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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.
... In the assessments, 43.1% of patients had current mood disorders, and 62.5% had a lifetime conditions of mood disorders. Among patients with mood disorders, 5.9% had current BD and a lifetime history of BD [25]. Obesity is correlated with a poorer outcome in patients with BD1. ...
... Studies that have investigated the effect of preoperative psychiatric diagnoses on BS consequences have controversial findings; they often suggest a worse consequence for obese patients with psychiatric comorbidities [7,25]. The roles of psychological factors in the consequences of BS seem contradictory. ...
... Patients with current mood disorders (depression and BD) at the time of assessment had lower excessive weight loss (EWL%) than patients without psychiatric diagnosis in the first, third, sixth, and ninth months, wherever this difference was significant even after exclusion of patients with a diagnosis of BD. Patients with current depressive disorder also had lower weight loss at the first, third, ninth, and ninth months during follow-up in comparison with patients without psychiatric disorders [25]. ...
Bipolar disorder (BD) patients are at high risk of obesity, which affects their quality of life (QOL). Since there is a high comorbidity between BD and obesity, most BD patients seek surgical intervention for obesity. Nowadays, bariatric surgery (BS) is considered appropriate for carefully selected patients with BD. Evaluations before performing BS and careful follow-up of patients with the bipolar spectrum are highly recommended. This study reviews the effects of BS on the course of BD and, at the same time, assesses the effect of BD on the consequences of the surgery. Our results showed that the number of studies approving the promising impact of surgery on BD was more than those disapproving it. However, more accurate results require more than 3-year follow-ups.
... A similar finding was reported for patients with a lifetime anxiety disorder (d = .28). Although results reported by Kalarchian et al. (2008) were associated with smaller effect size coefficients compared to findings reported by Semanscin-Doerr et al. (2010), the associations may have been attenuated due to surgery type. Kalarchian et al. (2008) also found that there were no BMI reduction differences at the six month follow-up (d = .17) ...
... A number of studies were reviewed that sought to examine whether presurgical depression/anxiety, eating behaviors, substance use, and cognitive functioning predicts postoperative weight loss. Studies that relied on presurgical diagnoses of a mood or anxiety disorder have yielded inconsistent findings (c.f., de Zwaan et al., 2011;Kalarchian et al., 2008;Semanscin-Doerr et al., 2010). Data obtained with psychological assessment instruments have also produces mixed results, where some authors reported higher presurgical scores on the BDI-II predict positive weight loss outcomes (c.f., Averbukh et al., 2003;Odom et al., 2010) whereas scores on instruments such as the MMPI are unassociated or negatively correlated with weight loss outcomes (c.f., Tarescavage et al., 2013;Tsushima et al., 2004). ...
... For instance, using the Beck Depression Inventory (BDI; Beck et al., 1996) as a presurgical assessment measure, some authors have reported negative associations with post-surgical weight loss (Averbukh et al., 2003) and positive associations with weight gain (Odom, 2010). On the other hand, studies using structured interviews to derive MDD diagnoses have yielded inconsistent findings; some reporting no association with weight loss (e.g., Kalarchian et al., 2008) and others finding a positive association with this outcome (de Zwaan et al., 2011;Semanscin-Doerr et al., 2010). ...
Although a number of studies have asserted that psychosocial factors contribute to suboptimal weight loss outcomes following bariatric surgery; research has been inconsistent regarding the associations between preoperative psychiatric diagnoses and psychological testing results and suboptimal weight loss. Research implies that psychopathology and personality are best capture by a hierarchical framework. The current investigation examined the utility of using the hierarchical model of psychopathology to predict 5-year Body Mass Index (BMI) outcomes. A total of 446 consecutively, locally residing consented patients who underwent a Roux-en-Y Gastric Bypass (RYGB) at least 5-years ago were included in the study. A majority were women (74.2%) and of Caucasian descent (66.2%). Patients’ mean pre-surgical BMI was 49.14 kg/m2 [Standard Deviation (SD) = 9.50 kg/m2]. Psychiatric diagnoses were obtained from a pre-surgical, semi-structured clinical interview and all participants were administered the MMPI-2-RF at their pre-surgical evaluations. BMIs were collected at 4 post-operative time points across a 5-year trajectory. Age significantly predicted the nonlinear rate of BMI-reduction across time, such that older individuals evidenced a slower rate of change over time. Pre-surgical levels of Externalizing and Low Positive Activation/Emotionality predicted higher BMIs at the 5-year outcome. Pre-operative indicators of psychopathology are important in predicting post-operative outcomes, particularly when they are dimensional in nature and aligned with the hierarchical model of psychopathology. A closer follow-up with patients who evidence pre-surgical problems, both before and after surgery, may help improve outcomes.
... [3][4][5][6][7] Pre-surgical behavioral and psychosocial factors, including internalizing (i.e., anhedonia, anxiety, low frustration tolerance) and externalizing (i.e., impulsivity, sensation seeking, substance use) psychopathology, maladaptive eating behaviors, and poor behavioral adherence have been linked to poorer weight loss outcomes following bariatric surgery. [8][9][10][11][12][13][14][15][16][17] Due in part to this association, a number of obesity-related societies recommend conducting pre-surgical psychological evaluations as part of patients' pre-surgical regimen. 5,18 A primary goal of these evaluations is to identify psychosocial factors that could impede outcomes and recommend appropriate pre-surgical and/or postoperative interventions to help the patient achieve and maintain optimal results. ...
... Despite numerous studies demonstrating evidence that pre-surgical psychopathology predicts poorer weight loss outcomes, [8][9][10][11][12][13] much of the literature on the role of pre-surgical internalizing and externalizing psychopathology in predicting poorer weight loss outcomes is mixed. For example, some studies reported that pre-surgical measures of depression predicted poorer short-term outcomes 16,17,19 whereas others found no association between measures of depression and short-term outcomes. 12,20 Some studies indicate that pre-surgical externalizing behaviors, such as binge and graze eating are predictive of poorer weight loss outcomes, 10 whereas other studies do not support those associations. ...
... Based on prior literature, no specific psychiatric diagnosis consistently predicts poorer weight loss outcomes; [8][9][10][11][12][13][14][15][16][17] therefore, all diagnoses and chart review information (e.g., history of abuse, number of psychiatric medications, etc) were tested for exploratory purposes. Lastly, MMPI-2-RF scale assessing internalizing and externalizing dysfunction were added to the prediction model to test the incremental contribution of an objective personality assessment instrument that adheres to contemporary dimensional conceptualizations of psychopathology in the pre-surgical psychological evaluation. ...
Background: Psychosocial factors contribute to poorer weight
loss outcomes following bariatric surgery; however, findings on
associations between preoperative psychiatric diagnoses, psychological
testing, and weight loss are inconsistent.
Objectives: Examine associations between pre-surgical psychiatric
diagnoses derived from a semi-structured clinical interview and test
scores from the Minnesota Multiphasic Personality-Inventory - 2 -
Restructured Form (MMPI-2-RF) and 5-year Body Mass Index (BMI) outcomes.
Setting: Cleveland Clinic Bariatric and Metabolic Institute
Methods: 446 consecutively, consented patients who underwent a Roux-en-Y
Gastric Bypass (RYGB) at least 5-years prior were included in the study.
A majority were women (74.2%) and Caucasian (66.2%). Patients' mean presurgical
BMI was 49.14 kg/m2 [Standard Deviation (SD) = 9.50 kg/m2].
Psychiatric diagnoses were obtained from a pre-surgical, semi-structured
clinical interview and all participants were administered the MMPI-2-RF
at their pre-surgical evaluations. BMIs were collected at 4 postoperative
time points across a 5-year trajectory. This prospective design
utilized latent growth curve modeling.
Results: Older individuals evidenced a slower rate of BMI reduction over
time. A pre-surgical diagnosis of Binge Eating Disorder predicted higher
BMIs at the 5-year outcome. Scores on MMPI-2-RF measures of emotional and
behavioral dysfunction domains incrementally predicted poorer weight loss
outcomes.
Conclusions: Pre-operative indicators of psychopathology, notably
indicators that are dimensional in nature, are important in predicting
post-operative outcomes. Closer follow-up with patients who evidence pre-surgical psychological factors, both before and after surgery, may help
improve outcomes.
... Further, Steinmann et al., reported similar follow up attendance for patients with bipolar disorder at 12 months compared to those without bipolar disorder (2) . A few other studies have examined surgical outcomes among bariatric patients with bipolar spectrum disorders, but these studies have combined bipolar spectrum disorders with other mental health diagnoses (e.g., schizophrenia) (12,13) and have also included relatively short follow-up periods (12 months) (13) limiting their value for revealing any impact of bipolar disorder symptoms on weight loss outcome in the longer-term. ...
... Further, Steinmann et al., reported similar follow up attendance for patients with bipolar disorder at 12 months compared to those without bipolar disorder (2) . A few other studies have examined surgical outcomes among bariatric patients with bipolar spectrum disorders, but these studies have combined bipolar spectrum disorders with other mental health diagnoses (e.g., schizophrenia) (12,13) and have also included relatively short follow-up periods (12 months) (13) limiting their value for revealing any impact of bipolar disorder symptoms on weight loss outcome in the longer-term. ...
... Overall, weight losses within the first 12 months post-surgery were similar for patients with and without bipolar spectrum disorders, which is consistent with a previous studies examining patients diagnosed with a bipolar spectrum disorder (2) . Other studies have shown less weight loss after bariatric surgery with psychiatric comorbidities that have included bipolar disorder, among other disorders (13) . Unlike previous studies, we also examined weight change occurring greater than 12 months after surgery, and found no differences in weight between patients with bipolar spectrum disorders and matched control patients who attended medical follow-up care at 24 months or longer (average of 52 months) after surgery. ...
Background
As many as 3% of bariatric surgery candidates are diagnosed with a bipolar spectrum disorder.
Objectives
1) To describe differences between patients with bipolar spectrum disorders who are approved and not approved for surgery by the mental health evaluator and 2) to examine surgical outcomes of patients with bipolar spectrum disorders.
Setting
Academic medical center, United States.
Methods
A retrospective record review was conducted of consecutive patients who applied for bariatric surgery between 2004 and 2009. Patients diagnosed with bipolar spectrum disorders who were approved for surgery (n = 42) were compared with patients with a bipolar spectrum disorder who were not approved (n = 31) and to matched control surgical patients without a bipolar spectrum diagnosis (n = 29) on a variety of characteristics and surgical outcomes.
Results
Of bariatric surgery candidates diagnosed with a bipolar spectrum disorder who applied for surgery, 57% were approved by the psychologist and 48% ultimately had surgery. Patients with a bipolar spectrum disorder who were approved for surgery were less likely to have had a previous psychiatric hospitalization than those who were not approved for surgery. Bariatric surgery patients diagnosed with a bipolar spectrum disorder were less likely to attend follow-up care appointments 2 or more years postsurgery compared to matched patients without bipolar disorder. Among patients with available data, those with a bipolar spectrum disorder and matched patients had similar weight loss at 12 months (n = 21 for bipolar; n = 24 for matched controls) and at 2 or more years (mean = 51 mo; n = 11 for bipolar; n = 20 for matched controls).
Conclusion
Patients diagnosed with a bipolar spectrum disorder have a high rate of delay/denial for bariatric surgery based on the psychosocial evaluation and are less likely to attend medical follow-up care 2 or more years postsurgery. Carefully screened patients with bipolar disorder who engage in long-term follow-up care may benefit from bariatric surgery.
... All rights reserved. behavioral adherence have been linked to poorer weight loss outcomes following bariatric surgery [8][9][10][11][12][13][14][15][16][17]. Due in part to this association, a number of obesity-related societies recommend conducting presurgical psychological evaluations as part of patients' presurgical regimen [5,18]. ...
... Despite numerous studies demonstrating evidence that presurgical psychopathology predicts poorer weight loss outcomes [8][9][10][11][12][13], much of the literature on the role of presurgical internalizing and externalizing psychopathology in predicting poorer weight loss outcomes is mixed. For example, some studies reported that presurgical measures of depression predicted poorer short-term outcomes [16,17,19] whereas others found no association between measures of depression and short-term outcomes [12,20]. Some studies indicate that presurgical externalizing behaviors, such as binge and graze eating are predictive of poorer weight loss outcomes [10], whereas other studies do not support those associations [21]. ...
... The multimethod assessment practice conducted at the hospital made it possible to explore associations between findings in a medical chart review, a semistructured clinical interview, and internalizing and externalizing scale scores from the MMPI-2-RF with 5-year BMI outcomes. Based on prior literature, no specific psychiatric diagnosis consistently predicts poorer weight loss outcomes [8][9][10][11][12][13][14][15][16][17]; therefore, all diagnoses and chart review information (e.g., history of abuse, number of psychiatric medications, etc.) were tested for exploratory purposes. Lastly, MMPI-2-RF scales assessing internalizing and externalizing dysfunction were added to the prediction model to test the incremental contribution of an objective personality assessment instrument that adheres to contemporary dimensional conceptualizations of psychopathology in the presurgical psychological evaluation. ...
... Another study showed that patients with pre-operative depression (measured by BDI) had more post-operation weight loss after 1 year [53]. However, a number of studies found no correlation between pre-operative depression versus weight loss in patients with bariatric surgery [31,55,56]. Powers et al. investigated 131 patients at 2 years and 5.7 years postoperatively with known psychiatric assessments prior to surgery [55]. ...
