Surgery type and psychosocial factors contribute to poorer weight loss outcomes in persons with a body mass index greater than 60 kg/m 2 .

BACKGROUND: The current investigation aims to predict 3-year postoperative percent total weight loss among a sample of bariatric surgery patients with super-super obesity.

OBJECTIVE: Previous research implies that persons with presurgical super-super obesity (body mass index [BMI] ≥60 kg/m2 ) tend to have poorer loss outcomes compared with those with a lower presurgical BMI after bariatric surgery.

SETTING: Cleveland Clinic, Bariatric & Metabolic Institute, Cleveland, OH.

METHODS: Bariatric surgery candidates (N = 1231; 71.9% female; 65.8% Caucasian) completed a presurgical psychological evaluation and the Minnesota Multiphasic Personality Inventory-2-Restructured Form. Participants with a baseline BMI ≥60 (n = 164) were compared with BMI<60 (n = 1067) on psychosocial and demographic factors, the Minnesota Multiphasic Personality Inventory-2-Restructured Form, and in the subset that had surgery (n = 870), percent total weight loss extending to the 3-year follow-up.

RESULTS: Patients with a BMI ≥60 were younger, less educated, and more likely to be male compared with lower BMI patients. Patients with a BMI ≥60 had greater psychosocial sequelae as evidenced by being more likely to have a history of sexual abuse, history of psychiatric hospitalization, more binge eating episodes, and higher prevalence of major depression disorder and binge eating disorder. On the Minnesota Multiphasic Personality Inventory-2-Restructured Form, those with BMI ≥60 reported greater demoralization, low positive emotions, ideas of persecution, and dysfunctional negative emotions. After controlling for surgery type, weight loss for individuals with BMI ≥60 did not greatly differ from weight loss in patients with BMI<60. Variables predictive of less weight loss at 3 years regardless of presurgical BMI, included being older, having a sexual abuse history, and higher ideas of persecution scores.

CONCLUSION: Although patients with BMI ≥60 evidenced more psychopathology before surgery, findings suggest that the relationship between higher BMI and poorer outcome may better be explained by other co-morbid factors.