Older bariatric surgery candidates: is there greater psychological risk than for young and midlife candidates?

doi:10.1016/j.soard.2011.11.005

Surgery for Obesity and Related Diseases

Volume 8, Issue 5, September–October 2012, Pages 616-622

https://doi.org/10.1016/j.soard.2011.11.005 Get rights and content

Abstract

Background

Although severe obesity is dramatically increasing in older adults, many bariatric programs use age cutoffs due to concerns about greater perioperative morbidity and mortality risks. More recently, surgical outcomes have been reported in older adults. However, a paucity of data is available on the psychological risks of older bariatric candidates. Our objective is to examine psychiatric risk factors and weight loss outcomes in older (≥65 yr) versus midlife (40–55 yr) versus young adult (18–29 yr) patients.

Methods

Older, midlife, and young adults (n = 608) who underwent weight loss surgery (74.6% women, 75.6% white, mean body mass index 48.07 ± 9.61 kg/m²) at the Cleveland Clinic Bariatric and Metabolic Institute completed a psychiatric diagnostic interview, and the Minnesota Multiphasic Personality Inventory-2-Restructured Form, Binge Eating Scale, and Cleveland Clinic Behavioral Rating Scale before surgery. The data gathered from follow-up visits and weight loss outcomes at 1, 3, 6, 9, 12, and 18 months after surgery were measured.

Results

Young adults had a greater reduction in excess body mass index than those at midlife in the first 6 months but no age differences were noted in the following year. Older patients were less likely to have a suicide history but the groups were equivalent on other psychiatric variables and self-report measures. Psychologist evaluators rated older adults less favorably on the capacity to consent and realistic nature of expectations.

Conclusion

Although medical risks may cause concern, older adults do not demonstrate any increased psychological risk factors compared with midlife or young adult surgical candidates and evidenced equivalent weight loss. However, concerns with lower ratings on consent and expectations warrant additional research.

Section snippets

Participants

Participants were included if they had undergone weight loss surgery at the Cleveland Clinic Bariatric and Metabolic Institute at the analysis and had ≥2 scheduled follow-up visits at 1, 3, 6, 9, 12, and 18 months postoperatively. Of the larger sample of 948 participants, 608 were selected that fit the following age categories: young adult (18–29 yr; n = 82), midlife (40–55 yr; n = 460), and older adult (≥65 yr; n = 70). Most patients were women (74.6%) and white (75.6%; 20.9% black). The mean

Results

The groups differed by surgery type [Chi-square (4, 608) = 26.71, P < .001]. Midlife patients were more likely to have undergone Roux-en-Y gastric bypass (70.5% versus 62% of young adult patients versus 51% of older patients), laparoscopic adjustable gastric banding was more common in older patients (35.7% versus 20% of young adult and 14.2% of midlife patients), and laparoscopic sleeve gastrectomy was more common in young adult patients (17.5% versus 14.2% of midlife patients and 11.4% of

Discussion

These findings indicate that older adults show equivalent weight loss and do not demonstrate any increased psychological risk factors compared with young adult and midlife surgical candidates. Young adult patients demonstrated greater %EBMI loss compared with midlife patients in the first 6 months; however, this effect was no longer significant in the year after this point, and equivalent weight loss benefits were noted at all points for older patients consistent with other studies [8], [9].

Conclusion

Although medical risk factors could cause concern, these findings indicate that older adults do not demonstrate any increased psychological risk factors over young adult or midlife surgical candidates. Equivalent weight loss benefits were also found. Older patients were less likely to have a past suicide attempt and were more likely to attend follow-up appointments with their surgeon and dietitian. However, psychologists rated their consent and expectations less favorably than younger cohorts,