... The study observed that there was no difference in percentage excess weight loss (%EWL) and psychiatric disorders including depression at 1-year post-surgery (p = 0.76). In line with these studies, Semanscin-Doerr and colleagues also found no difference between the presence and absence of lifetime history of depression and %EWL [56]. Our result was in line with these studies. ...
Purpose
The association between bariatric surgery outcome and depression remains controversial. Many patients with depression are not offered bariatric surgery due to concerns that they may have suboptimal outcomes. The aim of this study was to investigate the relationship between baseline World Health Organization-Five Wellbeing Index (WHO-5) and percentage total weight loss (%TWL) in patients after bariatric surgery.
Materials and Methods
All patients were routinely reviewed by the psychologist and screened with WHO-5. The consultation occurred 3.5 ± 1.6 months before bariatric surgery. Body weight was recorded before and 1 year after surgery. A total of 45 out of 71 (63.3%) patients with complete WHO-5 data were included in the study. Data analysis was carried out with IBM SPSS Statistics (version 27) to determine the correlation between baseline WHO-5 and %TWL in patients having bariatric surgery.
Results
Overall, 11 males and 34 females were involved with mean age of 47.5 ± 11.5 and BMI of 46.2 ± 5.5 kg/m ² . The %TWL between pre- and 1-year post-surgery was 30.0 ± 8.3% and the WHO-5 Wellbeing Index mean score was 56.5 ± 16.8. We found no correlation between %TWL and the WHO-5 Wellbeing Index ( r = 0.032, p = 0.83).
Conclusion
There was no correlation between the baseline WHO-5 Wellbeing Index and %TWL 1-year post-bariatric surgery. Patients with low mood or depression need to be assessed and offered appropriate treatment but should not be excluded from bariatric surgery only based on their mood.
Graphical Abstract
... We previously demonstrated that alexithymia is associated with lower total weight loss percentage (%TWL) at 3 and 6 months after gastric bypass (GBP) [16] and a similar result was found at 12 months after laparoscopic sleeve gastrectomy (LSG) [17]. Moreover, depression and anxiety were found to be negative predictors of weight loss after bariatric surgery [18,19], especially if concomitant [20]. There are few studies that investigated the role of anxiety and depression on mid-and long-term outcome in bariatric patients [18,20]. ...
... Our study is coherent, in part, with a previous study showing that patients who underwent LSG with a life history of mood disorder have a lower %TWL compared to patients without this mood disorder [19]. Similarly, according to our data, a previous study has found that patients with two or more psychiatric diagnoses are significantly more likely to experience interruption of weight loss or weight recovery after 1 year from bariatric surgery [27]. ...
Background
The purpose of this study was to investigate the relationship between preoperative psychological factors and percentage of total weight loss (%TWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB) to identify possible psychological therapy targets to improve the outcome of bariatric surgery.Methods
Seventy-six patients completed the Hamilton's Anxiety and Depression Scales (HAM-A, HAM-D) and Toronto Alexithymia Scale (TAS-20) the day before surgery (T0). The pre-operative body weight and the %TWL at 3 (T1), 6 (T2), and 24–30 (T3) months were collected.ResultsAt T3, depressed and alexithymic patients showed a lower %TWL compared to non-depressed patients (p = 0.03) and to non-alexithymic patients (p = 0.02), respectively. Finally, patients who had at least one of the three analyzed psychological factors showed less weight loss, at T2 (p = 0.02) and T3 (p = 0.0004).Conclusions
Psychological factors may also affect long-term outcome of bariatric surgery. This study shows an association between alexithymia/depression pre-operative levels and the weight loss at 30 months’follow-up after bariatric surgery.Level of evidenceLevel III, longitudinal cohort study.
... A review of psychological evaluation in 81 bariatric surgery programs reported active symptoms of schizophrenia to be one of the most common contraindications for surgery [11]. Many studies suggested worse outcome of bariatric surgery in psychiatric patients [12][13][14][15], other reports found weight loss after bariatric surgery to be independent from psychiatric diagnoses like bipolar disorder or schizophrenia [16,17]. ...
... Studies evaluating the efficacy and safety of LSG in psychiatric comorbid patients are very rare and the results are contradictory. The results are based on small groups of patient with heterogeneous psychiatric comorbidities including bipolar disorder, depression, anxiety and schizophrenia and described lower [14] or similar [20] weight loss in psychiatric compared to non-psychiatric patients (LSG) . ...
Purpose
The aim of this study was to compare surgical and psychiatric outcome and weight loss in schizophrenia patients with mentally healthy patients after sleeve gastrectomy.
Materials and Methods
A cohort study design was selected, comprising patients with schizophrenia with mentally healthy patients who underwent sleeve gastrectomy and were adherent to a follow-up at least 12 months after surgery.
Results
Seven schizophrenia (5 male, 2 female) and 59 (12 male, 47 female) mentally healthy patients were included in this study. A laparoscopic sleeve gastrectomy was performed safely in all 66 patients. The calculated excess weight loss (%EWL) showed no significant differences in both groups and reached 51.68 ± 15.84% for schizophrenia group and 60.68 ± 19.95% for mentally healthy group at 24-month follow-up (p = 0.33). The decrease in the HbA1c levels within 2 years after sleeve gastrectomy was similar in both groups (p = 0.79, 0.88, 0.82, 0.73 for surgery time, time of 6-, 12-, and 24-month follow-up respectively). The psychiatric status of the patients of the schizophrenia group was stable in all cases and no exacerbation of psychiatric symptoms was observed during time of follow-up. Furthermore, an overall significant improvement of the self-estimated mood and satisfaction was observed in both groups (Manova: f = 1.26, p < 0.0001).
Conclusions
The results 2 years after sleeve gastrectomy in stable patients with schizophrenia and after an adequate psychological evaluation were encouraging and comparable to the outcome in mentally healthy patients.
... 8 Comorbid drug addiction, tobacco dependence, and obesity may all contribute to increased costs and shortened lifespans by 10-25 years 9 and a 3.5-fold increased mortality risk. 10 Approaches to address weight gain include pharmacotherapy, 5 bariatric surgery, 11,12 and behavioral interventions. 13,14 Pharmacotherapy, while shown to have a short-term effect, is often ineffective in the long term. ...
... Therefore, patients taking APDs may require additional pre-and postoperative care to improve long-term weight loss. 11,12 In contrast, a behavioral approach is the least medically invasive and unlikely to have side effects associated with pharmacotherapy and surgery. The United States Preventative Services Task Force (USPSTF) found behavioral interventions can result in weight loss and improved metabolic parameters in the general population. ...
Background
Weight gain and other metabolic sequelae of antipsychotic medications can lead to medication non-adherence, reduced quality of life, increased costs, and premature mortality. Of the approaches to address this, behavioral interventions are less invasive, cost less, and can result in sustained long-term benefits. Objective
We investigated behavioral weight management interventions for veterans with mental illness across four medical centers within the Veterans Affairs (VA) Healthcare System. DesignWe conducted a 12-month, multi-site extension of our previous randomized, controlled study, comparing treatment and control groups. ParticipantsVeterans (and some non-veteran women) diagnosed with mental illness, overweight (defined as having a BMI over 25), and required ongoing antipsychotic therapy. InterventionsOne group received “Lifestyle Balance” (LB; modified from the Diabetes Prevention Program) consisting of classes and individual nutritional counseling with a dietitian. A second group received less intensive “Usual Care” (UC) consisting of weight monitoring and provision of self-help. Main MeasuresParticipants completed anthropometric and nutrition assessments weekly for 8 weeks, then monthly. Psychiatric, behavioral, and physical assessments were conducted at baseline and months 2, 6, and 12. Metabolic and lipid laboratory tests were performed quarterly. Key ResultsParticipants in both groups lost weight. LB participants had a greater decrease in average waist circumference [F(1,1244) = 11.9, p < 0.001] and percent body fat [F(1,1121) = 4.3, p = 0.038]. Controlling for gender yielded statistically significant changes between groups in BMI [F(1,1246) = 13.9, p < 0.001]. Waist circumference and percent body fat decreased for LB women [F(1,1243) = 22.5, p < 0.001 and F(1,1221) = 4.8, p = 0.029, respectively]. The majority of LB participants kept food and activity journals (92%), and average daily calorie intake decreased from 2055 to 1650 during the study (p < 0.001). Conclusions
Behavioral interventions specifically designed for individuals with mental illness can be effective for weight loss and improve dietary behaviors. “Lifestyle Balance” integrates well with VA healthcare’s patient-centered “Whole Health” approach.ClinicalTrials.gov identifier NCT01052714.
... Overall, the literature assessing predictive utility of psychological evaluations is mixed. Although a number of studies have shown associations between psychological domains such as depression and disordered eating and weightloss outcomes [19][20][21][22], others have not demonstrated such associations, and systematic reviews and meta-analytic studies do not demonstrate predictive utility of these preoperative variables [7,23,24]. More consistently, studies have shown that it is the presence of post-MBS psychiatric symptoms and disordered eating that are associated with weight loss and weight recurrence [23,25]. ...
Clinical Practice Guidelines for the peri-operative support of metabolic and bariatric surgery (MBS) patients have recommended a formal psychological evaluation prior to surgery for over 30 years. However, the predictive utility of the evaluation in determining future outcomes has been mixed, leading to controversy regarding whether such evaluations should be required for all potential patients. This empirically based commentary will review the utility and value of the psychological evaluation, the limitations in the extant literature that reduce predictive validity and provide recommendations on how to improve quality of the empirical literature and refinements to increase the utility of pre-operative evaluations. Pre-MBS psychological evaluation, conducted by an appropriately trained clinician and properly reimbursed by the payor that includes time for psychological testing, integration of data, report writing, medical record review, and feedback to the patient and surgical team, should continue to be the standard of care as it benefits all stakeholders.
... The main cause of unsuccessful weight loss appears to be unmodified behavior, mainly related to maladaptive eating patterns and sedentary lifestyle [10]. Mental illness, particularly anxiety disorders and depression, also play a significant role [11,12] and should be addressed during the preoperative preparation [13][14][15][16]. Current preparation is provided through one-time information sessions or educational materials after conservative weight loss attempts have failed [7,17]. ...
Introduction: Short educational programs prior to metabolic and bariatric surgery (MBS) provide information to prepare patients adequately for surgery and subsequent changes. Our knowledge of the beneficial effects of these programs on stabilizing and improving mental health of patients with obesity awaiting surgery is incomplete. The objective of this study was to assess the effects of a group-based educational program before MBS on three key factors: (i) patients’ mental health, (ii) the program’s perceived helpfulness from the patients’ perspective, and (iii) the effectiveness of delivering the program online via videoconferencing. Methods: Validated questionnaires for anxiety, depression, stress, and quality of life before and after the program were assessed. Additionally, participants’ perspectives of benefits were assessed. Two subgroups, one participating in face-to-face classes, the other participating online via videoconferencing, were compared. Results: Three hundred five patients with obesity waiting for MBS participated in the program. The dropout rate was 3%. On mean average, symptoms of anxiety (−1.1 units [SD 4.6], p < 0.001), depression (−0.9 units [SD 4.6], p < 0.001), and stress (−4.6 units [SD 15.6], p < 0.001) improved, while physical quality of life (+1.7 units [SD 9.7], p = 0.016) and body weight (−0.3 kg [SD 8.7], p = 0.57) remained stable. Patients perceived the program as very beneficial. The results were similar between delivery methods (face-to-face vs. videoconferencing). Conclusion: The educational program proved to be effective in bridging the gap in preoperative preparation while also stabilizing participants’ mental health. In addition, participants perceived the program as supportive. Online participation via video conferencing can be offered as an equivalent option to face-to-face classes.
... In particular, studies examining the impact of psychiatric disorders on weight loss and postoperative outcomes after bariatric surgery have yielded mixed results, possibly due heterogeneity of samples and methodology. We made a review of those studies and summarized in Annexe 1 [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. This review confirms divergent results, with various assessments of the weight loss outcomes, making comparison with others studies uneasy. ...
Introduction
To analyze the safety and long-term result of bariatric surgery in patients with psychiatric disorders.
Material and methods
From January 2009 to December 2018, n = 961 patients underwent bariatric surgery in a tertiary center. Among them, two groups of patients were created: a group of patients with psychiatric disorders (PG) and a group without psychiatric disorders (CG), using a propensity score matched (PSM). Primary endpoint was long-term outcomes and secondary endpoints were the postoperative morbidity 90 days after surgery, late morbidity, occurrence of psychiatric adverse events, and resolution of obesity-related comorbidities.
Results
Analysis with PSM permitted to compare 136 patients in each group, with a ratio 1:1. TWL% at 2 years in the PG was 32.7% versus 36.6% in the CG (p = 0.002). Overall surgical morbidity was higher in the PG than the CG (28% vs 17%, p = 0.01). Severe surgical complications were not statistically significant (4% vs 3%, p = 0.44). Psychiatric adverse events were significantly more frequent in the PG than in the CG. The resolution of obesity comorbidities was equivalent for both groups at 2 years.
Conclusion
Substantial weigh loss was reported among patients with psychiatric disorders receiving bariatric surgery at the cost of more non-severe surgical complications. Further, a psychiatric postoperative follow-up visit may be warranted for patients with preoperative psychiatric disorders, given the incidence of psychiatric adverse events.
