Post-surgery Adherence to Scheduled Visits and Compliance, More than Personality Disorders, Predict Outcome of Bariatric Restrictive Surgery in Morbidly Obese Patients

Background. With bariatric restrictive procedures a major issue is represented by search of predictors of clinical outcome; non-surgical and psychological factors play a role in bariatric surgery long term-results. In this study we evaluated a set of predictors of short-term and long-term clinical outcome including psychiatric and psychological variables. Methods. 172 consecutive patients undergoing laparoscopic adjustable gastric banding (LAGB) with a minimum 12 months follow-up, were studied; before surgery they were administered the NIMH Diagnostic Interview Schedule (Version III-R, DIS III-R), and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (Version 2.0, SCID-II). After surgery, patients were scheduled for visits at fortnight intervals for the first two months, at monthly intervals up to one year, at three-monthly intervals for 2 years; compliance with diet, rules, physical exercise, plus integrated compliance (sum of scores), and percentage of attendance at scheduled visits were recorded; patients were contacted again at 36 and at 48 months. Results. BMI, compliance, percentage of attendance at scheduled visits (positively), and narcissitic personality (negatively) were all associated with weight loss at 12, 24 (and 36 months); percentage of attendance was also associated at 48 months. At stepwise regression analysis, BMI and integrated compliance predicted weight loss at 12, 24, and 36 months, while percentage of attendance at scheduled visits predicted weight loss at 48 months; narcissistic personality predicted weight loss only at 12 months. Conclusion. Adherence to scheduled visits, compliance to recommended rules, narcissistic personality, predict success of LAGB, at least during the first 4 years.