Louisiana Tech University Louisiana Tech Digital Commons Doctoral Dissertations Graduate School Summer 2016 Factors predicting weight loss and weight gain in bariatric surgery patients Deborah Potisek Simpson Follow this and additional works at: https://digitalcommons.latech.edu/dissertations Part of the Clinical Psychology Commons, and the Counseling Psychology Commons FACTORS PREDICTING WEIGHT LOSS AND WEIGHT GAIN IN BARIATRIC SURGERY PATIENTS By Deborah Potisek Simpson, B.A., M.A. A Dissertation Presented in Partial Fulfillment Of the Requirements for the Degree Doctor of Philosophy COLLEGE OF EDUCATION LOUISIANA TECH UNIVERSITY August 2016 ProQuest Number: 10301423 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. ProQuestQue ProQuest 10301423 Published by ProQuest LLC(2017). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 LOUISIANA TECH UNIVERSITY THE GRADUATE SCHOOL June 28th, 2016 Date We hereby recommend that the dissertation prepared under our supervision by Deborah Potisek Simpson entitled_____________________________________________ Factors Predicting Weight Loss and Weight Gain in Bariatric Surgery Patients be accepted in partial fulfillment of the requirements for the Degree of Doctor of Philosophy Supervisor of Dissertation Research Head of Department Psychology and Behavioral Sciences Department Recommendation concurred in: Advisory Committee Approved: Approved: Jju J JLi $SuUsr>n‘t/t Director of Graduate Studies i of the Graduate School Dean of the College GS Form 13a (6/07) ABSTRACT Obesity has become an epidemic in the United States that can result in problems in multiple areas of an individual’s life. Bariatric surgery has been shown to be an effective weight loss treatment for obese and morbidly obese individuals; however, although many individuals obtain long-term weight loss success after surgery, there is a percentage of patients who do not obtain the expected weight loss or end up regaining the weight they had initially lost. In an attempt to identify those who may be at risk for poorer results after bariatric surgery, most surgeons require that an individual undergo a psychological evaluation before they are approved for surgery. Previous research has attempted to identify specific factors assessed in the psychological evaluation that may be used to identify those patients who are at risk for poorer surgery outcomes; however, results have been contradictory. This study examined whether specific psychological variables obtained during the psychological evaluation for gastric bypass surgery, specifically, scores on measures of disordered eating behavior, anxiety, and depression, could be used to predict short and long-term success post-surgery, as measured by the percentage of excess weight loss (EWL). This study also examined the role that behaviors engaged in after surgery: binge eating, night eating, grazing, and alcohol use play in longer term bariatric surgery success. The results of the present study did not support the majority of the hypotheses. Anxiety and depression was not found to be a predictor of EWL in the majority of hypotheses; however, anxiety post-surgery was found to predict EWL at two points post-surgery. There were some interesting significant findings when examining the variables measuring disordered eating and health. Results showed that the Binge Eating Scale and the Night Eating Questionnaire were negatively correlated with the percentage of excess weight loss at various points post-surgery. The results also showed that excess weight loss was correlated with physical and mental health. Additionally, the Grazing Questionnaire was found to be positively correlated with the Binge Eating Scale. APPROVAL FOR SCHOLARLY DISSEMINATION The author grants to the Prescott Memorial Library of Louisiana Tech University the right to reproduce, by appropriate methods, upon request, any or all portions of this Dissertation. It is understood that “proper request” consists of the agreement, on the part of the requesting party, that said reproduction is for his personal use and that subsequent reproduction will not occur without written approval of the author of this Dissertation. Further, any portions of the Dissertation used in books, papers, and other works must be appropriately referenced to this Dissertation. Finally, the author of this Dissertation reserves the right to publish freely, in the literature, at any time, any or all portions of this Dissertation. Author I , \ i n j)ScQ Date 2^ 2 ^ 1 ^ GS Form 14 (5/03) TABLE OF CONTENTS ABSTRACT................................................................................................................................. iii LIST OF TABLES........................................................................................................................x CHAPTER 1 INTRODUCTION................................................................................................ 1 Statement of the Problem .........................................................................................................3 Justification ................................................................................................................................5 Literature Review......................................................................................................................6 Obesity....................................................................................................................................6 Causes of obesity ..............................................................................................................7 Physical consequences of obesity ...................................................................................9 Psychiatric disorders in obese individuals ...................................................................10 Obesity prejudice and discrimination .......................................................................... 13 Quality of life and obesity .............................................................................................. 17 Economic costs of obesity .............................................................................................18 Treatment of obesity ........................................................................................................... 19 Behavioral treatments .................................................................................................... 20 Cognitive treatments ...................................................................................................... 21 Pharmacological treatment .............................................................................................22 Surgical treatments ......................................................................................................... 22 Complications of bariatric surgery ........................................................................... 24 Quality of life after bariatric surgery ................................................................................26 Pre-surgical evaluation ...................................................................................................... 27 Pre-and post-eating behaviors...........................................................................................29 Prevalence of binge eating disorder ............................................................................. 30 Binge eating disorder diagnostic criteria .....................................................................31 Night eating syndrome ................................................................................................... 32 Prevalence of night eating syndrome .......................................................................33 Disordered eating as a predictor of success ................................................................ 34 Psychiatric variables...........................................................................................................41 Depression and anxiety ..................................................................................................42 vi Alcohol use/abuse ............................................................................................................... 44 Alcohol use and obesity .................................................................................................44 Alcohol use in the bariatric surgery population ..........................................................45 The Present Study................................................................................................................... 48 Hypotheses .............................................................................................................................. 49 Hypothesis 1 ........................................................................................................................49 Justification for hypothesis 1 .............................................................................................49 Hypothesis