Although bariatric surgery is obviously successful in leading to weight loss, it is more difficult to predict who will ultimately be unsuccessful in achieving their weight reduction goals, those whose weight may rise again to presurgical levels or even beyond. Understanding the factors associated with worse outcomes when it comes to sustained weight reduction may help guide intervention. Studies in other dieting populations identify commonsense factors related to sustained weight reduction, including early weight loss, setting and reaching a predetermined goal weight, having a physically active lifestyle, keeping to a regular meal rhythm, overall healthy eating patterns, control of overeating, self-monitoring of behavior, social support, better coping strategies, and an capability to assume responsibility in life and handle life stresses. Clearly, some of those factors are markers of psychological strength and stability in general, and, unsurprisingly, the factors that’ll pose a chance for weight regain include eating in response to negative emotions or stress, passive reactions to problems, and dysfunctional eating behaviors such as for instance disinhibited eating, binge eating, a history of weight cycling, and experiencing hunger.18 Studies of patients after bariatric surgery are finding the exact same commonsense association of improved results connected with baseline cognitive restraint and adherence to the recommended diet postoperatively,19 whereas subjective hunger, nonhungry eating, and apparent symptoms of depression were associated with a lower percentage of weight loss.20 Overall, younger female patients have been obese before adult life and have good self-esteem, a reasonable marriage, high socioeconomic status, realistic expectations from the surgery, and undisturbed eating behaviors usually, but not always, obtain better results.21 On the other hand, patients who have been binge eaters just before surgery can become “grazers” postoperatively, eating small quantities almost nonstop. Although the grade of these grazing episodes after surgery is actually different from the binges prior to surgery, the continued sense of lack of control can result in overconsumption and an unsatisfactory postoperative result.22,23 Behavioral change is difficult to sustain, and many patients followed postoperatively in a single study reported noncompliance in a minumum of one behavioral area, with exercise recommendations ignored by 41%, whereas 37% continued to snack.24 Patient expectations may also play a role in unsuccessful fat loss, specially when patients choose bariatric surgery in the hopes that weight control will then be easy, that they may not need to do the job implicit in the typical recommendations of diet and exercise. One number of interviews with patients who’d been unsuccessful in maintaining weight loss after bariatric surgery unearthed that some patients seemed insufficiently aware that their own effort will be needed to accomplish and maintain weight loss postoperatively and indeed for the others of the lives.25 Though it might seem as though depression and other psychiatric symptoms can lead to a worse outcome, these factors haven’t been found to have a consistent effect on outcome. Several studies have suggested that some patients who’ve more depressive or anxiety symptoms ahead of surgery do better when it comes to weight loss than patients without such symptoms.26,27 It might be that such individuals experienced greater psychological stress from their obesity and thus are far more motivated to succeed in a weightloss program. Efforts to know the behavioral and psychological impact of weight reduction and weight regain or cycling have resulted in somewhat contradictory findings. Overall, most studies report greater weight reduction results in improved standard of living, enhanced self-esteem, and lower psychopathology,28 but there may be mixed consequences for some. One small study of Brazilian women who’d had bariatric surgery discovered that, although patients felt positive about the likelihood of being more socially accepted, their increased sense of femininity left them feeling more vulnerable. These patients’changed bodies also generated alterations in family balance and conjugal relationships, changes that were not at all times comfortable and sometimes resulted in discontinuation of treatment.29 Loss in weight can result in changed expectations in regard to work, school, and sexual or family function, expectations that may be problematic for a patient to meet up and sustain. Families that include multiple members in many generations who’re obese may overtly or covertly undermine efforts at weight loss. Studies in other populations have found that small losses of weight can cause major improvements in body image and that continued fat loss is not associated with further improvements in self-image, limiting motivation for more drastic change. Women with a history of obesity could have a greater degree of body dissatisfaction irrespective of their current weight30 and thus might not experience the sense of satisfaction from weight loss that could sustain change. The clear presence of psychiatric disorders can complicate progress toward sustained weight loss in many ways, with respect to the diagnosis. A patient with depression could have feelings of hopelessness, helplessness, or worthlessness that may lead to giving on the work of weight reduction or weight maintenance. In a bipolar patient with mania, recommendations for a healthier lifestyle and appropriate eating may be ignored and only excesses of all types. It might be burdensome for someone with panic attacks with agoraphobia to leave your house regularly, for appointments, exercise, as well as food shopping. Patients with preoperative eating disorders, such as for example bulimia, or personality disorders may act out around the opportunities for manipulation of the around them by disturbed eating postoperatively. Monitoring for substance abuse, particularly alcohol, might be important, as an eternity history of substance abuse is within almost one third of patients undergoing bariatric surgery;31 changes in the metabolism of alcohol after bypass may enhance its effects.30 In addition, in the setting of decreased caloric intake, increasing the proportion of calories obtained from alcohol can have significant nutritional and health risks. Thus, the interactions between psychological factors and fat loss or regain are complex and not easily characterized but certainly ought to be watched for and addressed to maximize outcome.