... While procedural failures such as slippage of the gastric band, gastro-gastric fistulas, dilated gastric fundus, and enlargement of the gastric pouch or gastro-jejunal stoma can result in weight regain [48,51,[54][55][56], the most common causes are thought to be dysregulated (e.g., loss-of-control eating) or maladaptive (e.g., grazing) eating, noncompliance to dietary recommendations, return to previous eating habits, sedentary lifestyle, and physiological compensatory mechanisms such as changes in hormones that regulate energy intake leading to increased appetite and food cravings, and increased caloric intake [51,[57][58][59][60][61][62][63][64][65][66][67][68][69]. Comorbid psychiatric disorders, especially history of depression, have also been implicated as potential causes of treatment failure [70,71]. ...
Purpose of Review
Although bariatric surgery is the most effective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further out from surgery. The purpose of this review is to summarize the prevalence, predictors, and causes of weight regain.
Recent Findings
Estimating the prevalence of WR is limited by a lack of consensus on its definition. While anatomic failures such as dilated gastric fundus after sleeve gastrectomy and gastro-gastric fistula after Roux-en-Y gastric bypass can lead to WR, the most common causes appear to be dysregulated/maladaptive eating behaviors, lifestyle factors, and physiological compensatory mechanisms. To date, dietary, supportive, behavioral, and exercise interventions have not demonstrated a clinically meaningful impact on WR, and there is limited evidence for pharmacotherapy.
Summary
Future studies should be aimed at better defining WR to begin to understand the etiologies. Additionally, there is a need for non-surgical interventions with demonstrated efficacy in rigorous randomized controlled trials for the prevention and reversal of WR after bariatric surgery.
... For the determination and treatment of preoperative anxiety, help may be required from psychiatry and thus recommendations can be taken for the restructuring of the mental health of these patients. Patients with anxiety disorder have also been found to be negatively affected by long-term weight loss (16)(17)(18). Therefore, in an effort to obtain better results, preoperative STAI-S measurement might be utilized as an indicator of psychiatric needs. ...
Aim: To determine the effectiveness of weight loss with obesity surgery in reduction of preoperative anxiety by comparing the anxiety levels of the patients before undergoing One Anastomosis Gastric Bypass (OAGB) surgery and before their subsequent surgery. Material and Method: Sixty patients undergoing OAGB and secondary operations who had gastrectomized were enrolled in the study. The patients were divided into two groups in such a way that the morbidly obese patients who underwent OAGB surgery were included in the Group 1 and the patients who lost weight with OAGB surgery and were then admitted for a second operation were included in the Group 2. The preoperative anxiety levels of all the patients were measured with the State-Trait Anxiety Inventory (STAI). Results: The preoperative anxiety levels were found to be high in both groups. There were no statistically significant differences between the groups in terms of both state (STAI-S) (p=0.134) and trait (STAI-T) measurements (p = 0.436). Conclusion: The preoperative anxiety levels did not decrease with weight loss indicated by reduction in BMI among the patients who underwent OAGB. It has been reported before that the preoperative anxiety as well as anxiety disorders are persistent in such patient groups. Thus, anxiety levels of patients who underwent bariatric surgery should be measured and managed before secondary other operations even if their BMI decreases.
... 11 However, if present after surgery, it seems to negatively influence weight loss postoperatively. 8,[12][13][14] To our knowledge, no study has evaluated these psychological factors in older adults undergoing bariatric surgery. ...
INTRODUCTION: The literature remains scarce on the late effects of bariatric surgery on the general health of patients who underwent such procedures at an older age. The present study aimed to evaluate depression and anxiety symptoms, risky alcohol consumption, and binge eating in older adults undergoing bariatric surgery. METHODS: This study used current data (from medical records and tests) to conduct a cross-sectional study. A total of 74 individuals aged 60 years and older who underwent bariatric surgery after 55 years of age at a specialist center for obesity management located in Brazil were included and evaluated by the Beck Depression Inventory, Beck Anxiety Inventory, Alcohol Use Disorders Identification Test, and Binge Eating Scale. Demographic and clinical data related to the surgical procedure (weight loss) were also collected. The Cochran-Armitage trend test, Pearson’s χ2 test, and a multiple linear regression model were used as needed. A p < 0.05 was considered significant. RESULTS: The individuals were white (65.70%) and women (78.30%), with a mean age of 65.8 (SD 3.90) years. The mean time elapsed from surgery to evaluation was 75.70 (SD 43.70) months; 10.80% of the participants had moderate to severe depression, 8.10% moderate to severe anxiety, and 5.40% risky or high-risk alcohol consumption. None of the participants had binge eating problems. Weight regain was not associated with depressive symptom severity or risky alcohol consumption, but it was significantly associated (p = 0.034) with few or neither anxiety symptoms. Excess weight loss was not associated with any study variable. CONCLUSION: The results show a low prevalence of mental symptoms in older adults undergoing bariatric surgery compared to data from the literature on younger adults undergoing the same procedure.
... 11 However, if present after surgery, it seems to negatively influence weight loss postoperatively. 8,[12][13][14] To our knowledge, no study has evaluated these psychological factors in older adults undergoing bariatric surgery. ...
INTRODUCTION: The literature remains scarce on the late effects of bariatric surgery on the general health of patients who underwent such procedures at an older age. The present study aimed to evaluate depression and anxiety symptoms, risky alcohol consumption, and binge eating in older adults undergoing bariatric surgery. METHODS: This study used current data (from medical records and tests) to conduct a cross-sectional study. A total of 74 individuals aged 60 years and older who underwent bariatric surgery after 55 years of age at a specialist center for obesity management located in Brazil were included and evaluated by the Beck Depression Inventory, Beck Anxiety Inventory, Alcohol Use Disorders Identification Test, and Binge Eating Scale. Demographic and clinical data related to the surgical procedure (weight loss) were also collected. The Cochran-Armitage trend test, Pearson's χ 2 test, and a multiple linear regression model were used as needed. A p < 0.05 was considered significant. RESULTS: The individuals were white (65.70%) and women (78.30%), with a mean age of 65.8 (SD 3.90) years. The mean time elapsed from surgery to evaluation was 75.70 (SD 43.70) months; 10.80% of the participants had moderate to severe depression, 8.10% moderate to severe anxiety, and 5.40% risky or high-risk alcohol consumption. None of the participants had binge eating problems. Weight regain was not associated with depressive symptom severity or risky alcohol consumption, but it was significantly associated (p = 0.034) with few or neither anxiety symptoms. Excess weight loss was not associated with any study variable. CONCLUSION: The results show a low prevalence of mental symptoms in older adults undergoing bariatric surgery compared to data from the literature on younger adults undergoing the same procedure.
... Obesity is known as the main cause of many problems like hyperlipidemia, diabetes type 2, cancers, cardiovascular and psychological disorders, high blood pressure (hypertension), sleep apnea, musculoskeletal disorders and significant decrease in quality of life (1)(2)(3)(4)(5)(6)(7). Laparoscopic sleeve gastrectomy surgeries are proposed as one of the procedure to achieve efficient weight loss for morbidly obese patients nowadays (8). ...
Background: Bariatric surgery has resulted in body weight loss, which claimed by surgery removal specific parts of the stomach with enzyme or sleeve gastrectomy. Objectives: The aim of this study is to determine weight loss and endocrine changes by 12-week fundus resection and sleeve gastrectomy in rabbits. Methods: Twenty-one rabbits, weighing 2.5 - 3.5 kg, were divided into three groups (n = 7): sleeve gastrectomy, experimental fundus resection, and sham group. The weight of rabbits and total ghrelin and leptin levels in the plasma before and after surgery were measured in 12 weeks. Statistical analyses were performed using the Kruskal-Walis test for comparison of the means between the groups, and the difference after months in one group was assayed by Friedman test. Results: The results showed sleeve gastrectomy had a significant weight loss after one month when compared to fundus resection and sham-operated controls (P = 0.008). There was no significant difference in the ghrelin levels after these surgeries, but leptin levels decreased significantly after the fundectomy (P = 0.025). Conclusions: Sleeve gastrectomy is more efficient than the fundus resection in weight loss. It could be suggested as a new option in metabolic disorders due to the high level of leptin.
... Moreover, some authors have found that patients with depressive symptomatology presented poor weight or BMI loss after surgery 38,[51][52][53] . One explanation was that the former affects one's ability to adapt to post-surgical behavioural changes 53 . ...
Abstract The changes in depressive symptomatology during the first year following one-anastomosis gastric bypass (OAGB) were evaluated and its association with uric acid (sUA). Fifty patients were included in this analysis. Beck Depression Inventory (BDI) for measuring depressive symptomatology, blood samples, and anthropometric measurements were assessed before (T0), at 6 (T6), and 12 months (T12) after surgery. There was a significant reduction in BDI total score at T6 (− 5.6 (95% CI − 2.1, − 9.1) points; p = 0.001) and at T12 (− 4.3 (95% CI − 0.9, − 7.9) points; p = 0.011). BMI loss was unrelated to depressive symptomatology. Patients with moderate to severe depressive symptomatology presented lower sUA levels than patients with none or minimal to mild (p = 0.028). ROC analysis revealed that sUA levels below 5.0 at T6 and 4.5 mg/dl at T12 had a prognostic accuracy for depression severity. Furthermore, delta sUA was significantly associated with delta BMI (β = 0.473; p = 0.012) and delta waist circumference (β = 0.531; p = 0.003). These findings support an improvement in depressive symptomatology in the first year postoperatively, however, without relation to BMI loss. Patients with moderate to severe depressive symptomatology presented with lower sUA levels over time. Therefore, sUA could be useful to predict moderate to severe depressive symptomatology in patients undergoing OAGB in clinical practice.
... There is evidence that presurgical problematic eating behaviors and psychiatric symptoms contribute to lower postsurgical weight loss [4][5][6][7][8][9][10]. Problematic eating behaviors, including food addiction [6], emotional eating [6,9], and loss of control eating [8], have been associated with reduced postsurgical weight loss. ...
Background
Black patients typically lose less weight than White patients following bariatric surgery; however, the reasons for this racial disparity are unclear. The purpose of the current study was to evaluate whether there are differences in psychiatric symptoms and problematic eating behaviors between White and Black patients pursuing bariatric surgery as this may aid in understanding postsurgical weight loss disparities and inform psychosocial assessment of bariatric candidates.MethodsA retrospective chart review was conducted of participants (N = 284) who completed a psychological evaluation prior to surgery. Information collected included history of binge eating and purging as well as data from measures administered (i.e., the Hospital Anxiety and Depression Scale, the Emotional Eating Scale, and the Yale Food Addiction Scale 2.0).ResultsWhite patients reported higher levels of eating in response to anger/frustration (p = .03) and eating in response to depression (p = .01) than Black patients. White patients also reported more symptoms of food addiction, a difference that was trending toward significance (p = .05). No significant differences were found on measures of anxiety or depression.Conclusion
White patients appear to have higher levels of presurgical problematic eating as compared with Black patients pursuing bariatric surgery; thus, these measurements of problematic eating may not explain the racial disparity in outcomes. However, future research should determine whether measures are valid among diverse populations and identify additional factors that may contribute to racial disparities in bariatric outcomes.
... In addition to the association between mental illness and obesity, mental illness might also play a role in preventing significant weight loss. A prospective analysis examining 104 bariatric surgery candidates found that patients with a current or lifetime history of mood disorders lost significantly less weight than patients without a psychiatric diagnosis following bariatric surgery (Semanscin-Doerr et al. 2010). Furthermore, a study conducted by Kinzl et al. (2006) exploring psychiatric disorders among bariatric surgery patients in relation to weight loss success found that there were poorer weight loss outcomes among patients with multiple psychiatric disorders. ...
Background:
The digitalization of healthcare information provides hospitals with the ability to gain insight into patterns and associations pertaining to disease and management. Using bariatric patient data as an example provided an opportunity to explore the potential of electronic medical record (EMR) data to generate insights.
Objective:
The aim of this study was to extract EMR data pertaining to bariatric patient information as a means to explore predictive factors of weight loss post-bariatric surgery.
Methods:
We conducted a retrospective cohort study of patients undergoing bariatric surgery between January 1, 2018, and April 30, 2019, at Humber River Hospital. Multiple linear regression was used to examine whether age, pre-surgery body mass index (BMI), comorbidities and mental health disorders predicted higher weight loss 6 months following bariatric surgery.
Results:
A total of 502 patients were included in the final analysis. Age (ß = 0.04 [95% CI 0.01, 0.06], p = 0.005), baseline BMI (ß = -0.16 [95% CI -0.19, -0.13], p = <0.0001) and diabetes (ß = 0.82 [95% CI 0.23, 1.42], p = 0.007) were associated with weight loss six months post-bariatric surgery.
Conclusion:
EMRs are a rich source of data with the potential to generate insights that can lead to improved care.
... To date there is no clear evidence regarding the impact of pre-operative mental health conditions and of depression specifically, on post-BS weight outcomes. Multiple studies have found preoperative depression to negatively impact weight loss [11][12][13][14], while several others have found no association [5,8,9,[15][16][17][18][19][20][21][22][23]. Some studies have also found a positive link with pre-operative depression resulting in greater weight loss [24][25][26]. ...
... Similar results were also reported in studies conducted with LSG [15,39]. For example, Semanscin-Doerr et al. reported no difference in the %EWL at the 12-month follow-up after LSG in patients with and without preoperative current depressive disorder [40]. ...
Purpose
The aim of this study was to assess depressive symptoms, self-esteem, and eating psychopathology in bariatric surgery patients at the preoperative period (t0) and at the 6-month (t1) and 12-month (t2) follow-ups after laparoscopic sleeve gastrectomy (LSG). A second aim was to investigate associations between these variables and weight loss.
