The biopsychosocial characteristics of people seeking treatment for obesity

To determine prospectively the characteristics of obese patients allowed to select either a medically supervised weight-reduction treatment program or a surgical treatment program, both offered at the same location.

This was a cohort study at a university medical center where patients, who self-referred themselves for weight loss treatments, were introduced to two different programs before they were allowed to start either program. Four hundred forty-three patients with a mean body mass index (BMI) of 45.6 +/- 0.5 (85 men, 358 women) self-selected either a combined supplemented fast with behavior modification (DIET, n = 208) or gastric bypass surgery (SURG, n = 235). Three hundred forty of these patients had private insurance (PI,) and 103 were receiving Medicaid/Medicare (publicly funded, PF). Each patient completed a semistructured psychiatric interview, obesity questionnaire, Profile of Mood Status (POMS), Beck Depression Inventory (BDI), Minnesota Multiphasic Personality Inventory (MMPI), and Hollingshead Index.

Three distinct groups of patients emerged on the basis of their insurance reimbursement patterns (employed versus disabled or indigent) and biopsychosocial factors. The disabled and/or indigent group receiving PF usually chose SURG (n = 89) because their insurance program covered it, but 14 disabled patients receiving Medicare chose DIET (together labeled the PF:DS group). The PI patients were divided into two groups: SURG (PI:S), n = 146, and DIET (PI: D), n = 194, respectively, based on their program selection. These three groups differed significantly in their biopsychosocial patterns. The PF:DS subjects appeared to have the strongest degree of biologic influence, followed by the PI:S and PI:D subjects. The pattern of social influences was consistent with the pattern of biologic influences and the selection bias created in forming the PF and PI groups. The pattern of psychologic influences, however, did not appear to follow the pattern of biologic and social influences. PF:DS had the strongest psychologic loading, but PI:D had a stronger degree of psychopathologic impairment than PI:S.

The significant differences in the biopsychosocial characteristics of these three groups of obese patients need to be considered by policy-makers when they design and review treatment studies and decide what treatment programs should be offered in medical insurance programs.