By Royal College of Psychiatrists, UK, [RxPG] Laparoscopic adjustable gastric band (LAGB) surgery is a procedure that involves placing an inflatable band around the upper part of the stomach. This creates a small pouch above the bans which limits the amount of food that can be consumed before becoming uncomfortable. The procedure is effective and safer than previous surgical techniques as it is easily reversible and does not lead to vitamin deficiencies.
Psychological factors are the best predictors of which patients receiving surgery for obesity will fail to comply with strict medical and dietary advice after the operation.
Failure to attend follow-up appointments, and consuming high calorie liquid foods, are both linked to poor weight loss during the year after surgery, and to post-operative complications.
In this study nine patients classified as 'poor compliers' a year after surgery were compared with nine controls who were fully compliant. Case notes were examined for evidence of psychiatric disorders, eating disorders, pre-surgery attitudes towards surgery and weight loss, and socio-demographic information.
It was found that the non-compliers 'grazed' on foods and ate more when they were feeling negative. They were reluctant to undergo psychiatric assessment, viewed their gastric band as responsible for weight loss rather than themselves, and made the psychiatric assessor feel cautious about them.
Poor compliance was not, however, associated with binge eating, purging, impulsiveness or psychiatric illness.
The authors of the study comment that unrealistic expectations and anxiety are known to predict non-compliance. Grazing may be a method of self-treating constant negative feelings.
It seems likely that people who lack a belief in their own ability to bring about change will not stick to a strict medical regime.
Psychiatrists should be involved in the pre-surgical assessment of obese patients who are being considered for LAGB surgery, say the researchers. Patients identified as possible non-compliers should be given motivational interviewing before surgery, and the effectiveness of this intervention should be studied in future research.
Publication:
Faculty of liaison psychiatry annual conference - 16th - 18th March 2005. Catalonia Barcelona Plaza, Barcelona, Spain
On the web:www.rcpsych.ac.uk
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