Gordon Pedro Caldana, Sallet José Afonso, Sallet Paulo Clemente
Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,
Obes Surg. 2014 Oct;24(10):1647-55. doi: 10.1007/s11695-014-1229-7.
A significant proportion of patients who undergo bariatric surgery fail to achieve enduring weight loss. Previous studies suggest that psychosocial variables affect postoperative outcome, although this subject is still considered unclear. The purpose of this study is to further investigate the impact of psychosocial variables on Roux-en-Y gastric bypass (RYGB) outcomes over long-term follow-up.
Individuals eligible for bariatric surgery were evaluated using validated psychopathological scales and the Temperament and Character Inventory in a specialized clinic for bariatric treatment. Adult patients who had RYGB were selected for the study. Percent of excess weight loss (%EWL) was measured after surgery at 6 months, 1 year, 2 years, and on the last clinical observation.
This study included 333 subjects who had RYGB. Before surgery, mean age was 35.4 years (±9.5) and mean BMI was 43.3 kg/m(2) (±4.8). Higher baseline age and BMI were associated with lower %EWL across endpoints, although this association diminished over time. Follow up at 2 years and on the last clinical observation demonstrated that lower scores on the persistence personality variable and lower body dissatisfaction before surgery predicted lower %EWL.
Psychosocial variables and personality traits assessed during preoperative evaluation significantly predicted weight loss after bariatric surgery. Greater impact was observed in long-term follow-up at 2 years. These findings provide guidance in identifying patients at risk for worse outcomes and designing interventions to improve long-term weight loss.
相当一部分接受减肥手术的患者未能实现持久的体重减轻。先前的研究表明，社会心理变量会影响术后结果，尽管这个问题仍被认为不太清楚。本研究的目的是通过长期随访进一步调查社会心理变量对Roux-en-Y胃旁路术（RYGB）结果的影响。
在一家专门的减肥治疗诊所，使用经过验证的心理病理学量表和气质与性格量表对符合减肥手术条件的个体进行评估。选择接受RYGB手术的成年患者进行研究。在术后6个月、1年、2年以及最后一次临床观察时测量超重体重减轻百分比（%EWL）。
本研究纳入了333例接受RYGB手术的受试者。术前，平均年龄为35.4岁（±9.5），平均体重指数为43.3kg/m²（±4.8）。在各个观察点，较高的基线年龄和体重指数与较低的%EWL相关，尽管这种关联会随着时间减弱。在2年随访及最后一次临床观察时发现，术前坚持性人格变量得分较低和身体不满意程度较低预示着%EWL较低。
术前评估中所评估的社会心理变量和人格特质显著预测了减肥手术后的体重减轻情况。在2年的长期随访中观察到的影响更大。这些发现为识别预后较差的风险患者以及设计改善长期体重减轻的干预措施提供了指导。
