Mood disorders in laparoscopic sleeve gastrectomy patients: Does it affect early weight loss?

Cleveland Clinic, Cleveland, OH 44195, USA.
Surgery for Obesity and Related Diseases (Impact Factor: 4.07). 03/2010; 6(2):191-6. DOI: 10.1016/j.soard.2009.11.017
Source: PubMed


Research has demonstrated that laparoscopic Roux-en-Y gastric bypass patients with a lifetime history of a mood disorder have a lower percentage of excess weight loss (%EWL) compared with patients without this lifetime history. No studies have examined the effect of psychiatric history on postoperative outcomes among laparoscopic sleeve gastrectomy (LSG) patients. The objectives of the present study were to determine whether mood disorders relate to the first year of weight loss for patients undergoing LSG at an academic medical center.
A total of 104 patients (78.6% white and 71.2% women), with a median body mass index of 60.35 kg/m(2) (range 31.37-129.14) underwent LSG. The patients were prospectively followed up at 1, 3, 6, 9, and 12 months. The semistructured preoperative psychiatric evaluations demonstrated that 43.1% had a current, and 62.5% a lifetime, diagnosis of a mood disorder.
LSG patients with current mood disorders had a significantly lower %EWL than patients without a psychiatric diagnosis at the 1-, 3-, 6-, and 9-month follow-up visits. LSG patients with a lifetime history of a mood disorder had a significantly lower %EWL than patients without psychiatric diagnosis at the 1-, 9-, and 12-month follow-up examinations. However, after removing patients with bipolar disorder from the analyses, no significant differences were found in the %EWL between patients with and without a lifetime history of depressive disorders.
Consistent with the laparoscopic Roux-en-Y gastric bypass findings, a lifetime history of mood disorders appears to be associated with significantly less weight loss in LSG patients. These findings highlight the importance of the psychiatric assessment in bariatric patients. Additionally, patients with a current or lifetime history of mood disorders might need additional pre- and postoperative care to improve their outcomes.

