When insurance is not a barrier: psychological factors predicting whether bariatric candidates undergo surgery

Surg Obes Relat Dis. 2024 Oct;20(10):953-961. doi: 10.1016/j.soard.2024.04.012. Epub 2024 Apr 16.

Abstract

Background: Despite the effectiveness of bariatric surgery, utilization rates have increased only marginally over the last 2 decades; candidates who are eligible for bariatric surgery regularly fail to undergo surgery. The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) has previously been used to assist in identification of those who will not move forward with surgery after being identified as eligible. However, medical insurance has been identified as a significant barrier to surgery; research in those who have universal healthcare may yield different results.

Objectives: Determine if MMPI-RF scales are associated with failure to undergo bariatric surgery in patients eligible to have the procedure.

Setting: Large military hospital in the Northwestern U.S.

Methods: This study used archival data for 279 patients psychologically screened for eligibility for bariatric surgery. All assessments took place between January 2017 and December 2019. T-tests and chi-square tests were used to compare groups of patients who did and did not have surgery on relevant medical and demographic variables. Profile analyses of patient MMPI-2-RF scores were conducted to examine scale associations with undergoing surgery.

Results: A total of 86 bariatric surgery candidates (30.8%) did not undergo surgery. Results showed that sex, age, employment status, and arthritis were different between groups. Additionally, MMPI-2-RF scales were different between groups, including somatic complaints, neurological complaints, cynicism, and helplessness/hopelessness.

Conclusions: MMPI-2-RF scales were associated with not having bariatric surgery, although not all scales exceeded clinical cut-offs. Findings indicate psychological and psychosocial differences, rather than psychopathology per se, may play a role in who undergoes bariatric surgery.

Keywords: Bariatric surgery; MMPI-2-RF; Obesity; Psychological assessment.

MeSH terms

  • Adult
  • Bariatric Surgery* / psychology
  • Female
  • Humans
  • Insurance, Health / statistics & numerical data
  • MMPI*
  • Male
  • Middle Aged
  • Obesity, Morbid* / psychology
  • Obesity, Morbid* / surgery