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Abstract
Bariatric surgery is among the most effective treatments for obesity, but 10-20% of patients fail to achieve sufficient weight loss or to maintain weight loss over time. This variability in outcomes may be associated with variability in adherence to treatment instructions after bariatric surgery. The first aim of this thesis was to identify psychosocial predictors of post-operative adherence that can be addressed through psychological interventions. A systematic review (Chapter 2) was conducted to consolidate current literature of clinically malleable psychosocial factors associated with post-operative adherence. The review indicated that depression is commonly linked to poorer adherence, and self-efficacy was associated with better adherence, although the literature overall was fairly sparse. Next, a pilot study (Chapter 3) and a longitudinal study (Chapter 4) were conducted to identify psychosocial predictors of post-operative adherence. The cross-sectional pilot study found that higher self-efficacy and more positive beliefs about adherence were associated with better adherence, and higher levels of depressive symptoms were associated with poorer adherence. The longitudinal study (with 6- and 12-month follow-ups) found that baseline self-efficacy predicted better dietary and exercise adherence at the 6-month follow-up. Conversely, baseline anxiety about weight regain predicted poorer adherence to follow-up appointments. Adherence to dietary and exercise instructions, follow-up appointments, and support groups at the 6-month follow-up was positively predictive of adherence at the 12-month follow-up which, in turn, was associated with better treatment outcomes (weight loss, quality of life, improvements in comorbidities).
The second aim of this thesis was to qualitatively explore patient perspectives on psychological services in the bariatric setting (Chapter 5). Participants reported believing that psychological care is essential for treatment success and indicated that they wanted support with adjusting to lifestyle, self-identity, and relationship changes after surgery. Participants suggested that psychological aftercare should be recommended by their medical team and incorporated into standard patient management after bariatric surgery.
Taken together, the findings of this thesis suggest that there may be value in providing psychological care to patients after bariatric surgery to address psychosocial factors that are associated with adherence and to offer support in patients’ adjustment to life after bariatric surgery.