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    • "The prevalence rate for alcohol abuse 2 years postoperatively is 9.6% and is statistically higher than the presurgical prevalence rate, although it is unrelated to weight loss [11]. In terms of factors related to internalizing psychopathology (mood-and anxiety-related problems), some reports suggest that a presurgical presence of a mood or anxiety disorder impedes weight loss outcomes [12] [13] [14], whereas others suggest no association [13] [15] or enhanced outcomes [16] between measures of mood or anxiety and weight loss outcomes. Because of these high rates of psychosocial comorbidities and their potential impact on treatment, the American Society for Metabolic and Bariatric Surgery (ASMBS) [17] recommends multidisciplinary assessment of the bariatric surgery candidates that includes presurgical psychological screening [18]. "
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    ABSTRACT: Previous studies suggest that presurgical psychopathology accounts for some of the variance in suboptimal weight loss outcomes among Roux-en-Y gastric bypass (RYGB) patients, but research has been equivocal. The present study seeks to extend the past literature by examining associations between presurgical scale scores on the broadband Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and suboptimal weight loss and poor adherence to follow-up 1 year postoperatively after accounting for several methodologic considerations. Cleveland Clinic Bariatric and Metabolic Institute, Cleveland, Ohio, USA. The sample consisted of 498 RYGB patients, who produced a valid presurgical MMPI-2-RF protocol at program intake. The sample was primarily female (72.9%), Caucasian (64.9%), and middle-aged (mean = 46.4 years old; standard deviation [SD] = 11.6). The mean presurgical body mass index (BMI) was 47.4 kg/m(2) (SD = 8.2) and mean percent weight loss (%WL) at 1 year postoperatively was 31.18 %WL (SD = 8.44). As expected, scales from the Behavioral/Externalizing Dysfunction (BXD) domain of the MMPI-2-RF were associated with worse weight loss outcomes and poor adherence to follow-up, particularly after accounting for range restriction due to underreporting. Individuals producing elevated scores on these scales were at greater risk for achieving suboptimal weight loss (<50% excess weight loss) and not following up with their appointment compared with those who scored below cut-offs. Patients who are more likely to engage in undercontrolled behavior (e.g., poor impulse control), as indicated by presurgical MMPI-2-RF findings, are at greater risk for suboptimal weight loss and poor adherence to follow-up following RYGB. Objective psychological assessments should also be conducted postoperatively to ensure that intervention is administered in a timely manner. Future research in the area of presurgical psychological screening should consider the impact of underreporting and other discussed methodologic issues in predictive analyses. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
    Surgery for Obesity and Related Diseases 04/2015; DOI:10.1016/j.soard.2015.03.020 · 4.07 Impact Factor
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    • "Identification of these disorders improves the quality of perioperative management and helps predict the weight loss outcome after bariatric surgery. For example, a lifetime history of mood disorder implies poor weight loss [16]. In a follow-up study, patients with two or more psychiatric diagnoses were significantly more likely to experience weight loss cessation or weight regain after 1 year compared with those with less than two psychiatric diagnoses [17]. "
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    ABSTRACT: Purpose of review Bariatric surgery has been consistently shown to be effective in long-term marked weight loss and in bringing significant improvement to medical comorbidities such as metabolic syndrome. Empirical data suggest a high prevalence of psychiatric disorders among bariatric surgery candidates. In this review, we focus on the studies published recently with a high impact on our understanding of the role of psychiatry in bariatric surgery. Recent findings This article reviews the specific psychopathologies before surgery, changes in psychopathologies after surgery, suicide risk related to bariatric surgery, factors associated with weight loss, and recommendations for presurgical and postsurgical assessment and management. Research indicates a decrease in certain psychiatric symptoms after weight loss with bariatric surgery. However, the risk of suicide and unsuccessful weight loss in some bariatric surgery patients make monitoring following surgery as important as careful assessment and management before surgery. Specific considerations for youth and older populations and future potential research foci are discussed. Summary Recent publications suggest new directions for psychiatric evaluation and interventions for bariatric surgery patients. Future research on outcomes of specific populations, effectiveness of psychopharmacotherapy, and underlying pathophysiology are warranted for the advancement of treating bariatric surgery patients.
    Current Opinion in Psychiatry 07/2014; 27(5). DOI:10.1097/YCO.0000000000000085 · 3.94 Impact Factor
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    ABSTRACT: The studies in this thesis were aimed at examining cognitive and emotional factors that predict or obstruct a successful weight outcome after bariatric surgery (weight loss surgery) for morbid obesity. The thesis includes two studies with a cross-sectional and four studies with a prospective design. The models of assessment used were semi-structured interviews, self-report questionnaires, and actual weight and height measurements, with repeated assessments taken six months before, and six months, one year, and each next year after operation. Before the operation, self regulation cognitions of patients reflected a helpless and pessimistic state. Female patients with morbid obesity showed before operation less positive and more negative affect, more difficulty identifying feelings, and more suppression of emotions than women from the general population. Both worse affect and the unhealthy processing of emotions were reported to be associated with emotional eating. Regarding pre-post differences, virtually all variables, including the psychological, reflected a severely worse state before, than after bariatric surgery. This indicates that bariatric surgery not only accomplishes weight loss and a reduction of co-morbidity, but also changes in well-being and cognitions. A premise of this thesis was that the appropriate tools to improve the outcome of bariatric surgery could be found by examining cognitive and emotional factors that impact on eating behavior of patients after bariatric surgery. However, the results indicate that most of the cognitive or emotional factors measured did not predict the post-surgical weight outcome. Aspects of self-regulation, outcome expectations, and satisfaction were not associated with weight-loss outcome after the operation. The only possible predictor found for more weight loss in the long-term was a lower mental quality of life. Patients with a lower mental quality of life preoperatively or short-term postoperatively had a better weight loss outcome in the long-term. With respect to clinical implications, the most important issue is whether our findings can be used to improve intake screening and long-term weight loss outcome after bariatric surgery. That operatively induced effects of weight loss after bariatric surgery appear to be achieved independently of preoperative self-regulation cognitions, outcome expectations, and satisfaction implies that preoperative psychological variables cannot be used as intake screening or gatekeeper to indicate who will achieve a good weight outcome, needs additional counseling, or should be selected for surgery. The finding that patients with a higher preoperative and postoperative mental quality of life are at risk for a poorer long-term weight outcome suggests that the bariatric team should be aware that this specific group may need help in postoperative weight loss management.
    Journal of Geophysical Research Atmospheres 01/2011; · 3.43 Impact Factor
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