Cognitive Functioning in Bariatric Eligible SWAN Patients

Lauren Borato, Saint Louis University, St. Louis, United States
Jeremiah Weinstock, PhD, Saint Louis University, St. Louis, United States


Objective:  Bariatric surgery, the most effective treatment for severe obesity, requires sustained pre-operative and post-operative lifestyle changes, such as eating numerous small nutrient- dense meals during the day, adhering to strict medication and vitamin regimens, engaging in moderate exercise, and following medical recommendations. Adherence to these changes is critical for sustained weight loss and improved health. About 75% of individuals undergoing the procedure are women, with a median age of 41 years old. Though there is no gold standard battery, the specificity and sensitivity of psychological domains most often chosen (i.e., presence of psychopathology) to assess candidate readiness has been doubted. Cognitive functioning, which is an important predictor of adherence to lifestyle changes post-surgery is poorly characterized in bariatric surgery candidates, though research has recommended including cognition as an assessment area within the bariatric surgery evaluation. Thus, the need to examine the relationship between cognitive functioning and candidacy for bariatric surgery in women exists. The objective of this study is to examine whether potential bariatric surgery candidates have lower total scores than noncandidates in cognitive function tests assessing processing speed, attention, immediate and delayed recall.

Participants and Methods:

Participants and methods: This analysis examines cognitive functioning and psychological characteristics in women who meet requirements for bariatric surgery using the Swan III Study of Woman’s Health across the Nation (Follow-up Visit 10; N = 1,777). Participants completed performance-based tests of cognition (Symbol Digit Modality Test, Digit Span Backward, and the East Boston Memory Test), as well as self-report measures assessing psychosocial functioning, health, and social support (Short Form-36, Center for Epidemiological Services Depression, Perceived Stress Scale, and the Social Support Scale). The sample was dichotomized into women who meet eligibility criteria for bariatric surgery (i.e., having a BMI > 40 or a BMI >35 with a chronic condition; n = 305), and women who do not meet these criteria (n = 1,472).


Results: After accounting for demographic and clinical characteristics, univariate analyses found that women who were eligible for bariatric surgery scored significantly lower on Symbol Digit Modality Test scores, F(4, 1425) = 77.30, p < 0.001, East Boston Memory Test (EMBT) Immediate Recall scores, F(4, 1425) = 48.02, p < 0.001, and EBMT Delay scores F(4, 1425) = 44.47 p < 0.001. Participants also differed significantly on Digit Span Backward t(416.91) = 16.83, p < .001.


Conclusions: Results indicate that women who qualify for bariatric surgery attain lower scores on cognitive testing in the domains of processing speed, attention, and immediate and delayed recall. Cognitive testing has ecological validity that is applicable to individuals who undergo bariatric surgery, such as using abilities in processing speed to understand and follow medical recommendations, attention-related tasks to keep multiple pieces of information within working memory and using memory for medication adherence. Results from this study contribute to the discipline’s knowledge about predictors that aid in eligibility for bariatric surgery. With this knowledge, the discipline can develop domain-specific intervention strategies delivered at pre-surgery to enhance successful post-surgical weight loss as well as cognitive and psychological health outcomes.

Category: Executive Functions/Frontal Lobes

Keyword 1: assessment
Keyword 2: attention
Keyword 3: adaptive functioning