Mood disorders in laparoscopic sleeve gastrectomy patients: does it affect early weight loss?
ABSTRACT 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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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; · 3.44 Impact Factor
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ABSTRACT: Candidates for bariatric surgery frequently have co-morbid psychiatric problems. This study investigated the course and the prognostic significance of preoperative and postoperative anxiety and depressive disorders in 107 extremely obese bariatric surgery patients in a prospective design with face-to-face interviews (SCID) conducted prior to the surgery and postoperatively after 6-12 months and 24-36 months. The point prevalence of depressive disorders but not of anxiety disorders decreased significantly after surgery. Preoperative depressive disorders predicted depressive disorders 24-36 months but not 6-12 months after surgery, whereas preoperative anxiety significantly predicted postoperative anxiety disorders at both follow-up time points. Preoperative lifetime and current depressive disorders were unrelated to postoperative weight loss whereas preoperative lifetime, but not current anxiety disorders were of negative prognostic value for postoperative weight loss. Patients with both depressive and anxiety disorders at baseline (current and lifetime) lost significantly less weight after surgery. Postoperative anxiety disorder was not associated with the degree of weight loss at any follow-up time-point; however postoperative depressive disorder was negatively associated with weight loss at the 24-36 month follow-up assessment point. Missing data, limited statistical power, self-reported height and weight are the limitations of this study. As opposed to anxiety disorders, the point prevalence of depressive disorders decreased significantly after bariatric surgery. However, the presence of depressive disorders after bariatric surgery significantly predicted attenuated post-surgical improvements and may signal a need for clinical attention.Journal of Affective Disorders 04/2011; 133(1-2):61-8. DOI:10.1016/j.jad.2011.03.025 · 3.71 Impact Factor
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ABSTRACT: Persons with bipolar disorder (BD) have an increased risk of obesity and associated diseases. Success of current behavioral treatment for obesity in patients with BD is inadequate. Existing literature on bariatric surgery outcomes in populations with BD were reviewed, and needed areas of research were identified. Knowledge about bariatric surgery outcomes among patients with BD is limited. Available evidence indicates that bariatric surgery is a uniquely effective intervention for achieving and sustaining significant weight loss and improving metabolic parameters. Notwithstanding the benefits of bariatric surgery in nonpsychiatric samples, individuals with BD (and other serious and persistent mental illnesses) have decreased access to this intervention. Areas of needed research include: (1) current practice patterns; (2) metabolic course after bariatric surgery; (3) psychiatric course after bariatric surgery; and (4) mechanisms of psychiatric effect. The considerable hazards posed by obesity in BD, as measured by illness complexity and premature mortality, provide the basis for hypothesizing that bariatric surgery may prevent and improve morbidity in this patient population. In addition to physical health benefits, bariatric surgery may exert a robust and favorable effect on the course and outcome of BD and reduce obesity-associated morbidity, the most frequent cause of premature mortality in this patient population.Advances in Therapy 05/2011; 28(5):389-400. DOI:10.1007/s12325-011-0015-3 · 2.44 Impact Factor