Preoperatif Bilişsel İşlevler ile Bariatrik Cerrahi Sonuçları Arasındaki İlişki: Kapsam Derlemesi

Öz

Bariatrik cerrahi, obezite tedavisinde en etkili müdahalelerden biri olarak kabul edilmektedir. Cerrahinin başarısı sadece kilo kaybı ve ilişkili biyolojik faktörlere değil, aynı zamanda psikolojik ve bilişsel etmenlere de bağlıdır. Bu kapsam derlemesi, bariatrik cerrahi sonuçlarında preoperatif bilişsel işlevlerin ve süreçlerin rolünü inceleyen ampirik literatürü sistematik biçimde derleyerek literature katkı sunmayı amaçlamaktadır. Web of Science, Scopus ve PubMed veri tabanlarında yürütülen sistematik tarama sonucunda, belirlenen dahil etme ve dışlama ölçütlerine göre 11 çalışma bu derlemenin kapsamına dahil edilmiştir. Taramalar PRISMA-ScR yönergeleri temel alınarak gerçekleştirilmiş ve analizler popülasyon, kavramsal odak ve bağlama göre yapılandırılmıştır. Bulgular üç ana tema altında sunulmuştur: (1) Dikkat, bellek ve yürütücü işlevlerde düşük performans gösteren bireylerde kilo kaybı düzeylerinin daha düşük olduğu ancak bu ilişkinin tüm çalışmalarda tutarlı olmadığı görülmüştür. (2) Tedaviye uyum davranışlarındaki (randevuya katılım, diyet takibi, fiziksel aktivite) azalma ile bilişsel işlevlerdeki zayıflıkların ilişkili olduğu anlaşılmaktadır. (3) Dikkat eksikliği ve hiperaktivite bozukluğu veya yüksek dürtüsellik gibi bilişsel risk profillerine sahip bireylerde cerrahi sonrası dönemde madde kullanımı, yeme bozukluğu davranışları ve komplikasyon riskinde artış rapor edilmiştir. Bu bulgular, preoperatif bilişsel işlevlerin bariatrik cerrahi sonrası yalnızca fiziksel değil, davranışsal ve psikososyal uyum açısından da etkili olabileceğini göstermektedir.

Anahtar Kelimeler

• Bariatrik cerrahi
• bilişsel işlevler
• obezite cerrahisi
• yürütücü işlevler

Relationship Between Preoperative Cognitive Functions and Bariatric Surgery Outcomes: A Scoping Review

Abstract

Bariatric surgery is recognized as one of the most effective interventions in the treatment of obesity. Its success depends not only on weight loss and related biological factors, but also on psychological and cognitive aspects. This scoping review aims to systematically review empirical studies that examine the role of cognitive functions and processes assessed before surgery in predicting bariatric surgery outcomes. A comprehensive literature search was carried out using the Web of Science, Scopus, and PubMed databases. In total, 11 studies that satisfied the established inclusion and exclusion criteria were selected for analysis. The review was performed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Analyses were structured using the population, concept, and context framework. Findings were organized under three main themes. First, individuals with lower performance in attention, memory, and executive functions tended to lose less weight after surgery, though this relationship was not consistently observed across all studies. Second, reduced cognitive functioning before surgery was associated with lower adherence to treatment-related behaviors such as attending medical appointments, maintaining dietary routines, and engaging in physical activity. Third, individuals with cognitive risk profiles, including symptoms of attention deficit hyperactivity disorder or high impulsivity, were more likely to experience complications such as substance use, disordered eating, and psychosocial difficulties postoperatively. These findings suggest that preoperative cognitive functioning may influence not only physical outcomes but also behavioral and psychosocial adaptation following surgery.

Keywords

• Bariatric surgery
• cognitive functions
• obesity surgery
• executive functions

Kaynakça

1. Alosco ML, Galioto R, Spitznagel MB, Strain G, Devlin M, Cohen R et al. (2014) Cognitive function after bariatric surgery: evidence for improvement 3 years after surgery. Am J Surg, 207:870-876.
2. Alvarez JA, Emory E (2006) Executive function and the frontal lobes: A meta-analytic review. Neuropsychol Rev, 16:17-42.
3. Altfas JR (2002) Prevalence of attention deficit/hyperactivity disorder among adults in obesity treatment. BMC Psychiatry, 2:9.
4. Barkley RA (1997) Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychol Bull, 121:65-94.
5. Bartsch M, Langenberg S, Gruner-Labitzke K, Schulze M, Köhler H, Crosby RD et al. (2016) Physical activity, decision-making abilities, and eating disturbances in pre- and postbariatric surgery patients. Obes Surg, 26:2913-2922.
6. Cabeza R, Nyberg L (2000) Imaging cognition II: An empirical review of 275 PET and fMRI studies. J Cogn Neurosci, 12:1-47.
7. Chen Y, Feng Y, Zhang X, Gifford KA, Elmanzalawi Y, Samuels J et al. (2025) Bariatric surgery is associated with reduced incidence of mild cognitive impairment and Alzheimer disease and related dementias: A retrospective cohort study. Ann Surg Open, 1:e541.
8. Cortese S (2019) The association between ADHD and obesity: Intriguing, progressively more investigated, but still puzzling. Brain Sci, 9:256.

