Background

Patients pursuing metabolic and bariatric surgery (MBS) often show executive function deficits. While previous research shows that executive function improves after MBS, few studies have used standardized tests to directly assess planning/problem-solving ability which may be important for adherence to postoperative behavioral recommendations.ObjectivesCompare 1-year postoperative changes in planning/problem-solving ability among sleeve gastrectomy (SG) patients and non-operative controls.

Methods

Fifty-four SG patients and eleven non-operative controls with obesity completed the Tower of London task (TOL) at pre- and 1-year postoperatively. The TOL presents computer-generated images of balls and asks participants to think ahead about how to arrange the balls in the fewest moves possible to achieve a specific goal. ANCOVA compared postoperative changes in TOL percent correct responses (%CR) and mean response time (RT), controlling for baseline performance.

Results

The SG and control groups were similar in age (42.3+-8.2 vs. 43.0+9.1 years), sex (81.5% vs. 90.9% females), and BMI (45.4+-7.1 vs. 42.9+-5.0 kg/m2). SG had greater 1-year percent weight loss compared to controls (23.0 %+-9.7 vs. 3.9%+-7.8). TOL results showed a significant difference in change in %CR from pre- (SG: 74.5%+-21.7 vs. Controls: 82.7%+-11.4, p=0.36) to 1-year postoperatively, that favored SG (SG: +3.89+-21.7% vs. Controls: -13.87+-24.59%, p=.03). The groups did not differ in RT.

Conclusions

The contrasting pattern of change in planning/problem-solving ability between SG patients and nonoperative controls suggests that SG may help prevent deterioration in this area of executive functioning. Future studies should assess the role of planning/problem-solving ability in postoperative behavioral compliance and weight outcomes.