Psychosocial Issues and Bariatric Surgery

Study Overview
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Brief Summary
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Bariatric surgery is associated with long-term weight loss, as well as short-term improvements in obesity-related medical comorbidities. However, a significant proportion of patients fail to lose sufficient weight, or experience significant weight regain. Although no robust predictors of response have been identified, pilot data that will be presented and reviewed suggest that surgery has profound effects on eating behaviors and psychosocial functioning, and that these factors may affect postoperative weight control. The present investigation capitalizes on the Longitudinal Assessment of Bariatric Surgery (LABS) consortium to conduct an in-depth examination of the psychosocial aspects of surgery among a geographically, ethnically, and racially diverse sample of men and women undergoing bariatric surgery. This project unites experts in the areas of psychopathology, eating behaviors and quality of life to conduct a naturalistic study using state-of-the-art assessment tools; to document the relationships among psychosocial factors; and to examine psychosocial predictors of surgical outcomes.

Detailed Description
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Primary Objective. Despite the obvious impact of bariatric surgery procedures on intake, no study to date has included a careful assessment of psychological factors, feeding patterns, energy intake and eating problems in this group of patients longitudinally. The Investigators believe that a careful examination of the structure of eating behavior and eating problems (e.g. vomiting) would be very helpful in guiding bariatric surgeons and dieticians who work with this group of patients in terms of dietary advice and recommendations, and with the prediction of eating problems and poor nutrient intake in the subgroup that develops such problems. This study involves prospective assessment of psychosocial outcomes of surgery by adding a supplemental battery to the LABS-2 assessment schedule. Conducting assessments at three of the LABS clinical sites assures the geographic, ethnic, and racial diversity of the sample, and hence enhances the potential to identify a subgroup or subgroups of patients susceptible to poor outcomes after surgery and the generalizability of study results. This study would also include an evaluation of psychopathological and behavioral variables that might impact on weight loss and weight regain, and psychosocial complications post-operatively, as well as quality of life. The overall goal of this study is to obtain detailed information that will allow a careful assessment of psychopathology, quality of life and eating behavior pre-surgically and at regular intervals for up to 7 years after the surgical intervention. The Investigators believe that the instruments and procedures selected will allow a detailed examination of psychopathology, eating pathology and quality of life in detail. The Investigators believe that the measures and tasks added at year 7 will allow the examination of theories of affect regulation, cognitive control, and reward processing in understanding postsurgical outcomes regarding pathological eating behavior and alcohol/substance use and their shared similarities as well as underlying neurobiological systems.

Official Title
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Psychosocial Issues and Bariatric Surgery

Conditions
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Obesity, Eating Disorders, Bariatric Surgery Candidate, Depressive Disorder

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male and female patients who are at least 18 years of age and undergo bariatric surgery by a LABS certified surgeon. Previous enrollment in LABS-1 and LABS-2. BMI at baseline of greater than or equal to 35. Exclusion Criteria: Informed consent not obtained Type 1 Diabetes Mellitus Unlikely to comply with follow-up protocol (ie: geographically inaccessible for study visits) Unable to communicate with local study staff

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Psychopathology as measured by the SCID | Structured Clinical Interview for DSM-IV, Patients Edition (SCID) will be administered to assess comorbid Axis I psychopathology. | annually up to 7 years post bariatric surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Quality of life as measured by the IWQOL | Impact of Weight on Quality of Life Questionnaire: This is a 31-item, self-report, obesity-specific quality of life measure that will be utilized to assess quality of life. | annually up to 7 years post bariatric surgery | 
| Change in Quality of life as measured by the SF-36 | ShortForm-36: The SF-36 is a 36-item questionnaire that assesses functioning and quality of life as it relates to health status. | annually up to 7 years post bariatric surgery | 
| Change in Depression as measured by the BDI | Beck Depression Inventory: The BDI is a 21-item instrument that is widely used to assess depressive symptoms. | annually up to 7 years post bariatric surgery | 
| Change in Eating behaviors as measured by the EDE | Eating Disorder Examination: The diagnostic version of the EDE will be used as the primary measure of eating behavior and pathology. | annually up to 7 years post bariatric surgery | 
| Change in Impulse Control as measured by the SCID-ICD module | The impulse control module of the SCID will be administered to assess impulsive/compulsive disorders for participants. | annually up to 7 years post bariatric surgery |