Method
The study participants were 48 bariatric surgery candidates and 50 non-obese controls. Both groups underwent assessment with the Sociodemographic Data Form, Hamilton Depression Rating Scale (HDRS), Eating Disorder Examination Questionnaire (EDE-Q), and Rosenberg Self-esteem Scale (RSES). These assessments were repeated for the patient group at t1 and t2.
Results
The HDRS, RSES, and EDE-Q scores were higher in the patients before LSG (t0) than in the control group. A significant progressive improvement was identified in the patient HDRS and RSES scores as well as EDE-Q weight and shape subscale scores at t1 and t2. However, the patient EDE-Q total and dietary restraint scores improved at t1 then stabilized. The patient EDE-Q eating concern subscale improved at t1, but then worsened. The patient HDRS scores at t2 were similar to the control group, but the EDE-Q and RSES scores were still higher than the control scores at t2. Regression analyses revealed no association between the preoperative scores and percent changes in postoperative scores for any scale and patient weight loss at t2.
Conclusion
Depressive symptoms, self-esteem, and eating psychopathology showed an improving trend in patients after LSG. However, some aspects of eating psychopathology worsened despite an initial improvement.
Level of evidence
III, prospective cohort and case–control study.
... In addition to eating behaviors, a number of studies suggest that pre-surgical anxiety and depression result in less weight loss in the short term after surgery [30][31][32]. Nevertheless, mixed findings have been published, as other authors have found no association between mood disorders at baseline and weight loss 1 year after surgery [29,33]. ...
Background
Problematic eating behaviors and general psychopathology have been associated with poor weight loss after bariatric surgery. However, little is known about how these aspects impact weight loss outcomes for the increasing number of patients undergoing reoperative surgeries. This study compares disordered eating and weight-related outcomes before and 6 months after surgery in patients undergoing primary (P-Group) and reoperative bariatric surgery (R-Group).
Methods
This longitudinal study assessed 122 P-Group and 116 R-Group patients before and 6 months after surgery. The assessment included the eating disorder examination diagnostic items, and a set of self-report measures assessing eating disorder symptomatology, grazing, depression, anxiety, and negative urgency.
Results
Preoperatively, no differences were found between the R- and P-Groups in terms of disordered eating-related variables (except for shape concern, which was higher for the R-Group). At 6 months after surgery, the R-Group revealed significantly higher values for restraint (F(1,219) = 5.84, p = 0.016), shape (F(1,219) = 5.59, p = 0.019), weight concerns (F(1,219) = 13.36, p = 0.000), depression (F(1,219) = 7.17, p = 0.008), anxiety (F(1,219) = 6.94, p = − 0.009), and compulsive grazing (F(1,219) = 6.13, p = 0.014). No significant pre- or post-surgery predictors of weight loss were found for the P-Group (χ2 = 0.70, p = 0.872). In the R-Group, post-surgery anxiety (Waldχ²(1) = 6.19, p = 0.01) and the post-surgery number of days with grazing in the previous month (Waldχ²(1) = 3.90, p = 0.04) were significant predictors of weight loss.
Conclusion
At 6 months after surgery, the R-Group presented more problematic eating and general psychological distress, which may put these patients at greater risk of poorer long-term weight outcomes.
... The relationship between surgically induced weight loss and depression has been studied, but there is important variability in results. Some authors have found that depressive patients present with poor weight loss after surgery [9,45], but others did not find differences compared with patients without depression (similar to our findings) [36]. It has been also reported that bariatric patients with mental disorders tend to refer more pain and present with higher readmission rates and increased postoperative mortality [37,46]. ...
Background
The prevalence of psychological disorders in bariatric surgery candidates is well established, where anxiety and depression are commonly observed. Depression prevalence and evolution after gastric bypass, and its impact on weight loss, have been less explored, especially among low-income patients. MethodsA retrospective study with low-income patients undergoing bariatric surgery from 2015 to 2016. A comparative analysis of preoperative depression (the Beck Depression Inventory II) was performed and compared at 6 and 12 months. A demographic and weight loss analysis was also performed. ResultsSeventy-three patients were included. Female sex comprised 76.7% of cases, and baseline depression was present in 45.2%, being severe in 2.7%. The analysis at 6 months showed Beck’s score improvement (12.3 baseline vs. 4.2 points at 6 months, p = 0.006), as well as for individual items (excepting irritability). At 12 months, the mean score was 5 points, without difference vs. 6 months. At 6 and 12 months, depression (any degree) was present in 9.6 and 8.6%, corresponding to percentage change rates of − 65.8 and − 59.3%. Only one patient (2.7%) presented severe depression. Depression status before surgery had no influence in weight loss amount at 12 months. Conclusion
Almost half of bariatric surgery candidates have some degree of depression that improves dramatically soon after bariatric surgery. Such change continues stable during the first year. Improvement was independent of gender, and depression has no influence on weight loss. In low-income bariatric patients, depression is lower than reports from developed countries, but similar improvement has been observed.
... Similar results were also reported by Semanscin-Doerr et al in their 104 LSG cases, whereby mood disorders were associated with significantly less weight loss after LSG. 31 A similar result was reported in RYGB by Kalarchian et al. 68.1% patients with an Axis I disorder, especially mood or anxiety disorders, exhibited poorer %EWL loss in 6 months than patients who had never had an Axis I disorder (47.7% v.s 56.9%). 32 Anti-psychotic medications were correlated with weight gain, particularly clozapine and olanzapine, tricyclic antidepressants such as amitriptyline, and doxepin. ...
Background
Obesity is a great concern in developed countries such as Taiwan. Laparoscopic sleeve gastrectomy (LSG) is becoming a popular and stand-alone bariatric procedure. The aim of this study is to analyze the factors that affect the weight loss outcome in our patients after LSG.
Methods
Eighty-two consecutive patients who underwent LSG between Oct. 2012 and Sept. 2015 were included. Patients were asked to fill out questionnaires during first visit. The endpoint of this review was the factors affecting excess weight loss (%EWL) ≧ 50% at post-operative 12-months.
Results
Sixty-seven patients (81.7%) completed 12 months of post-operative follow-up. The pre-operative mean weight and height were 109.7 kg and 165.7 cm (BMI of 40.4 kg/m²). There was no surgical mortality, but 2 (2.4%) patients suffered from severe complications. The mean post-operative body weights in post-operative months 1, 3, 6 and 12 were 100.4 kg, 90.5 kg, 88.0 kg, 83.6 kg, with 18.8%, 37.1%, 57.1% and 51.2% EWL. The percentage of total weight loss (%TWL) after 12 months follow-up was 23.2%. In univariate analysis, younger patients achieved better than 50% EWL (p = 0.013). Patients who reported pre-operative alcohol consumption, without psychiatric history and without osteoarthritis showed a better trend of achieving 50% EWL. In multi-variate analysis, younger patients (p = 0.042), with pre-operative alcohol consumption (p = 0.036) and without psychiatric history (p = 0.040) significantly achieved more than 50% EWL.
Conclusion
Younger age, pre-operative alcohol consumption and absence of psychiatric disease were positive predictor factors for successful weight loss after LSG.
... Studies examining the relationship of depression and anxiety disorders prior to surgery with the postoperative course of weight, at least regarding the first three years after surgery, have yielded heterogeneous results. While some studies showed a negative relationship (de Zwaan et al. 2011;Kalarchian et al. 2008;Semanscin-Doerr 2010), others observed a positive association (Averbukh et al. 2003;Odom et al. 2010). A third group found no relationship at all (Marek et al. 2015;Tarescavage et al. 2013). ...
Subject:
In view of the epidemic increase in severe obesity and the ineffectiveness of conservative weight-loss interventions, bariatric surgery delivers compelling results for patients with class II (BMI ≥ 35 kg/m²) and class III obesity (BMI ≥ 40 kg/m²), not only in reducing weight over the long term, but also in reducing obesity-related somatic comorbidity and improving psychosocial functioning and quality of life. Investigations into the psychosocial aspects of obesity surgery have proliferated over the last 15 years, providing a huge amount of essential research data. Yet the results are partly contradictory and highly dependent on the duration of follow-up.
Methods:
Based of a narrative review, this article provides an overview of the current status and recent developments of the reciprocal effects between bariatric surgery and psychosocial functioning. The review focused on eight domains representing important psychosomatic and psychosocial aspects of bariatric surgery.
Results:
Especially in cases of class II and III obesity, bariatric surgery is the only means to reduce bodyweight significantly and permanently, though they carry with them the associated risk factors of metabolic, cardiovascular, and oncological diseases.With regard to psychosocial and psychosomatic aspects, studies with a short-term catamnesis (approx. 3 years) speak in favor of an improvement in the quality of life including mental disorders. If we consider studies with longer follow-ups, however, the results are not as uniform. In particular, we observe an increase in harmful alcohol consumption, self-harm behavior, and suicide risk.
Conclusions:
In light of mental well-being and thus also quality of life, bariatric surgery would appear to convey an elevated risk for a minority of patients.Yet identifying these patients before surgery has so far been insufficient.
... Notably, patients with comorbid MS and obesity report worse depression, quality of life, and slower ambulation [5]. The bariatric literature raises concerns regarding the potential impact of depressive symptoms on weight loss and psychiatric outcomes; untreated preoperative depression may adversely impact postoperative physical and mental health outcomes [11,12]. Risk of suicide is another important concern post-bariatric surgery; not only do individuals seeking bariatric surgery present with a rate of past suicide attempts that is greater than population base rates [13], rates of suicide may also be increased after bariatric surgery [14][15][16]. ...
Background:
Bariatric surgery has been shown to be a safe and effective intervention for patients with comorbid obesity and multiple sclerosis (MS); however, this sub-population may be at heightened risk for pre- and postoperative depressive symptoms.
Objective:
This current exploratory study aims to describe the prevalence and nature of depressive symptoms in a sample of patients with MS who undergo bariatric surgery.
Methods:
Medical records were retrospectively reviewed to identify patients who received bariatric surgery and had a diagnosis of MS (n = 31) and a control sample of non-surgical MS patients with severe obesity (n = 828). Longitudinal outcome measures included the Patient Health Questionnaire-9 (PHQ-9) and Multiple Sclerosis Performance Scale (MSPS).
Results:
There were no significant differences in PHQ-9 total and item scores between groups at baseline. PHQ-9 scores significantly improved at years 1 (p < 0.01) and 2 (p = 0.03) post-bariatric surgery when compared to non-surgical controls. Higher BMI (p = 0.03) and worse overall quality of life (p < 0.01) were associated with worsening of PHQ-9 scores in the bariatric group. When compared to controls, the bariatric group demonstrated improved MSPS scores on a trend level 1 year post-surgery (p = 0.08).
Conclusions:
Consistent with the literature on more general bariatric surgery populations, current findings highlight the possible early benefits of bariatric surgery for reducing depressive symptoms in this population when compared to controls. Importantly, results should be viewed as preliminary and additional research is needed to examine bariatric surgery and associations with depressive symptoms and performance in the MS population.
... Before surgery, patients often report relatively high instances of sexual abuse, binge eating episodes, and other maladaptive eating patterns [9][10][11][12], also internalizing psychopathology, such as depression and anxiety [13]. However, when considering psychosocial factors related to postsurgical weight loss, research on the impact of psychiatric diagnoses and personality factors demonstrate mixed relationships with weight loss after surgery [14][15][16][17][18]. Although much research has been conducted on demographic and psychosocial factors within the general bariatric surgery population, less is known about how these factors might present in candidates with super-super obesity. ...
... Before surgery, patients often report relatively high instances of sexual abuse, binge eating episodes, and other maladaptive eating patterns [9][10][11][12], also internalizing psychopathology, such as depression and anxiety [13]. However, when considering psychosocial factors related to postsurgical weight loss, research on the impact of psychiatric diagnoses and personality factors demonstrate mixed relationships with weight loss after surgery [14][15][16][17][18]. Although much research has been conducted on demographic and psychosocial factors within the general bariatric surgery population, less is known about how these factors might present in candidates with super-super obesity. ...
Background:
The current investigation aims to predict 3-year postoperative percent total weight loss among a sample of bariatric surgery patients with super-super obesity.
Objective:
Previous research implies that persons with presurgical super-super obesity (body mass index [BMI] ≥60 kg/m(2)) tend to have poorer loss outcomes compared with those with a lower presurgical BMI after bariatric surgery.
Setting:
Cleveland Clinic, Bariatric & Metabolic Institute, Cleveland, OH.
Methods:
Bariatric surgery candidates (N = 1231; 71.9% female; 65.8% Caucasian) completed a presurgical psychological evaluation and the Minnesota Multiphasic Personality Inventory-2-Restructured Form. Participants with a baseline BMI ≥60 (n = 164) were compared with BMI<60 (n = 1067) on psychosocial and demographic factors, the Minnesota Multiphasic Personality Inventory-2-Restructured Form, and in the subset that had surgery (n = 870), percent total weight loss extending to the 3-year follow-up.
Results:
Patients with a BMI ≥60 were younger, less educated, and more likely to be male compared with lower BMI patients. Patients with a BMI ≥60 had greater psychosocial sequelae as evidenced by being more likely to have a history of sexual abuse, history of psychiatric hospitalization, more binge eating episodes, and higher prevalence of major depression disorder and binge eating disorder. On the Minnesota Multiphasic Personality Inventory-2-Restructured Form, those with BMI ≥60 reported greater demoralization, low positive emotions, ideas of persecution, and dysfunctional negative emotions. After controlling for surgery type, weight loss for individuals with BMI ≥60 did not greatly differ from weight loss in patients with BMI<60. Variables predictive of less weight loss at 3 years regardless of presurgical BMI, included being older, having a sexual abuse history, and higher ideas of persecution scores.
