Phenotyping of Patients Seeking Third or Higher-Order Metabolic Bariatric Surgery

Background: There is a continuous upward trend in the number of repeated metabolic bariatric surgeries (MBS) performed worldwide. In some cases, patients undergo a third or even higher-order MBS, yet there is a paucity of data regarding the clinical profiles of this population. This study aims to characterize the surgical history, anthropometric outcomes, and mental health profiles of patients seeking a third or higher-order MBS. Methods: Between 2016 and 2021, candidates for a third or higher-order MBS underwent comprehensive evaluations by a clinical psychologist and a registered dietitian. Sociodemographic, psychological, and health data were collected from medical records, with psychological interviews conducted using a semi-structured DSM-5-based format. Results: Data was collected from 99 candidates; 84 planned a third MBS, 14 a fourth, and one a fifth. The mean age and BMI were 47.8 years and 41.7 kg/m², respectively, and 80.8% were women. Most participants (95%) had undergone banding-based procedures as their primary MBS, and about 70% were converted to sleeve gastrectomy as a secondary MBS. Excess weight loss was lower after secondary compared to primary MBS (54.3 ± 47.4% vs. 64.9 ± 35.4%). High rates of psychopathology were observed, including depression (58.8%), anxiety (35.8%), post-traumatic stress disorder (58.5%), and 23.7% reported on psychiatric medication use. Conclusions: This study illuminates a distinctive population of candidates seeking a third or higher-order BMS, revealing a notable prevalence of psychopathologies within this group. The findings underscore the importance of conducting further prospective studies to delve into clinical features associated with repeatable BMS. Key Points: • Third or higher-order MBS are increasingly performed worldwide. • Patients seeking repeated MBS often present with complex surgical histories. • Weight loss outcomes were less favorable after secondary vs. primary MBS. • High prevalence of psychopathology was observed in this unique population.