive expectations of the treatment outcomes and stronger beliefs, according to researchers from the Oslo Bariatric Surgery Study (OBSS). The paper titled, ‘A comparison of behavioural and psychological characteristics of patients opting for surgical and conservative treatment for morbid obesity’ published in the BMC Obesity, also stated that patients starting conservative treatment had stronger beliefs in readiness to change physical activity levels.

It is known that a patient’s psychological characteristics can impact the success from bariatric surgery. Previous studies looking at the differences between surgical and non-surgical patients have focused on psychopathological factors, such as depression, anxiety, eating disorders or problematic eating behaviours. The most consistent finding is that surgical patients more frequently report high levels of depressive symptoms than non-surgical patients.

The aim of the study was to compare patients scheduled for bariatric surgery with patients receiving conservative treatment for morbid obesity on measures of behavioural and psychosocial characteristics. This then was considered predictors of their adoption of and adherence to long-term lifestyle recommendations. The study measured characteristics in both groups, such as self-efficacy, motivation, goal attainment, mental health, and social support.

The study used the data from the Oslo Bariatric Surgery Study which is a prospective study on the two groups of patients that will be followed up over a period of 10 years. The clinical paper goes into detail on the measures used to recruit patients and their outcomes. The results showed that the surgical group were younger, a higher percentage were female and had a higher BMI. Patients belonging to this group also reported a high frequency of drinking soda, using unhealthy weight reduction methods and had a family history of obesity. In addition they had a longer history of dieting, participated more often in organised weight loss programmes and had lost more than 10 kilos in the past.

Overall there were few differences regarding self-evaluative and mental health factors. The surgical group reported higher levels of depressive symptoms and fewer binge eating episodes. They also exhibited more dispositional resilience and a realistic life orientation and structured style giving them the ability to keep daily routines, to plan and to be organised compared to the non-surgical group.

The researchers report that the most notable group difference were that the patients opting for bariatric surgery scored higher on factors considered central to initiating and maintaining behaviour change, such as higher general self-efficacy, weight loss goals, and expectations of increased well-being in the future, as a result of the surgery.

“The pre-treatment differences in psychological predictors indicate that the results of studies addressing effective behaviour change and weight loss maintenance programmes for conservative weight loss treatment patients may, with some adjustments, also apply to patients undergoing bariatric surgery” the researchers write…..

“Our findings imply that future research may examine how high outcome goals and expectations interact with depressive symptoms depending on the degree of weight loss throughout the post-operative course”. They concluded that future studies should explore the effect of interventions for bariatric surgery patients, promoting post op physical activity and stressing realistic outcome expectations.

Reference: BMC Obesity BMC Series 2016 3:6 DOI:10.1186/s 40608-016-0084-6


Authors: Ingela Lundin Kvalem, Irmelin Bergh, Tilmann von Soest, Jan H Rosenvinge, Tina Avantis Johnsen, Egil W Martinsen. Tom Mala and Jon A Kristinsson