Predictors of unsatisfactory outcomes in the most common bariatric interventions

Background. Morbid obesity is currently one of the serious problems of modern health care, given the increasing trend in the incidence of this condition in both developed and developing countries. Bariatric surgery, being a good alternative to other weight loss methods for such patients, also have some problems, and one of the most significant is insufficient weight loss and weight regain in the postoperative period. Objective. The aim of the study was to identify the main predictors of the most frequently practiced bariatric interventions unsatisfactory results, as well as the threshold values of these predictors. Material and methods. The study was based on the results of 502 patients with obesity treatment who underwent various types of bariatric interventions — longitudinal gastrectomy, Roux-en-Y gastric bypass, and mini-gastric bypass. The results of the operations performed were subsequently assessed based on the indicators of excess weight loss and weight return recorded by the end of the 1st, 3rd and 5th year after the intervention. After receiving the results, the main clinical, laboratory and psychological parameters were assessed for their aasociation with the unsatisfactory result. Results. Among a number of clinical, laboratory and psychological parameters, the most associated with unsatisfactory results of bariatric interventions were the patient’s belonging to older age groups (>45 years), high initial BMI (47 kg/m2 and above), low preoperative EWL (<11.5 kg), the presence of diabetes mellitus, as well as high scores on the domains of anxiety (>1.50), depression (>1.46) according to the SCL-90 questionnaire and eating disorders according to the DEBQ scale (>3.8). Conclusion. It seems advisable to include psychological correction measures in the preoperative preparation program with subsequent re-evaluation of the results using the SCL-90 and DEBQ questionnaires and, if the disorders persist or worsen, to refuse bariatric intervention due to its futility. As for the other parameters (age, initial BMI, preoperative EWL, presence of diabetes mellitus), their consideration may be appropriate for developing more intensive tactics for monitoring patients at risk in the postoperative period, which may likely contribute to a reduction in weight regain.