Conclusion:
Although patients with BMI ≥60 evidenced more psychopathology before surgery, findings suggest that the relationship between higher BMI and poorer outcome may better be explained by other co-morbid factors.
... There are several reasons that patients with mental illness might experience less weight loss after bariatric surgery, including behavioral aspects of some mental illnesses that could predispose to weight regain (e.g., diminished impulse control) (7) and the weight gainpromoting nature of many psychiatric medications (8). Research findings on this topic are mixed; some studies have concluded that patients with mood or anxiety disorders experience less weight loss following bariatric surgery (3,9), while others have shown no difference in weight loss according to mental illness status (10,12). ...
Objective:
To compare bariatric surgery outcomes according to preoperative mental illness category.
Methods:
Electronic health record data from several US healthcare systems were used to compare outcomes of four groups of patients who underwent bariatric surgery in 2012 and 2013. These included the following: people with (1) no mental illness, (2) mild-to-moderate depression or anxiety, (3) severe depression or anxiety, and (4) bipolar, psychosis, or schizophrenia spectrum disorders. Groups were compared on weight loss trajectory using generalized estimating equations using B-spline bases and on all-cause emergency department visits and hospital days using zero-inflated Poisson and negative binomial regression up to 2 years after surgery. Models were adjusted for demographic and health covariates, including baseline healthcare use.
Results:
Among 8,192 patients, mean age was 44.3 (10.7) years, 79.9% were female, and 45.6% were white. Fifty-seven percent had preoperative mental illness. There were no differences between groups for weight loss, but patients with preoperative severe depression or anxiety or bipolar, psychosis, or schizophrenia spectrum disorders had higher follow-up levels of emergency department visits and hospital days compared to those with no mental illness.
Conclusions:
In this multicenter study, mental illness was not associated with differential weight loss after bariatric surgery, but additional research could focus on reducing acute care use among these patients.
... Nine studies investigated the influence of psychopathology on weight loss outcome after BS (Table 3). Some studies have found poor weight loss postoperatively in the presence of preoperative mood disorders [22,49,50]. In 2008, Kalarchian et al. [51] provided that the presence of a lifetime Axis I disorder, especially mood or anxiety disorders, was associated with poorer weight outcomes up to six months after surgery. ...
... For example, most studies suggest that a pre-surgical history or current diagnosis of a mood disorder may negatively impact post-surgical weight loss whereas others have found no evidence of such an association. (18)(19)(20) Far less is known about the influence of more global indices of psychological and somatic distress or personality constructs on other post-surgical outcomes including post-surgical complications or readmissions. When using non-weight related outcome criteria in this setting, previous work has demonstrated that pre-surgical scores on MMPI-2-RF scales measuring internalizing dysfunction (e.g., demoralization, low positive emotions) were associated with more psychological distress at 1 and 3-month post-surgical follow-up. ...
Background: 30-day readmissions occur in 5% or more of bariatric surgery patients. Some readmissions relate directly to surgical risks whereas others relate to more non-specific complaints or non-adherence and may reflect risks outside of the surgical procedure.
Objective: To investigate whether pre-surgical psychosocial factors are related to readmission.
Setting: Tertiary/quaternary academic referral center.
Methods: Bariatric surgery patients readmitted within 30 days during 2012-2015 were identified (n=102). Patients were matched (2:1) on body mass index (BMI), age, gender and race to 204 non-readmitted patients. Psychiatric variables and psychological testing (Minnesota Multiphasic Personality Inventory-2-Restructured Form; MMPI-2-RF) at intake were compared between the 2 groups. Amongst those readmitted, the indication for readmission was investigated. Those with specific complications (n=61) were delineated from those with non-specific indications (n=33).
Results: Those with non-specific readmissions were younger and more likely to be female. These patients were also less likely to be in outpatient psychiatric care than non-readmitted patients. Significant differences were found on the Uncommon Virtues scale of the MMPI-2-RF which reflects a tendency to under-report disinhibited behaviors. Those with non-specific re-admissions had significantly higher under-reporting scores compared to those with specific indications or those not readmitted.
Conclusions: Readmitted patients, particularly those with non-specific indications, were more likely to pre-surgically present themselves in an overly positive manner. The tendency to under-report may impact the team’s ability to identify risk factors that could be ameliorated prior to surgery. Readmitted patients were also less likely to be receiving mental health care. Such ongoing treatment may increase monitoring and/or adherence following surgery.
... The analysis 1 3 of bariatric patients do not reach the expected weight loss and that about 20-30% of them re-gain substantial weight [7][8][9]. Several studies showed correlation between postsurgery weight loss or %EWL and personality disorders, eating disorders [10], psychiatric disorders, cognitive functions [11], adverse childhood experiences, mood disorders and anxiety disorders [12][13][14]. A recent study showed that also the alexithymia seems to have a role in affecting short-term post-surgery outcomes in bariatric patients [15]. ...
Purpose:
Obesity is a multifactorial disease characterized by genetic, social, cultural and psychological factors. Currently, bariatric surgery represents the gold-standard intervention to treat morbid obesity in order to counteract associated disabling comorbidities. Several studies showed correlation between post-surgery weight loss and psychological factors. Also, the alexithymia may have a role in affecting post-surgery outcomes in bariatric patients, even if there are no studies investigating its role at 12-month follow-up. The purpose of the present study was to investigate the association between alexithymia and the postoperative weight loss 12 months after laparoscopic sleeve gastrectomy.
Methods:
Seventy-five patients undergoing laparoscopic sleeve gastrectomy were enrolled. The Toronto Alexithymia Scale (TAS-20) was administered to patients. A postoperative weight loss check was performed at 3 and then 12?months after surgery.
Results:
The TAS-20 total score was negatively correlated with the percent of excess weight loss (%EWL) at the 12-month follow-up (r?=?-0.24; p?=?0.040). The analysis showed that non-alexithymic patients had a greater weight loss at 12 months after surgery compared to both probably alexithymics (71.88???18.21 vs. 60.7???12.5; p?=?0.047) and probably alexithymic patients (71.88???18.21 vs. 56???22.8; p?=?0.007). The preoperative BMI was a significant covariate [F(1,70)?=?6.13 (p?=?0.016)].
Conclusion:
In the present study, the patients with higher preoperative BMI and identified as alexithymic showed lower %EWL at 12?months after laparoscopic sleeve gastrectomy. Findings point out the importance to take into consideration possible psychological treatments focused on improving emotional regulations of patients who are seeking bariatric surgery.
... Perceived stress and depressive symptoms were also improved at 1 year after LSG [13], and two studies reported that the quality of life was high in patients even at a 5-year follow-up [11,14]. However, as for RYGB and LAGB, a lifetime history of mood disorders was associated with less favourable weight loss outcomes 1 year after LSG [15]. Overall, there is strong evidence that psychopathology decreases and quality of life increases in the majority of patients, especially after RYGB and LAGB [16]. ...
Background
Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric surgery procedure and currently the second most performed technique worldwide. Follow-up data on depression, stress and eating behaviour are scarce. The aim of this longitudinal study was to investigate the medium-term effects of LSG on mental health and eating behaviour and their influence on weight loss by using a comprehensive interview-based assessment.
Methods
Seventy-five individuals, who had undergone LSG at a university hospital, were included in the study. Symptoms of disordered eating were assessed using a structured clinical interview (eating disorder examination) and the Three-Factor Eating Questionnaire with depressive symptoms and stress assessed via the Patient Health Questionnaire.
Results
Mean interval from LSG to follow-up (FU) examination was 48 ± 13.3 months. The total body weight loss was 24.2 ± 12.0 %. Depressive symptom scores improved from pre-operative to FU (9 [IQR 5–14] vs. 6 [IQR 2–10], p = 0.002) as did stress scores (8.7 ± 4.6 vs. 6.3 ± 4.7, p = 0.001). At FU, 11 % of patients reported loss-of-control eating and 39 % grazing, paralleled by increased body mass index, stress and depressive symptoms. Prior to LSG, nine patients fulfilled the diagnostic criteria of binge eating disorder but only one at FU.
Conclusions
Post-surgical mental health appears to be highly relevant in terms of weight loss maintenance. It is likely that the surgical outcome could be positively influenced if patients at risk of developing mental health issues or eating disorders were identified and monitored in order to offer targeted interventions.
... Studies have shown that depression attenuates weight loss outcomes and is a significant risk factor in treatment failure [14][15][16]. However other, conflicting studies in the literature suggest that pre-operative depression is not associated with weight outcomes following surgery [17][18][19]. A systematic review in 2012 on this question stated that depression was an unclear/non-predictor of weight loss after bariatric surgery [20]. ...
More than half of patients with obesity who present for medical or surgical management meet the criteria for a psychiatric illness, commonly a mood disorder. Bariatric surgery leads to significant improvement in depression symptomology and a reduction in the overall prevalence of depression. Studies generally report short-term overall reduction in depression rates between approximately 55 to 65 % within the first two years following surgery. It appears that there is a dose response relationship between weight loss and resolution of depression. There are some conflicting reports in the literature as to the maintenance of depression outcomes following bariatric surgery, with newer, long-term studies reporting the attenuation of depression symptomology improvements. While generally, bariatric surgery is beneficial for depression, there exists a cohort of patients who might actually worsen following surgery. A likely multifactorial consequence of weight regain, unrealistic expectations or other life stresses, this group needs to be monitored closely, as postoperative bariatric surgery patients surgery appear to be at an increased risk of suicide. Overall, a multidisciplinary team including psychiatrists, psychologists and other mental health professionals are vital to optimize patient care in the depressed, obese bariatric surgery patient.
... Findings from 1 recent study indirectly suggest that a lifetime history of bipolar disorder may be associated with poorer weight loss after surgery [142]. On the other hand, in 2 other studies weight loss for bipolar patients was not found to be significantly different from those without this disorder at 12 [143] and 24 [112] months after surgery. ...
Psychosocial factors have significant potential to affect long-term outcomes of bariatric surgery, including emotional adjustment, adherence to the recommended postoperative lifestyle regimen, weight loss outcomes, and comorbidity improvement/resolution. Thus, it is recommended that bariatric behavioral health clinicians with specialized knowledge and experience be involved in the evaluation and care of patients both before and after surgery. The evaluating clinician plays a number of important roles in the multidisciplinary treatment of the bariatric patient. Central among these is the role of identifying factors that may pose challenges to optimal surgical outcome and providing recommendations to the patient and bariataric team on how to address these issues. This document outlines recommendations for the psychosocial evaluation of bariatric surgery patients, appropriate qualifications of those conducting these evaluations, communication of evaluation results and suggested treatment plan, and the extension of behavioral health care of the bariatric patient to the entire span of the surgical and post-surgical process.
... Studies examining the relationship between presurgical depression and short-term outcomes (1 to 3 years postsurgery) have produced mixed results. For example, some studies support mood-and anxiety-related measures predict suboptimal weight loss (de Zwaan et al., 2011;Kalarchian et al., 2008;Semanscin-Doerr, Windover, Ashton, & Heinberg, 2010). On the other hand, other studies have found no associations be-tween weight loss outcomes and measures of mood and anxiety Tarescavage, Wygant, Boutacoff, & Ben-Porath, 2013). ...
Bariatric surgery is a viable treatment option for patients with extreme obesity and associated medical comorbidities; however, optimal surgical outcomes are not universal. Surgical societies, such as the American Society for Metabolic and Bariatric Surgery (ASMBS), recommend that patients undergo a pre-surgical psychological evaluation that includes reviewing patients’ medical charts, conducting a comprehensive clinical interview, and employing some form of objective psychometric testing. Despite numerous societies recommending the inclusion of self-report assessments, only about two-thirds of clinics actively use psychological testing – some of which have limited empirical support to justify their use. This review aims to critically evaluate the psychometric properties of self-report measures when used in bariatric surgery settings and provide recommendations to help guide clinicians in selecting instruments to use in bariatric surgery evaluations. Recommended assessment batteries include use of a broadband instrument along with a narrowband eating measure. Suggestions for self-report measures to include in a pre-surgical psychological evaluation in bariatric surgery settings are also provided.
Introduction
Multiple factors are related to lower weight loss after bariatric surgery. This review and meta‐analysis evaluates the influence of several mental and behavioral factors on weight loss.
Method
Six electronic databases were searched. Percentage excess weight loss (%EWL) was calculated for all moderator and non‐moderator groups of the variables: symptoms of depression, anxiety and binge eating, compliance, physical activity, quality of life, and body image. All moderators, surgery types, and follow‐up moments were analyzed separately.
Results
In total, 75 articles were included in the review; 12 meta‐analyses were conducted. Higher postoperative compliance to follow‐up was associated with 6.86%–13.68% higher EWL. Preoperative binge eating was related to more weight loss at 24‐ and 36‐month follow‐up (7.97% and 11.79%EWL, respectively). Patients with postoperative binge eating symptoms had an 11.92% lower EWL. Patients with preoperative depressive symptoms lost equal weight compared to patients without symptoms.
Conclusion
Despite the high heterogeneity between studies, a trend emerges suggesting that the presence of postoperative binge eating symptoms and lower postoperative compliance may be associated with less weight loss after bariatric‐metabolic surgery. Additionally, preoperative depressive symptoms and binge eating do not seem to significantly impact weight loss.
