Association between residual psycho-nutritional difficulties and percentage of excess weight loss two years after bariatric surgery: a controlled observational study.

Introduction: Bariatric surgery is increasingly proposed for grade 2 or 3 obesity, yet the failure rate remains around 20-25%. The role of psychological and nutritional factors in this unfavourable outcome remains controversial. This study investigates whether the existence of residual psycho-nutritional difficulties after well-managed preoperative care is associated with reduced effectiveness of bariatric surgery.

Methods: Between 2017 and 2020, 57 patients with residual psycho-nutritional difficulties after multidisciplinary preparation for bariatric surgery were included in this observational study. These patients were matched with 57 controls without such difficulties, based on age, sex, history of bariatric surgery, type of bariatric surgery planned and date of validation of surgical indication. To prevent introducing bias into the routine follow-up process, the patients were not informed of the objective of the study objective. Weight was measured at the time of surgery and at 1, 6, 12 and 24 months after surgery. The percentage of excess weight loss (PEWL) was assessed using a linear mixed model.

Results: At two years, the mean PEWL was 70.2% (95% CI [59.6; 80.8]) in patients with residual psycho-nutritional difficulties, compared with 71.4% (95% CI [63.4; 79.4]) in the control group. The rate of change in PEWL over time did not differ significantly between groups in the multivariate model (p = 0.54). No significant difference was found in adherence to surgical follow-up, quality of life at one and two years, or evolution of diabetes and hypertension at two years.

Conclusion: Residual psycho-nutritional difficulties did not impact bariatric surgery outcome at two years. Therefore, these patients should not automatically be considered at higher risk of failure. Further follow-up at 5-year is ongoing.