Inconsistent Personality Test Responses Associated with Bariatric Surgery Revisions

Several psychosocial and lifestyle factors influence post-surgical success in patients undergoing metabolic bariatric surgery (MBS). Research presented at this year’s American Society for Metabolic and Bariatric Surgery Annual Meeting looks at whether measurable psychosocial factors might be helpful in better understanding the reasons why individuals might return for a revisional procedure. The group found that responding to questions on the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) in an inconsistent style or by trying to portray themselves in an overly positive light may be indicative of having a future revision surgery and may provide insight into how providers can help set patients up for better success.

“Bariatric surgery can be incredibly beneficial for patients, but we also recognize that, for a variety of reasons, some individuals will seek a revision after their initial surgery,” explains Kaila Kutz, PsyD, a Postdoctoral Fellow at Cleveland Clinic and the study’s presenting and lead author. “Our goal with this retrospective study was to examine whether there are measurable psychosocial factors that could help us better understand why individuals might return for the revisional procedure.”

Design

The study included 87 participants who received revision MBS between 2019 and 2024 and completed an MMPI-2-RF at their index surgery.

“The MMPI-2-RF is a psychometric test that includes 51 scales to measure a variety of different aspects of someone’s personality,” says Dr. Kutz. “So, for example, it measures things like depression, anxiety, introversion/extraversion, life experiences and the various other factors that make up a patient’s personality.”

Indications for revision among the 87 participants included medical complications (n = 40), weight recurrence (n = 25) and insufficient weight loss (n = 22). The majority of patients were female (n = 88.5%), white/Caucasian (n = 35.3%), and their mean age was 46.34 years (range 24-73 years).

Findings

“When we did our analysis, we found that there was a significant relationship between the TRIN-r validity scale and the revision indication [F(2,84) = -3.354, P = .040],” explains Dr. Kutz. “The TRIN-r validity scale measures inconsistent responding, so answering two very similar questions in different ways over the course of the test.”

Dr. Kutz says the group also saw a significant relationship with higher BMI at the time of surgery and revision indication (F[2,84] = 14.74, P < .001) as well as a relationship approaching significance between higher L-r scale scores and revision indication (F[2, 84] = .420, P = .658.

“The L-r scale measures uncommon virtues, so things that people wouldn’t typically endorse,” says Dr. Kutz. “This preliminary finding could prove helpful in determining whether a respondent was attempting to present themselves in a more favorable way to their clinician. These scores were much higher in the weight recurrence group.”

Leslie Heinberg, PhD, MA, Vice Chair for Psychology in the Department of Psychiatry and Psychology at the Cleveland Clinic and senior author of the study notes, “Patients may try to portray themselves in a very positive way, denying any difficulties or challenges in order to get the surgery they desire. However, not admitting challenges or not recognizing them means that you can’t address them. This may make it harder to have positive outcomes, and unfortunately, this may result in a future revision.”

Takeaways and impact on care

The group believes their preliminary results indicate that MMPI-2-RF scores could be a useful tool for identifying potential MBS revision candidates.

“I think that our findings reinforce the value of an interdisciplinary approach to both pre- and post-surgical care,” says Dr. Kutz. “When we're able to collaborate across disciplines, as we do at Cleveland Clinic, we're able to share these data points across specialties and better contextualize our patients’ experience. So, when our medical team, psychologists, dietitians, and surgeons all have this level of understanding about our patients, we’re able to see patients in a more well-rounded way.”

Patients who come through the BMI Program at Cleveland Clinic meet with a psychologist for an initial evaluation. The provider looks at psychosocial factors, weight and eating history, mental health and social support. The bariatric psychology team then uses the evaluation to provide recommendations for interventions related to unhelpful eating patterns, stress management, and other psychosocial factors. That evaluation is also shared with the patient’s medical providers and surgery teams to identify any concerns or potential barriers to post-surgical success.

“We use those multidisciplinary discussions to put together a package plan as a united front to help give the patient the best chance of success after surgery,” explains Dr. Kutz. “So, having more understanding of how these psychosocial factors impact post-surgical success just gives us another tool in our toolbox to help our patients achieve their goals.”

Dr. Kutz suggests that future studies might explore additional factors and ways to create psychologically safe spaces that facilitate transparent and open conversations between patients and providers before and after surgery.