Im Hinblick auf das Körpergewicht und somatische Folgeerkrankungen ist die Effektivität der bariatrischen Chirurgie bei Patienten mit morbider Adipositas gut belegt. Im Verlauf der letzten Jahrzehnte konnte das Operationsrisiko stetig gemindert werden, und der Eingriff hat sich im Hinblick auf eine signifikante und anhaltende Gewichtsreduktion bewährt. Dennoch scheint es eine Minderheit von Patienten zu geben, deren postoperativer Gewichtsverlauf unzureichend ist, deren psychische Beschwerden bis hin zu Störungen zunehmen und die letztendlich über eine unzureichende Lebensqualität klagen. Die Ursachen lassen sich weniger im chirurgischen Fachgebiet finden als vielmehr im Kontext psychischer Probleme bis hin zu Störungen mit der Konsequenz einer deutlichen Minderung der Lebensqualität. Das Kapitel stellt die komplexen Zusammenhänge zwischen prä- und postoperativen komorbiden psychischen Störungen bei bariatrischen Patienten und deren Auswirkungen auf die Lebensqualität dar.
Psychobariatrics is a rapidly evolving field, and a psychiatric evaluation is critical to the sleeve gastrectomy pathway. This is especially true when the presence of psychiatric disorders among the bariatric population ranges to 30–50%. When done correctly, selection of cases will only minimally interfere with the postoperative result and enhance weight loss for those that need it. Thus, the psychiatric evaluation should be a part of the multidisciplinary program before such a life-changing procedure. Several mental disorders are prevalent among the bariatric population and may have a significant impact on the surgical outcome. In this chapter, we guide the reader through the quintessential pre-surgical psychiatric evaluation in detail and how to screen for contraindications. Also, we explore the assessments mental capacity of the participants with consideration to special populations and emphasizing the importance of a sound support system.
The prevalence of bipolar disorders in patients requesting bariatric surgery is estimated to be 1.5% to 3.4%. There are currently no specific recommendations regarding the way bariatric surgery should be managed in the context of bipolar disorder. The aim was to document the benefit-risk of bariatric surgery in patients with bipolar disorders. A systematic literature review was carried out. In addition, results were reported from a survey of current clinical practice in French referent centers for obesity care. Finally, 3 clinical cases from the "Severe Obesity Outcome Network" cohort are described. This systematic review shows there are few studies in the literature regarding the outcomes of bariatric surgery in patients with bipolar disorders and no randomized, controlled trials. Weight loss appeared similar in all patients, but psychiatric complications were sometimes reported in those with bipolar disorders. Almost all 11 referent centers for obesity care that responded had carried out bariatric surgery in patients with stable bipolar disorders. Postsurgical psychiatric destabilization occurred and included, at least, a need to reinforce treatment and follow-up. In the 3 case studies, postsurgical manic or hypomanic decompensation occurred. Thus, although effective in terms of weight loss, bariatric surgery could be a destabilizing factor for those with bipolar disorders. Current practice is to contraindicate surgery in patients with unstable disorders. There are insufficient data to conclude on the benefits and safety of bariatric surgery in patients with stable bipolar disease. Further studies are required to fully determine the benefits and risks.
Im Hinblick auf das Körpergewicht und somatische Folgeerkrankungen ist die Effektivität der bariatrischen Chirurgie bei Patienten mit morbider Adipositas gut belegt. Im Verlauf der letzten Jahrzehnte konnte das Operationsrisiko stetig gemindert werden, und der Eingriff hat sich im Hinblick auf eine signifikante und anhaltende Gewichtsreduktion bewährt. Dennoch scheint es eine Minderheit von Patienten zu geben, deren postoperativer Gewichtsverlauf unzureichend ist, deren psychische Beschwerden bis hin zu Störungen zunehmen und die letztendlich über eine unzureichende Lebensqualität klagen. Die Ursachen lassen sich weniger im chirurgischen Fachgebiet finden als vielmehr im Kontext psychischer Probleme bis hin zu Störungen mit der Konsequenz einer deutlichen Minderung der Lebensqualität. Das Kapitel stellt die komplexen Zusammenhänge zwischen prä- und postoperativen komorbiden psychischen Störungen bei bariatrischen Patienten und deren Auswirkungen auf die Lebensqualität dar.
Purpose of the review:
To update the recent findings on the influence of personality features on postoperative weight loss in patients undergoing bariatric surgery.
Recent findings:
Several studies investigated the influence of pre-surgical psychological variables on the outcome of bariatric surgery, but the effective role of personality factors (i.e., both normal personality traits and personality disturbances) in shaping bariatric surgery outcome is still unclear. We analyzed nine recent papers that examined the impact of pre-operative personality traits on postoperative weight loss among individuals undergoing surgery for severe obesity. A personality pattern denoting the ability to self-regulate in spite of the urges or demands of the moment emerged as a robust predictor of good outcome across studies, independently from baseline psychiatric comorbidity and personality disorders.
There currently is an obesity epidemic that threatens the population of the USA and that of the world. Currently, two thirds of the US population is overweight or obese. As a result, a large proportion of the population is at risk for a number of short- and long-term health consequences. These have been well described in the preceding chapters. However, obesity is also associated with a number of significant psychiatric and psychosocial consequences. This chapter will review the most common psychiatric comorbidities of obesity with a focus on depression, anxiety, eating disorders, and substance use. These sections will include strategies for assessment and the impact of these disorders on outcome as well as the impact of weight loss on these disorders. Next, psychosocial consequences of obesity such as stigma, quality of life, and body image will be reviewed. Similarly, the bidirectional impact of these factors on weight loss will be discussed. Finally, conclusions will include future directions for the examination of the complex relationship between obesity and psychological factors.
This chapter reviews the literature on psychosocial issues after bariatric surgery. This chapter discusses the research in several specific areas, including depression, suicide, eating pathology, and alcohol abuse. In addition, studies examining quality of life and body image following weight loss surgery are reviewed. Behavioral and social factors potentially influencing outcomes (adherence and social support) are also summarized. Overall, this literature underscores the complex relationship between surgical and psychosocial outcomes. Further, this research highlights the value of addressing psychosocial factors before and after surgery in an attempt to enhance outcomes.
Depression and obesity are both highly prevalent and are leading public health problems. These foregoing disorders independently have great impact on morbidity and mortality affecting patients’ health and well-being as well as on the socioeconomic aspect of functional impairment and healthcare expenditure. Results from epidemiological studies, clinical trials and recent meta-analyses support the association between mood disorders and obesity as both frequently co-occur in all races of populations examined. It is now well-established through longitudinal studies that obesity is a risk factor for mood disorders and vice versa. In the current review, we aim to address the evidence regarding 4 questions: (1) does obesity moderate response to antidepressants among patients with depressive disorders?, (2) does the presence of depressive disorders moderate the progression or outcome of obesity?, (3) does treatment of obesity moderate outcomes among patients with depressive disorders?, and (4) does treatment of depressive disorders moderate outcomes of obesity? In order to improve the interpretability of the results we confined the evaluations to studies where patients met the criteria for depressive disorders or obesity (i.e. BMI > 30). Extant evidence supports the association between obesity and adverse health outcomes among individuals with depressive disorders. In addition, the treatment of one condition (i.e. obesity or depressive disorders) appears to improve the course of the other condition. It might be beneficial to check for the other condition in patients presenting with one condition and treatment should be administered to treat both conditions.
Bariatric surgery is the most effective treatment for morbid obesity. While benefits include improvements in health, physical functioning, quality of life, and psychological well-being, 20 % of patients may fail to lose the expected amount of weight. Research on presurgical psychological factors that predict poor outcomes has been inconclusive, however, several postoperative factors warrant further investigation. A minority of patients experience other psychological challenges following surgery, which may affect overall success from surgery. In this chapter we review current research on bariatric surgery and suicide and discuss the integrated role of the mental health professional on the bariatric care team.
Gastric bypass (GBP) is the most common operation performed in the United States for morbid obesity. However, weight loss is poor in 10% to 15% of patients. We sought to determine the independent factors associated with poor weight loss after GBP.
Prospective cohort study. We examined demographic, operative, and follow-up data by means of multivariate analysis. Variables investigated were age, sex, race, marital and insurance status, initial weight and body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared), comorbidities (diabetes mellitus, hypertension, joint disease, sleep apnea, hyperlipidemia, and psychiatric disease), laparoscopic vs open surgery, gastric pouch area, gastrojejunostomy technique, and alimentary limb length.
University tertiary referral center.
All patients at our institution who underwent GBP from January 1, 2003, through July 30, 2006.
Weight loss at 12 months defined as poor (< or =40% excess weight loss) or good (>40% excess weight loss).
Follow-up data at 12 months were available for 310 of the 361 patients (85.9%) undergoing GBP during the study period. Mean preoperative BMI was 52 (range, 36-108). Mean BMI and excess weight loss at follow-up were 34 (range, 17-74) and 60% (range, 8%-117%), respectively. Thirty-eight patients (12.3%) had poor weight loss. Of the 4 variables associated with poor weight loss in the univariate analysis (greater initial weight, diabetes, open approach, and larger pouch size), only diabetes (odds ratio, 3.09; 95% confidence interval, 1.35-7.09 [P = .007]) and larger pouch size (odds ratio, 2.77;95% confidence interval, 1.81-4.22 [P <.001]) remained after the multivariate analysis.
Gastric bypass results in substantial weight loss in most patients. Diabetes and larger pouch size are independently associated with poor weight loss after GBP.
Although several studies have documented the existence of psychopathology in the morbidly obese, there is disagreement as to its extent and nature. The disagreement has been difficult to resolve because earlier studies have tended to use small, regional samples, and diverse, unstandardized approaches to measuring psychopathology.
To add clarity, the present study utilized an unusually large, national sample, all subjects of which were administered a standardized, comprehensive test of psychopathology (the MMPI-2), an intensive interview concerning psychosocial history, and a medical examination. Subjects' scores on the MMPI-2 were compared to available norms. The psychosocial interview yielded information about families of both origin and reference. Information about comorbidities, medications, and body mass index (BMI) were available from the medical examinations. Multiple regression analyses were performed to determine the variables that best predicted psychopathology and BMI.
The percentage of subjects whose MMPI-2 scores exceeded and approached psychopathological levels was in excess of normative expectations. The 1,3,2 pattern of scale scores on this test expresses depressive disorder, with anxiety and somatization features. Regression analyses showed that abuse of the subject and of substances in the family of origin positively predicted, while education and number of children negatively predicted both psychopathology and BMI.
Dysfunctionality in the family of origin may lead to obesity through such regressive coping styles as stress eating, but this can be offset by personal development and nurturance responsibilities.
Weight loss after bariatric surgery varies and depends on many factors, such as time elapsed since surgery, baseline weight, and co-morbidities.
We analyzed weight data from 494 patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGBP) by one surgeon at an academic institution between June 1999 and December 2004. Linear regression was used to identify factors in predicting % excess weight loss (%EWL) at 1 year.
Mean patient age at time of surgery was 44 +/- 9.6 (SD), and the majority were female (83.8%). The baseline prevalence of co-morbidities included 24% for diabetes, 42% for hypertension, and 15% for hypercholesterolemia. Baseline BMI was 51.5 +/- 8.5 kg/m(2). Mean length of hospital stay was 3.8 +/- 4.6 days. Mortality rate was 0.6%. Follow-up weight data were available for 90% of patients at 6 months after RYGBP, 90% at 1 year, and 51% at 2 years. Mean %EWL at 1 year was 65 +/- 15.2%. The success rate (> or = 50 %EWL) at 1 year was 85%. Younger age and lower baseline weight predicted greater weight loss. Males lost more weight than females. Diabetes was associated with a lower %EWL. Depression did not significantly predict %EWL.
The study demonstrated a 65 %EWL and 85% success rate at 1 year in our bariatric surgery program. Our finding that most pre-surgery co-morbidities and depression did not predict weight loss may have implications for pre-surgery screening.
The present study was designed to document psychiatric disorders among candidates for weight loss surgery and to examine the relationship of psychopathology to degree of obesity and functional health status.
The authors collected demographic and clinical information from 288 individuals seeking surgery. Assessments were administered independently of the preoperative screening and approval process. The study group was mostly female (83.3%) and white (88.2%). Mean body mass index (BMI) of the group was 52.2 kg/m(2) (SD=9.7), and the mean age was 46.2 years (SD=9.4).
Approximately 66% of the participants had a lifetime history of at least one axis I disorder, and 38% met diagnostic criteria at the time of preoperative evaluation. In addition, 29% met criteria for one or more axis II disorders. Axis I psychopathology, but not axis II, was positively related to BMI, and both axis I and axis II psychopathology were associated with lower scores on the Medical Outcomes Study 36-item Short-Form Health Survey.
Current and past DSM-IV psychiatric disorders are prevalent among bariatric surgery candidates and are associated with greater obesity and lower functional health status, highlighting the need to understand potential implications for surgery preparation and outcome. Future work also will focus on the course of psychiatric disorder during the post-surgery period and its relationship to weight loss and maintenance.
A certain weight gain occurs after obesity surgery compared to the lower weight usually observed between 18 and 24 months postsurgery. The objective of this study was to evaluate weight regain in patients submitted to gastric bypass over a 5-year follow-up period.
A longitudinal prospective study was conducted on 782 obese patients of both genders. Only patients with at least 2 years of surgery were included. The percentage of excess body mass index (BMI) loss at 24, 36, 48, and 60 months postsurgery was compared to the measurements obtained at 18 months after surgery. Surgical therapeutic failure was also evaluated.