9. Diamond A (2013) Executive functions. Annu Rev Psychol, 64:135-168.
10. Gunstad J, Paul RH, Cohen RA, Tate DF, Spitznagel MB, Gordon E (2007) Elevated body mass index is associated with executive dysfunction in otherwise healthy adults. Compr Psychiatry, 48:57-61.
11. Gunstad J, Strain G, Devlin MJ, Wing R, Cohen RA, Paul RH et al. (2011) Improved memory function 12 weeks after bariatric surgery. Surg Obes Relat Dis, 7:465-472.
12. Handley JD, Williams DM, Caplin S, Stephens JW, Barry J (2016) Changes in cognitive function following bariatric surgery: A systematic review. Obes Surg, 26:2530-2537.
13. Haslam DW, James WPT (2005) Obesity. Lancet, 366:1197-1209.
14. Hathaway DR, Griffin JW, Hall JR, Szabo AN (2024) Cognitive change after bariatric surgery: A systematic review of the evidence. Obes Surg, 34:2216-2226.
15. Hecht LM, Martens KM, Pester BD, Hamann A, Carlin AM, Miller-Matero LR (2022) Adherence to medical appointments among patients undergoing bariatric surgery: Do health literacy, health numeracy, and cognitive functioning play a role? Obes Surg, 32:1391-1393.
16. Kulendran M, Borovoi L, Purkayastha S, Darzi A, Vlaev I (2017) Impulsivity predicts weight loss after obesity surgery. Surg Obes Relat Dis, 13:490-497.
17. Marchesi DG, Ciriaco JGM, Miguel GPS, Batista GAP, Cabral CP, Fraga LC (2017) Does the attention deficit hyperactivity disorder interfere with bariatric surgery results? Rev Col Bras Cir, 44:140-146.
18. Miller AA, Spencer SJ (2014) Obesity and neuroinflammation: A pathway to cognitive impairment. Brain Behav Immun, 42:10-21.
19. Mobbs O, Crépin C, Thiébot MH, Bourgeois-Gironde S (2010) Obesity and the four faces of impulsivity. Appetite, 54:807-814.
20. Nederkoorn C, Smulders FTY, Havermans RC, Roefs A, Jansen A (2006) Impulsivity in obese women. Appetite, 47:253-256.
21. Nicolau J, Ayala L, Francés C, Sanchís P, Zubillaga I, Pascual S et al. (2015) Are subjects with criteria for adult attention-deficit/hyperactivity disorder doing worse after bariatric surgery? A case-control study. Nutr Hosp, 31:1052-1058.
22. Peters MDJ, Godfrey CM, McInerney P, Munn Z, Tricco AC, Khalil H (2020) Scoping reviews.
23. In JBI Manual for Evidence Synthesis. (Eds E Aromataris, Z Munn):Chapter 11. Adelaide, Joanna Briggs Institute.
24. Peromaa-Haavisto P, Luostarinen M, Juusela R, Tuomilehto H, Kössi J (2024) Obstructive sleep apnea: The effect of bariatric surgery after five years—A prospective multicenter trial. Obes Surg, 34:1544-1551.
25. Schag K, Schönleber J, Teufel M, Zipfel S, Giel KE (2013) Food-related impulsivity in obesity and binge eating disorder – A systematic review. Obes Rev, 14:477-495.
26. Simon GE, Ludman EJ, Linde JA, Operskalski BH, Ichikawa L, Arterburn D (2006) Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry, 63:824-830.
27. Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H et al. (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med, 357:741-752.
28. Smith E, Hay P, Campbell L, Trollor JN (2011) A review of the association between obesity and cognitive function across the lifespan: Implications for novel approaches to prevention and treatment. Obes Rev, 12:740-755.
29. Smith KR, Steele KE, Papantoni A, Harris C, Speck CL, Bakker A et al. (2023) The relationship between weight loss and cognitive function in bariatric surgery. Surg Endosc, 37:1976-1984.
30. Spitznagel MB, Garcia S, Miller LA, Strain G, Devlin M, Wing R et al. (2013a) Cognitive function predicts weight loss after bariatric surgery. Surg Obes Relat Dis, 9:453-461.
31. Spitznagel MB, Galioto R, Limbach K, Gunstad J, Heinberg L (2013b) Cognitive function is linked to adherence to bariatric postoperative guidelines. Surg Obes Relat Dis, 9:580-585.
32. Stenberg E, Larsson H, Marsk R, Cao Y, Sundbom M et al. (2023) Association between attention deficit hyperactivity disorder and outcomes after metabolic and bariatric surgery: A nationwide propensity-matched cohort study. Surg Obes Relat Dis, 19:92-101.
33. Squire LR, Zola-Morgan S (1991) The medial temporal lobe memory system. Science, 253:1380-1386.
34. Testa G, Granero R, Siragusa C, Belligoli A, Sanna M, Rusconi ML et al. (2020) Psychological predictors of poor weight loss following LSG: Relevance of general psychopathology and impulsivity. Eat Weight Disord, 25:1621-1629.
35. Thiara G, Cigliobianco M, Muravsky A, Paoli RA, Mansur R, Hawa R et al. (2017) Evidence for neurocognitive improvement after bariatric surgery: A systematic review. Psychosomatics, 58:217-227.
36. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D et al. (2018) PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med, 169:467-473.
37. Volkow ND, Wang GJ, Tomasi D, Baler RD (2013) The addictive dimensionality of obesity. Biol Psychiatry, 73:811-818.
38. Walø-Syversen G, Kvalem IL, Kristinsson J, Eribe IL, Rø Ø, Brunborg C et al. (2020) Preoperative inhibitory control predicts weight loss 1 year after bariatric surgery. Eur Eat Disord Rev, 28:613-622.