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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Metabolic Bariatric surgery in People with Obesity aged ≥65 Years
2024, European Journal of Internal Medicine
Obesity management guidelines recommend metabolic bariatric surgery for individuals with body mass index (BMI) ≥35 kg/m², regardless of the presence of any obesity-related comorbidity; and for individuals with BMI 30–34.9 kg/m² with metabolic diseases. Older age is not in itself a contraindication for bariatric surgeries, which can be performed after careful selection and assessment, to decrease the risks of postoperative complications. An essential amount of data has accumulated about bariatric surgery results for persons aged ≥60 years; but data are limited though increasingly accumulating for the ≥65-year-old population. Laparoscopic Roux-en-Y-gastric bypass and sleeve gastrectomy have been the preferred bariatric procedures for older adults with obesity, as for younger patients. This review summarizes the safety and efficacy of bariatric surgery for individuals aged ≥65 years with obesity, and the efforts that have been invested to improve the perioperative and long-term consequences.
Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients
2016, Surgery for Obesity and Related Diseases
Citation Excerpt :
There is a documented relationship between poor literacy and poor health outcomes in the general medical literature [186]. Concerns about cognitive functioning may be particularly relevant in older patients [187]. In cases where the evaluator has significant concerns about comprehension and the potential impact on ability to give informed consent or on postsurgical self-care and/or adherence is not clear, cognitive testing may be indicated, and information should be gathered from collateral sources (parent, spouse, other treaters) about the patient’s ability to manage the demands of daily living and whether adequate supports are in place to assist the patient in doing so.
Psychosocial factors have significant potential to affect long-term outcomes of bariatric surgery, including emotional adjustment, adherence to the recommended postoperative lifestyle regimen, weight loss outcomes, and co-morbidity improvement and or resolution. Thus, it is recommended that bariatric behavioral health clinicians with specialized knowledge and experience be involved in the evaluation and care of patients both before and after surgery. The evaluating clinician plays a number of important roles in the multidisciplinary treatment of the bariatric patient. Central among these is the role of identifying factors that may pose challenges to optimal surgical outcome and providing recommendations to the patient and bariatric team on how to address these issues. This document outlines recommendations for the psychosocial evaluation of bariatric surgery patients, appropriate qualifications of those conducting these evaluations, communication of evaluation results and suggested treatment plan, and the extension of behavioral healthcare of the bariatric patient to the entire span of the surgical and postsurgical process.
Validity of Minnesota Multiphasic Personality Inventory - 2 - Restructured Form (MMPI-2-RF) scores as a function of gender, ethnicity, and age of bariatric surgery candidates
2015, Surgery for Obesity and Related Diseases
Presurgical psychological screening is used to identify factors that may impact postoperative adherence and surgical outcomes in bariatric surgery candidates. Minnesota Multiphasic Personality Inventory – 2 Restructured Form (MMPI-2-RF) findings have demonstrated utility for this task.
To explore whether there are clinically meaningful gender, ethnicity, or age differences in presurgical MMPI-2-RF scores and the validity of these scores in bariatric surgery candidates.
The sample was composed of 872 men and 2337 women. Ethnicity/race groups included 2,204 Caucasian, 744 African American, and 96 Hispanic individuals. A sample of 165 were not included in the ethnicity/race analyses because they were of another descent. Ages groups included 18–35 year olds (n = 454), 36–49 year olds (n = 1154), 50–64 year olds, (n = 1246), and 65 years old or older (n = 355). Validity data, obtained via a retrospective chart review, were available for a subset patients (n = 1,268) who were similarly distributed. Step-down hierarchical regression analyses were conducted to assess for differential validity.
Bariatric surgery candidates produced comparable MMPI-2-RF scores in all subsamples, indicating that the test norms generalize across demographic groups. Validity findings were also generally comparable, indicating that MMPI-2-RF scores have the same interpretive implications in demographically diverse subgroups of bariatric surgery candidates.
The MMPI-2-RF can assist in presurgical psychological screening of demographically diverse bariatric surgery candidates.
Binge eating, depressive symptoms and suicidal ideation in obese candidates for bariatric surgery
2023, Eating and Weight Disorders
Treatment of obesity in older persons—A systematic review
2019, Obesity Reviews
Risk of Suicide and Self-harm Is Increased After Bariatric Surgery—a Systematic Review and Meta-analysis
2019, Obesity Surgery

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Integrated health articleOlder bariatric surgery candidates: is there greater psychological risk than for young and midlife candidates?

Abstract

Background

Methods

Results

Conclusion

Section snippets

Participants

Results

Discussion

Conclusion

Disclosures

J Gastrointest Surg

Surg Obes Relat Dis

Addict Behav

Surg Obes Relat Dis

Surg Obes Relat Dis

Prevalence and trends in obesity among US adults, 1999-2008National Center for Health Statistics, Center for Disease Control and Prevention

JAMA

The impact of age and Medicare status on bariatric surgical outcomes

Arch Surg

Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures

JAMA

National Coverage Determination (NCD) for Bariatric Surgery for Treatment of Morbid Obesity (100.1)

Bariatric surgery outcomes in patients aged 65 years and older at an American Society for Metabolic and Bariatric Surgery center of excellence

Obes Surg

Laparoscopic gastric bypass in patients 60 years and older: early postoperative morbidity and resolution of comorbidities

Obes Surg

Surgical weight loss >65 years old: is it worth the risk?

Surg Obes Relat Dis

National Survey on Drug Use and HealthPrevalence of Serious Mental Illness Among U.S. Adults by Age, Sex, and Race in 2008

Integrated health article
Older bariatric surgery candidates: is there greater psychological risk than for young and midlife candidates?