Percent excess BMI loss was significant up to 18 months postsurgery (p < 0.001), with a mean difference in BMI of 1.06 kg/m2 compared to 12 months postsurgery. Percent BMI loss was no longer significant after 24 months, and weight regain became significant within 48 months after surgery (p < 0.01). Among the patients who presented weight regain, a mean 8% increase was observed within 60 months compared to the lowest weight obtained at 18 months after surgery. The percentage of surgical failure was higher in the superobese group at all times studied, reaching 18.8% at 48 months after surgery.
Weight regain was observed within 24 months after surgery in approximately 50% of patients. Both weight regain and surgical failure were higher in the superobese group. Studies in regard to metabolic and hormonal mechanisms underlying weight regain might elucidate the causes of this finding.
Laparoscopic sleeve gastrectomy (LSG) is currently gaining ground as a new option for the treatment of morbid obesity. The main advantages of this procedure are less postoperative food restrictions, no vomiting, and absence of late complications due to the lack of foreign implants. The aim of this study is to present our experience with this new bariatric technique.
Ninety three obese patients (65 females and 28 males) who underwent LSG between September 2005 and September 2007 were studied in terms of postoperative complications and weight loss.
Mean age was 38.37 +/- 10.81 years (range 19-69) and mean preoperative weight and body mass index (BMI) were 139.12 +/- 24.03 kg (range 100-210) and 46.86 +/- 6.48 kg/m(2) (range 37-66), respectively. Mean follow-up was 12.51 +/- 4.15 months (range 3-24). There were no mortalities, but there were four major and four minor postoperative complications. The mean postoperative excess weight loss (EWL) was 58.32 +/- 16.54%, while mean BMI dropped to 32.98 +/- 6.54 kg/m(2). Mean EWL 3, 6, 12, and 24 months after the operation was 31%, 53%, 67%, and 72%, respectively. Superobese patients (BMI > 50 kg/m(2)) lost less weight.
In the short term, LSG is a safe and highly effective bariatric operation more suitable for intermediate morbidly obese patients with BMI between 40 and 50 kg/m(2).
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist healthcare professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.
In this paper we report a study designed to improve the ability to predict postoperative weight loss employing methods dictated by the premise that substantial psychological homogeneity is necessary within subsets of patients before similar weight losses can be observed within those subsets. Subjects were 138 women who completed the MMPI prior to undergoing vertical banded gastroplasty. Cluster analysis of the MMPI profiles identified 10 predictive MMPI types. Fifty-six percent of the patients were classified into the 10 types, the remainder were grouped into a residual category. Analysis of covariance revealed that MMPI type accounted for 50 percent of the variance in 12-month weight loss after covarying for initial weight and pre-operative percentage of ideal weight. Variables that added significantly to the prediction of weight loss were age and MMPI scale Pd. In general, the prototypic profiles indicative of the greatest disturbance predicted poor weight loss. In contrast to the 10 MMPI types described in this study, an alternative clustering of patients into fewer groups with much less psychological homogeneity was not predictive of outcome.
Fifty-two consecutive morbidly obese patients were evaluated psychiatrically before they were scheduled to undergo gastroplasty and again an average of twenty-six months later. Ten patients did not undergo surgery; six patients who did undergo gastroplasty were unavailable for follow up. In the remaining thirty-six patients, there was a statistically significant correlation between the degree of clinically estimated preoperative depression and the percent of body weight lost following surgery. Amount of preoperative weight was also correlated with postoperative weight loss, but depression before surgery was a more significant predictor of postoperative weight loss. Patients who expressed less distress prior to surgery tended to lose less weight after surgery and were more likely to manifest increased psychiatric distress postoperatively.
Weight losses following bariatric surgery have varied widely, depending on length of follow-up and various pre-surgical characteristics of patients undergoing surgery.
One hundred thirty one patients had a detailed presurgical psychiatric evaluation. Patients were assessed clinically for 2 years after surgery and at follow-up a mean of 5.7 years after surgery.
Mean presurgical body mass index (BMI) was 52.9 kg/m2; therefore, many patients had 'super obesity'. Two-thirds of the patients were located a mean of 5.7 years after surgery. The mean change in BMI at follow-up was 25% and the mean weight loss was 27%. One-third had excellent or good weight outcomes using the Griffen criteria. Five patients had died by follow-up. There was no relationship between age, gender, or fat content presurgically and weight loss at follow-up, although presurgical weight was associated with greater weight loss at follow-up. Weight regain began 2 years after surgery. There was no relationship between the presence or absence of a presurgical psychiatric diagnosis and weight loss at follow-up. There was also no relationship between the presence of a presurgical psychiatric diagnosis and various mental health parameters at follow-up. Satisfaction with the surgery was marginally associated with weight loss but significantly associated with improved mental and physical health.
Mean weight losses were less than have been previously reported with gastric restriction procedures but the follow-up was longer than usually reported and many patients had 'super obesity' prior to surgery. The implications of 'super obesity' for weight loss are discussed.
Qualitative analysis of the literature on cognitive side-effects of lithium in patients with a bipolar disorder identified four of 17 studies that fulfilled criteria of adequate methodological quality. Analysis of these four studies showed that lithium had a negative effect on memory and speed of information processing, often without subjective complaints or awareness of mental slowness. The consequences of these findings for daily practice are discussed, in particular with respect to driving performance. When neurocognitive complaints or deficits are present, lithium plasma level, thyroid functions and degree of mood disturbance should be assessed. In cases where all these parameters are within normal limits and neurocognitive complaints still persist, dose reduction of lithium, thyroid hormone addition, prescription of a slow release preparation or replacement of lithium by another moodstabiliser should be considered. Guidelines are suggested with respect to further neuropsychological screening.
This study analyzes eating behavior in a group of morbidly obese patients who have undergone gastric reduction surgery for weight loss, and evaluates whether the existence of psychiatric comorbidity marks significant differences in their eating behavior.
The study group was composed of 100 morbidly obese patients (85 females, 15 males) who had received surgical treatment for weight reduction (vertical banded gastroplasty). 40 of these patients (40%) met ICD-10 criteria for the diagnosis of psychiatric disorders and were included in the "Psychiatric Obese group" (PO). The other 60 patients (60%) did not show ICD-10 diagnostic criteria and were included in the "Non-Psychiatric Obese group" (NO). Each patients completed the Binge Eating Scale (BES), the Three Factor Eating Questionnaire, the Bulimia Investigatory Test-Edinburgh (BITE), and the Eating Disorder Inventory (EDI).
Significant differences were found between the two groups (PO and NO) in the Binge Eating Scale (p < 0.001), Three Factor Eating Questionnaire subscale Disinhibition (p < 0.001), BITE (p < 0.001), Eating Disorder Inventory subscale Perfectionism (p < 0.002), and Global EDI (p < 0.001). Logistic regression analysis showed correlation between PO group and Global EDI (Odds Ratio OR = 1.43) and BITE (OR = 1.16). No significant gender differences were found for eating behavior, clinical diagnosis, age, percentage of weight loss, time after operation, and BMI before surgery.
Surgically treated morbidly obese patients with a psychiatric disorder (PO) have a more destructured eating pattern (with a predominance of binge eating and disinhibition) than NO.
To determine the prevalence of the side effects of lithium therapy and possible predictors of hypothyroidism in women and men with bipolar disorder.
Twenty-two men and 38 women with bipolar disorder and taking lithium for at least 1 year, were interviewed about lithium side effects using a list of the most commonly reported symptoms.
The complaint most frequently reported was polyuria-polydipsia syndrome, which affected 36 (60%) of 60 patients. More men than women reported tremor (54% v. 26%, p < 0.05), but weight gain during the first year of treatment was more frequent in women than men (47% v. 18%, p < 0.05), as was the development of clinical hypothyroidism (37% v. 9%, p < 0.05). Weight gain during the first year of treatment (and not sex) was the only significant predictor of hypothyroidism.
Weight gain during the first year of lithium treatment, in the absence of biological evidence of subclinical hypothyroidism, was the most predictive and, possibly, the first sign of hypothyroidism.
Laparoscopic gastric bypass (GBP) is becoming a common approach for treatment of morbid obesity. We analyzed preoperative factors that may be associated with operative outcomes in laparoscopic GBP.
This prospective study evaluates 150 consecutive laparoscopic GBP procedures performed by a single surgeon. Preoperative factors were grouped into three categories: 1) patient-specific (gender, age, abdominal surgical history, smoking), 2) obesity-specific (body mass index, hypertension, diabetes, sleep apnea), and 3) procedure-specific (operative experience of the surgeon [75 cases or less versus more than 75 cases]). Length of operation (240 minutes or less versus more than 240 minutes), postoperative complications (yes versus no), major complications (yes versus no), reoperation (yes versus no), and length of hospital stay (4 days or less versus more than 4 days) were the operative outcomes considered. In this series all patients who had a major complication required a reoperation. Data were analyzed using univariate and multiple logistic regression analyses.
Operative experience of surgeon (75 cases or less) was associated with lengthy operative time (adjusted odds ratio [AOR], 3.8; 95% confidence interval [CI], 1.7 to 8.3), major complications (AOR, 15.0; 95% CI, 1.5 to 143.0), and a lengthy (more than 4 days) hospital stay (AOR, 4.5; 95% CI, 1.1 to 18.0). Higher patient age (50 years or more) was associated with more postoperative complications (AOR, 11.4; 95% CI, 3.0 to 43.1) and major complications (AOR, 7.6; 95% CI, 1.1 to 48.7). Male gender also was associated with more postoperative complications (AOR 5.2; 95% CI, 1.1 to 23.1). Obesity-related comorbidities, body mass index, past abdominal surgical history, and smoking had no statistical association with operative outcomes in this study.
There is an association of clinical outcomes after laparoscopic GBP with the age and gender of the patient and the operative experience of the surgeon. An operative experience of more than 75 laparoscopic GBP cases was associated with decreases in operative time, length of hospital stay, and number of major complications.
Surgical management of the supersuper obese patient (BMI >60 kg/m2) has been a challenging problem associated with higher morbidity, mortality, and long-term weight loss failure. Current limited experience exists with a two-stage biliopancreatic diversion and duodenal switch in the supersuper obese patient, and we now present our early experience with a two-stage gastric bypass for these patients.
We completed a retrospective bariatric database and chart review of super-super obese patients who underwent laparoscopic sleeve gastrectomy as a first-stage procedure followed by laparoscopic Roux-en-Y gastric bypass as a second-stage for more definitive treatment of obesity.
During a two-year period, 7 patients with BMI 58-71 kg/m2 underwent a two-stage laparoscopic Roux-en-Y gastric bypass by two surgeons at the Mount Sinai Medical Center. 3 patients were female, 4 patients were male, and the average age was 43. Prior to the sleeve gastrectomy, the mean weight was 181 kg with a BMI of 63. Average time between procedures was 11 months. Prior to the second-stage procedure, the mean weight was 145 kg with a BMI of 50 and average excess weight loss of 37 kg (33% EWL). Six patients have had follow-up after the second-stage procedure with an average of 2.5 months. At follow-up the mean weight was 126 kg with a BMI of 44 and average excess weight loss of 51 kg (46% EWL). The mean operative times for the two procedures were 124 and 158 minutes respectively. The average length of stay for all procedures was 2.7 days. 4 patients had 5 complications, which included splenic injury, proximal anastomotic stricture, left arm nerve praxia, trocar site hernia, and urinary tract infection. There were no mortalities in the series.
Laparoscopic sleeve gastrectomy with second-stage Roux-en-Y gastric bypass are feasible and effective procedures based on short-term results. This two-stage approach is a reasonable alternative for surgical treatment of the high-risk supersuper obese patient.
There is a world epidemic of overweight, obesity, and morbid obesity, encompassing 1.7 billion people. Bariatric surgery today is the only effective therapy for morbid obesity.
E-mail requests for information were sent to the presidents of the national societies of the 31 International Federation for the Surgery of Obesity (IFSO) nations, or national groupings, plus Sweden. Responses were tabulated; calculation of relative prevalence of specific procedures was done by weighted averages.
Responders were 26 of 32 (81%) for the general questions and 24 of 32 (75%) for the question on specific operative percentages. In the year 2002-2003, 146,301 bariatric surgery operations were performed by 2,839 bariatric surgeons; 103,000 of these operations were performed in USA/Canada by 850 surgeons. The earliest start date for bariatric surgery was 1953 in the USA; IFSO was founded in 1995. In the year 2002-2003, 37.15% of operations were open; 62.85% laparoscopic. The 6 most popular procedures by weighted averages were: laparoscopic gastric bypass, 25.67%; laparoscopic adjustable gastric banding, 24.14%; open gastric bypass, 23.07%; laparoscopic long-limb gastric bypass, 8.9%; open long-limb gastric bypass, 7.45%; and open vertical banded gastroplasty, 4.25%. Pooling open and laparoscopic procedures, relative percentages were: gastric bypass, 65.11%; gastric banding, 24.41%; vertical banded gastroplasty, 5.43%; and biliopancreatic diversion/duodenal switch, 4.85%. Categorizing into restrictive/malabsorptive, purely restrictive, and primarily malabsorptive, the relative distribution of procedures was 65.11%, 29.84%, and 4.85%, respectively. The number of countries performing gastric banding was 23 (95%), gastric bypass 21 (88%), vertical banded gastroplasty 19 (79%), and biliopancreatic diversion/duodenal switch 16 (67%). Purely restrictive procedures were performed in 24 (100%) of the countries, restrictive/malabsorptive in 21 (88%), and primarily malabsorptive in 18 (75%).
Bariatric surgery is expanding exponentially to meet the global epidemic of morbid obesity. Operative procedures in bariatric surgery are in flux and specific geographic trends and shifts are evident. Yet, of the patients qualifying for surgery, only about 1% are receiving this therapy--the only effective treatment currently available.
