The role of cognitive flexibility in weight loss after severe obesity surgery - a retrospective study

Cognitive flexibility (CF) is a fundamental skill for behavioural regulation and adaptation during the weight-loss process. Research suggests that bariatric surgery (BS) candidates underperform consistently in the Wisconsin Card Sorting Test (WCST), which is a neuropsychological instrument that measures this ability. The current study explored the predictive value of preoperative performance in WCST CF dimensions alongside relevant psychological factors on weight loss after BS. The sample comprised 100 female patients who underwent BS in a public hospital in Lisbon, Portugal. We collected data using the WCST, the Hopkins Symptom Checklist-90-Revised (SCL-90-R), and the Binge Eating Scale (BES). Multiple linear regression (MLR) analyses were performed to obtain explanatory models of total weight loss at 12- and 24-postoperative months (TWL 1 and TWL 2, respectively). MLR identified the number of preservative responses as a highly significant predictor of TWL 1 (p < 0.01) , and the SCL-90-R obsession–compulsion and anxiety indices as highly significant predictors of TWL 1 and TWL 2 (p < 0.01). The number of preservative responses was a relevant predictor of weight loss at 12 months. Persisting in maladaptive cognitive strategies was associated with a lesser weight loss during the important period after BS that requires the adoption new lifestyle habits.