Preoperative Predictors of Weight Loss Following Bariatric Surgery: Systematic Review

• Published in: Obesity surgery 2012, Vol.22 (1), p.70-89
• Main Authors: Livhits, Masha, Mercado, Cheryl, Yermilov, Irina, Parikh, Janak A., Dutson, Erik, Mehran, Amir, Ko, Clifford Y., Gibbons, Melinda Maggard
• Format: Article
• Language: English
• Subjects: Bariatric Surgery - psychology; Bariatric Surgery - statistics & numerical data; Body Mass Index; Clinical Research; Feeding and Eating Disorders - complications; Feeding and Eating Disorders - epidemiology; Female; Follow-Up Studies; Gastrointestinal surgery; Humans; Male; Medicine; Medicine & Public Health; Obesity; Obesity, Morbid - epidemiology; Obesity, Morbid - psychology; Obesity, Morbid - surgery; Patient Satisfaction; Personality Disorders - complications; Personality Disorders - epidemiology; Predictions; Predictive Value of Tests; Preoperative Period; Psychiatric Status Rating Scales; Risk Factors; Substance-Related Disorders - complications; Substance-Related Disorders - epidemiology; Surgery; Surveys and Questionnaires; Systematic review; Treatment Outcome; United States - epidemiology; Weight control; Weight Loss
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-011-0472-4

Background Obesity affects 32% of adults in the USA. Surgery generates substantial weight loss, but 20–30% fails to achieve successful weight loss. Our objective was to identify preoperative psychosocial factors associated with weight loss following bariatric surgery. Methods We performed a literature search of PubMed® and the Cochrane Database of Reviews of Effectiveness between 1988 and April 2010. Articles were screened for bariatric surgery and weight loss if they included a preoperative predictor of weight loss: body mass index (BMI), preoperative weight loss, eating disorders, or psychiatric disorder/substance abuse. One thousand seven titles were reviewed, 534 articles screened, and 115 included in the review. Results Factors that may be positively associated with weight loss after surgery include mandatory preoperative weight loss (7 of 14 studies with positive association). Factors that may be negatively associated with weight loss include preoperative BMI (37 out of 62 studies with negative association), super-obesity (24 out of 33 studies), and personality disorders (7 out of 14 studies). Meta-analysis revealed a decrease of 10.1% excess weight loss (EWL) for super-obese patients (95% confidence interval (CI) [3.7–16.5%]), though there was significant heterogeneity in the meta-analysis, and an increase of 5.9% EWL for patients with binge eating at 12 months after surgery (95% CI [1.9–9.8%]). Conclusions Further studies are necessary to investigate whether preoperative factors can predict a clinically meaningful difference in weight loss after bariatric surgery. The identification of predictive factors may improve patient selection and help develop interventions targeting specific needs of patients.