Laparoscopic gastric bypass (LGB) has proven efficacy in causing significant and durable weight loss. However, the degree of postoperative weight loss and metabolic improvement varies greatly among individuals. Our study is aimed to identify independent predictors of successful weight loss after LGB.
Socioeconomic demographics were prospectively collected on patients undergoing LGB. Primary endpoint was percent of excess weight loss (EWL) at 1-year follow-up. Insufficient weight loss was defined as EWL <or=-1 SD from mean EWL. Logistic regression was used in both univariate and multivariate models to identify independent preoperative demographics associated with successful weight loss.
A total of 180 consecutive patients were enrolled over 30 months. Mean preoperative body mass index (BMI) was 48. Mean EWL was 70.1 +/- 17.3% (1 SD); therefore, success was defined as EWL >or=52.8%. According to this definition, 147 patients (81.7%) achieved successful weight loss 1 year after LGB. On univariate analysis, preoperative BMI had a significant effect on EWL, with patients with BMI <50 achieving a higher percentage of EWL (91.7% vs 61.6%; p = 0.001). Marriage status was also a significant predictor of successful outcome, with single patients achieving a higher percentage of EWL than married patients (89.8% vs 77.7%; p = 0.04). Race had a noticeable but not statistically significant effect, with Caucasian patients achieving a higher percentage of EWL than African Americans (82.9% vs 60%; p = 0.06). Marital status remained an independent predictor of success in the multivariate logistic regression model after adjusting for covariates. Married patients were at more than two times the risk of failure compared to those who were unmarried (OR 2.6; 95% CI: 1.1-6.5, p = 0.04).
Weight loss achieved at 1 year after LGB is suboptimal in superobese patients. Single patients with BMI < 50 had the best chance of achieving greater weight loss.
The surgical treatment of obesity in the high-risk, high-body-mass-index (BMI) (>60) patient remains a challenge. Major morbidity and mortality in these patients can approach 38% and 6%, respectively. In an effort to achieve more favorable outcomes, we have employed a two-stage approach to such high-risk patients. This study evaluates our initial outcomes with this technique.
In this study, patients underwent laparoscopic sleeve gastrectomy (LSG) as a first stage during the period January 2002-February 2004. After achieving significant weight loss and reduction in co-morbidities, these patients then proceeded with the second stage, laparoscopic Roux-en-Y gastric bypass (LRYGBP).
During this time, 126 patients underwent LSG (53% female). The mean age was 49.5 +/- 0.9 years, and the mean BMI was 65.3 +/- 0.8 (range 45-91). Operative risk assessment determined that 42% were American Society of Anesthesiologists physical status score (ASA) III and 52% were ASA IV. The mean number of co-morbid conditions per patient was 9.3 +/- 0.3 with a median of 10 (range 3-17). There was one distant mortality and the incidence of major complications was 13%. Mean excess weight after LSG at 1 year was 46%. Thirty-six patients with a mean BMI of 49.1 +/- 1.3 (excess weight loss, EWL, 38%) had the second-stage LRYGBP. The mean number of co-morbidities in this group was 6.4 +/- 0.1 (reduced from 9). The ASA class of the majority of patients had been downstaged at the time of LRYGB. The mean time interval between the first and second stages was 12.6 +/- 0.8 months. The mean and median hospital stays were 3 +/- 1.7 and 2.5 (range 2-7) days, respectively. There were no deaths, and the incidence of major complications was 8%.
The staging concept of LSG followed by LRYGBP is a safe and effective surgical approach for high-risk patients seeking bariatric surgery.
One of the surgical options available for the super-obese patient is the sleeve gastrectomy. We present results of this operation in a series of 118 patients.
The charts of all patients who have had the sleeve gastrectomy performed were reviewed for demographic data, complications, weight, and nutritional parameters.
Median age was 47 years (16-70). Median BMI was 55 kg/m(2) (37-108), with 73% of patients having a BMI > or =50 kg/m(2). 41% of the patients were male. The operation was performed by laparotomy in all but three cases, which were performed laparoscopically. Median hospital stay was 6 days (3-59). There was one perioperative death (0.85%). 18 patients (15.3%) had postoperative complications. Median percent excess weight loss was 37.8% at 6 months, 49.4% at 12 months, and 47.3% at 24 months. Median follow-up was 13 months (1-66). At 1 year postoperatively, the percentage of patients with normal serum levels of albumin was 100%, hemoglobin 86.1%, and calcium 87.2%, compared to 98.1%, 85.6%, and 94.3% preoperatively. 6 patients requested conversion to a duodenal switch during the follow-up period; all left the hospital in 4-6 days without major complication.
Although the sleeve gastrectomy does not result in as much weight loss as the duodenal switch or gastric bypass, it can be used as a stand-alone operation or as a bridge to more complex procedures in the high-risk super-obese patient.
Because of the possibility of being denied or delayed surgery, bariatric patients might have a motivation to minimize any emotional difficulties in the preoperative psychological evaluation. This study examined changes in the psychometric test scores when extremely defensive patients were asked to repeat the testing.
Changes in the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scale scores were studied in a subsample of patients referred to the author for a preoperative psychological evaluation. After producing defensive MMPI-2 test profiles, these bariatric patients (n = 31) were provided feedback on their defensiveness and asked to be more open and honest on the repeat testing.
The vast majority (94%) of the patients produced valid profiles on the second test. On the second test, significant differences were found on 6 of the 13 MMPI-2 scales, as well as on separate measures of depression, anxiety, and anger.
It appears to be important to include a psychometric measure that includes a validity scale in the evaluation process, because patients might be motivated to present in a defensive or overly virtuous light in fear that a negative evaluation from the psychologist would adversely affect a decision regarding their candidacy for surgery. It is recommended that patients who are defensive in their testing be asked to repeat the test battery.
Many bariatric surgery programs require that candidates undergo a preoperative mental health evaluation. Candidates may be motivated to suppress or exaggerate psychiatric symptoms (i.e., engage in impression management), if they believe doing so will enhance their chances of receiving a recommendation to proceed with surgery.
237 candidates for bariatric surgery completed the Beck Depression Inventory-II (BDI-ll) as part of their preoperative psychological evaluation (Time 1). They also completed the BDI-II approximately 2-4 weeks later, for research purposes, after they had received the mental health professional's unconditional recommendation to proceed with surgery (Time 2).
There was a small but statistically significant increase in mean BDI-II scores from Time 1 to Time 2 (11.4 vs 12.7, P<.001). Clinically significant changes, defined as a change from one range of symptom severity to another, were observed in 31.2% of participants, with significant increases in symptoms occurring nearly twice as often as reductions (20.7% vs 10.5%, P<.008). Demographic variables were largely unrelated to changes in BDI-II scores from Time 1 to Time 2.
Approximately one-third of bariatric surgery candidates reported a clinically significant change in depressive symptoms after receiving psychological "clearance" for surgery. Possible explanations for these findings include measurement error, impression management, and true changes in psychiatric status.
Gastric restrictive surgery induces a marked change in eating behavior. However, the relationship between preoperative and postoperative eating behavior and weight loss outcome has received limited attention.
This study assessed a range of eating behaviors before and 1 year after laparoscopic adjustable gastric banding (LAGB) and explored the nature and extent of change in eating patterns, their clinical associates, and impact on weight loss.
A 12-month observational study assessed presurgical and postsurgical binge eating disorder (BED), uncontrolled eating, night eating syndrome (NES), grazing, nutrient intake and eating-related behaviors, and markers of psychological distress. A total of 129 subjects (26 male and 103 female, mean age 45.2 +/- 11.5 and BMI 44.3 +/- 6.8) participated in this study.
Presurgical BED, uncontrolled eating, and NES occurred in 14%, 31%, and 17.1% of subjects, which reduced after surgery to 3.1%, 22.5%, and 7.8%, respectively (P = 0.05 for all). Grazing was prevalent before (26.3%) and after surgery (38.0%). Preoperative BED most frequently became grazers (P = 0.029). The average percentage weight loss (%WL) was 20.8 +/- 8.5%; range -0.67 to 50.0% and percentage of excess weight loss (%EWL) 50.0 +/- 20.7%; range -1.44 to 106.9% (P < 0.001). Uncontrolled eating and grazing after surgery showed high overlap and were associated with poorer %WL (P = 0.008 and P < 0.001, respectively) and elevated psychological distress.
Consistent with recent studies, uncontrolled eating and grazing were identified as two high-risk eating patterns after surgery. Clearer characterization of favorable and unfavorable postsurgical eating behaviors, reliable methods to assess their presence, and empirically tested postsurgical intervention strategies are required to optimize weight loss outcomes and facilitate psychological well-being in at-risk groups.
In our centre laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the most effective weight loss surgical procedure performed. However, LRYGBP may be associated with higher risk of peri- and postoperative complications in contrast to a purely restrictive procedure to justify this procedure on all comers. Laparoscopic sleeve gastrectomy (LSG) as a staged procedure may be an alternate risk reduction strategy. The aim of this study is to report on the short-term outcomes of LSG, the effect on operative risk reduction and resolution of comorbidities.
A prospective review of 138 patients who underwent consecutive LSG from November 2004 to November 2006 was performed. Data were collected on all patients who attended the three to six monthly clinical follow-up and/or the patient questionnaire. Data collection included demographics, degree of weight reduction, postoperative complications, and changes in comorbidities.
Median BMI was 50.60 kg/m(2) (33-82). Of the patients, 46.38% had a BMI >or=50 kg/m(2). The overall median postoperative excess weight loss (EWL) was 43.26%, 31.08% at 6 months, 54.50% at 12 months, 51.47% at 18 months and 46.05% at 24 months. Of the patients, 39% had resolution of type 2 diabetes mellitus, 48% had resolution of dyslipidemia, 29% in hypertension, 52% in obstructive sleep apnea. Complication rate was 5.07% and four patients needed further surgical intervention. The mortality rate was zero.
LSG does minimize postoperative complication rates significantly on high-risk patients and achieves effective short-term weight loss with resolutions in comorbidities. Additional studies are required to evaluate LSG as a stand-lone procedure.
Although most bariatric surgery patients undergo a preoperative psychological evaluation, the potential effect of psychiatric disorders on weight loss is not well understood. We sought to document the relationship of preoperative psychiatric disorders to the 6-month outcomes after gastric bypass.
The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was used to assess current and lifetime Axis I clinical disorders, as well as Axis II personality disorders, before surgery. We used linear regression models to examine the relationship of psychiatric disorders to postoperative weight-related outcomes.
The sample (n = 207) was 83.1% female and 92.7% white. The preoperative body mass index (BMI) was 51.4 +/- 9.6 kg/m(2) and age was 45.8 +/- 9.5 years. After adjusting for the initial BMI, gender, race, and age, a lifetime Axis I disorder was associated with a smaller decrease in BMI (t = -3.7, df = 205, P <.001) at 6 months after surgery. The results of separate models for each class of disorder indicated that lifetime mood disorder was associated with a smaller decrease in BMI (t = -3.7, df = 205, P <.001), as was lifetime anxiety disorder (t = -2.6, df = 205, P = 0.009), but substance and eating disorders were not. In this sample, current Axis I clinical disorders and Axis II personality disorders were unrelated to outcomes at 6 months. Similar overall results were found when the percentage of weight loss and excess weight loss were predicted.
The results of our study have shown that patients who have ever had an Axis I clinical disorder, especially mood or anxiety, exhibit poorer weight outcomes 6 months after gastric bypass than those who have never had an Axis I disorder. Additional research with larger samples is needed to replicate these findings and examine more fully the effect of current clinical disorders and personality disorders on weight loss. Nevertheless, our results suggest that patients with current or past disorders might benefit from close monitoring or psychosocial intervention to improve their short-term outcomes. However, a greater duration of follow-up is needed to identify predictors of longer-term weight control.
Metabolic and Bariatric Surgery Fact Sheet Available from: http://www.asbs.org/ Newsite07/media/fact-sheet1_bariatric-surgery.pdf
- American Society
- Bariatric Metabolic
- Surgery
American Society for Metabolic and Bariatric Surgery. Metabolic and Bariatric Surgery Fact Sheet. Available from: http://www.asbs.org/ Newsite07/media/fact-sheet1_bariatric-surgery.pdf. Accessed De-cember 5, 2008.
Position state-ment on sleeve gastrectomy as a bariatric procedure Available from: http://asbs.org/Newsite07/resources/sleeve-statement.pdf
- American Society
- Bariatric Metabolic
- Surgery
American Society for Metabolic and Bariatric Surgery. Position state-ment on sleeve gastrectomy as a bariatric procedure. Available from: http://asbs.org/Newsite07/resources/sleeve-statement.pdf. Accessed December 5, 2008.
Depression inhibits weight loss amongst obese females: emotional and behavioural moderators of this relationship
- Dove
Dove E, Byrne S, Bruce N. Depression inhibits weight loss amongst obese females: emotional and behavioural moderators of this rela-tionship. Obes Rev 2006;7:313.
Staged laparoscopic sleeve gastrectomy followed by Roux-en-Y gastric bypass for morbidly obese patients: a risk reduction strategy.
- Yang O.O.
- Loi K.
- Liew V.
- Talbot M.
- Jorgenson J.
Impression management or real change? Reports of depressive symptoms before and after the preoperative psychological evaluation for bariatric surgery
- Fabricatore
Psychiatric disorders among bariatric surgery candidates: Relationship to obesity and functional health status
- Kalarchian