Psychological Traits of Bariatric Surgery Candidates and Predictors of Outcomes

Abstract: Background: Obesity is associated with a reduced life expectancy of 5 to 20 years, depending on the severity of the condition and the presence of comorbidities. Beyond first and second-line interventions such as lifestyle changes, pharmacotherapy, which includes appetite suppressants, drugs that reduce fat absorption or regulate neurohormonal path ways, and endoscopic procedures, bariatric surgery is currently considered one of the most effective long-term interventions for severe obesity. This exploratory study investigates the psychological functioning of bariatric surgery candidates in the preoperative phase, aiming to identify risk factors and potential predictors of response to surgery in an Italian sample. Methods: This is a retrospective, observational study with follow-up. Participants, evaluated between September 2021 and September 2022 at Messina University Hospital, were recontacted approximately one year after surgery for re-evaluation. Of the 97 initial patients, 33 agreed to complete online questionnaires for follow-up. Results: The baseline data showed no significant differences between men and women in psychological assess ments. In the subgroup that completed the follow-up, significant changes were observed, including a reduction in BMI and an increase in the discomfort index (Body Uneasiness Test) post-surgery, with large effect sizes in both cases. However, despite these changes, the regression analysis revealed that preoperative BMI values were not directly related to postoperative body image difficulties. These findings suggest a limited psychological impact of bariatric surgery, emphasizing the need for tailored psychological interventions to address these issues. Conclusions: While the intervention confirmed its effectiveness in reducing BMI, improvements in psychological well-being were less pronounced. In particular, a significant increase in body image concerns (PSDI) emerged after surgery, suggesting the need to address body-related distress in post-surgical care. These find ings may suggest multidisciplinary approaches that integrate physical and psychological interventions may be needed to maximise long term benefits. Further research should explore strategies to enhance patient awareness of treatment options, body image issues, and potential complications. These results should be interpreted with caution considering the limitations associated with this study such as a small sample size, lack of a control group, and the use of self-report and online methods to gather data, among others.