Psychological Outcome Two Years after Restrictive Bariatric Surgery

"I didn't see this coming.": why are postbariatric patients in substance abuse treatment? Patients' perceptions of etiology and future recommendations

BACKGROUND

Recent evidence suggests that bariatric patients may be overrepresented in inpatient substance abuse treatment, but the reasons for this are unclear. Patients' perceptions of this problem may be of heuristic value. Using a qualitative approach, the present study evaluated bariatric patients' impressions of how their postsurgical substance use disorders emerged and their future recommendations for those working with bariatric patients.

METHODS

Semi-structured interviews were conducted with 24 bariatric patients in an inpatient substance abuse treatment program. Seven prominent themes emerged, four referring to etiology of substance use (unresolved psychological problems, addiction transfer/substitution, faster onset or stronger effects from substances, and increased availability of pain medications) and three pertaining to future recommendations (counseling pre- and/or postsurgery, increased knowledge of the associated risks of substance use postsurgery, and greater "honesty"). Blind coders rated the presence or absence of each theme in each interview.

RESULTS

Of the four etiology themes, 75 % of patients acknowledged unresolved psychological problems, 83.33 % identified addiction transfer/substitution, 58.33 % noticed faster onset or stronger effects from substances, and 45.83 % identified increased availability of pain medications. For future recommendations, 41.67 % suggested counseling pre- and/or postsurgery, 70.83 % suggested increased education about the associated risks of substance use postsurgery, and 41.67 % identified a need for greater "honesty."

CONCLUSIONS

Patient perceptions suggest that several common themes may be related to risk for the development of postsurgical substance use disorders.

Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews

BACKGROUND

Candidates for bariatric surgery frequently have co-morbid psychiatric problems.

METHODS

This study investigated the course and the prognostic significance of preoperative and postoperative anxiety and depressive disorders in 107 extremely obese bariatric surgery patients in a prospective design with face-to-face interviews (SCID) conducted prior to the surgery and postoperatively after 6-12 months and 24-36 months.

RESULTS

The point prevalence of depressive disorders but not of anxiety disorders decreased significantly after surgery. Preoperative depressive disorders predicted depressive disorders 24-36 months but not 6-12 months after surgery, whereas preoperative anxiety significantly predicted postoperative anxiety disorders at both follow-up time points. Preoperative lifetime and current depressive disorders were unrelated to postoperative weight loss whereas preoperative lifetime, but not current anxiety disorders were of negative prognostic value for postoperative weight loss. Patients with both depressive and anxiety disorders at baseline (current and lifetime) lost significantly less weight after surgery. Postoperative anxiety disorder was not associated with the degree of weight loss at any follow-up time-point; however postoperative depressive disorder was negatively associated with weight loss at the 24-36 month follow-up assessment point.

LIMITATIONS

Missing data, limited statistical power, self-reported height and weight are the limitations of this study.

CONCLUSIONS

As opposed to anxiety disorders, the point prevalence of depressive disorders decreased significantly after bariatric surgery. However, the presence of depressive disorders after bariatric surgery significantly predicted attenuated post-surgical improvements and may signal a need for clinical attention.

Personality and obesity across the adult life span

Personality traits contribute to health outcomes, in part through their association with major controllable risk factors, such as obesity. Body weight, in turn, reflects our behaviors and lifestyle and contributes to the way we perceive ourselves and others. In this study, the authors use data from a large (N = 1,988) longitudinal study that spanned more than 50 years to examine how personality traits are associated with multiple measures of adiposity and with fluctuations in body mass index (BMI). Using 14,531 anthropometric assessments, the authors modeled the trajectory of BMI across adulthood and tested whether personality predicted its rate of change. Measured concurrently, participants higher on Neuroticism or Extraversion or lower on Conscientiousness had higher BMI; these associations replicated across body fat, waist, and hip circumference. The strongest association was found for the impulsivity facet: Participants who scored in the top 10% of impulsivity weighed, on average, 11Kg more than those in the bottom 10%. Longitudinally, high Neuroticism and low Conscientiousness, and the facets of these traits related to difficulty with impulse control, were associated with weight fluctuations, measured as the variability in weight over time. Finally, low Agreeableness and impulsivity-related traits predicted a greater increase in BMI across the adult life span. BMI was mostly unrelated to change in personality traits. Personality traits are defined by cognitive, emotional, and behavioral patterns that likely contribute to unhealthy weight and difficulties with weight management. Such associations may elucidate the role of personality traits in disease progression and may help to design more effective interventions.

Surgical treatment of morbid obesity among patients with bipolar disorder: a research agenda

INTRODUCTION

Persons with bipolar disorder (BD) have an increased risk of obesity and associated diseases. Success of current behavioral treatment for obesity in patients with BD is inadequate.

METHODS

Existing literature on bariatric surgery outcomes in populations with BD were reviewed, and needed areas of research were identified.

RESULTS

Knowledge about bariatric surgery outcomes among patients with BD is limited. Available evidence indicates that bariatric surgery is a uniquely effective intervention for achieving and sustaining significant weight loss and improving metabolic parameters. Notwithstanding the benefits of bariatric surgery in nonpsychiatric samples, individuals with BD (and other serious and persistent mental illnesses) have decreased access to this intervention. Areas of needed research include: (1) current practice patterns; (2) metabolic course after bariatric surgery; (3) psychiatric course after bariatric surgery; and (4) mechanisms of psychiatric effect.

CONCLUSION

The considerable hazards posed by obesity in BD, as measured by illness complexity and premature mortality, provide the basis for hypothesizing that bariatric surgery may prevent and improve morbidity in this patient population. In addition to physical health benefits, bariatric surgery may exert a robust and favorable effect on the course and outcome of BD and reduce obesity-associated morbidity, the most frequent cause of premature mortality in this patient population.

Predictors of psychological symptoms in morbidly obese patients after gastric bypass surgery

BACKGROUND

Morbid obesity is associated with debilitating psychosocial consequences, such as depression, anxiety, and low self-esteem. One of the main goals of bariatric surgery should not only be reducing weight and counteracting co-morbid conditions, but also improving postoperative psychosocial functioning. The objective of our study was to determine the preoperative variables that could predict the psychological symptoms 6 and 12 months after surgery to improve the clinical outcome of morbidly obese patients undergoing bariatric surgery. The setting was a university hospital in Spain.

METHODS

The study group consisted of 60 morbidly obese patients (46 women and 14 men) who had undergone gastric bypass surgery for weight reduction and had ≥ 1 year of follow-up. The patients were evaluated using different questionnaires (Symptom Checklist-90-Revised, Body Shape Questionnaire, Rosenberg Self-Esteem Questionnaire, COPE, Medical Outcomes Study Social Support Survey) at 3 points: before surgery, at 6 months postoperatively, and at 1 year postoperatively. To determine the influence of preoperative variables on long-term psychological status, a step-by-step multivariate linear regression analysis was performed, taking P < .05 as statistically significant.

RESULTS

The variables of self-esteem, instrumental support, and coping focused in the emotions were the main preoperative predictors for psychological symptoms 6 months after surgery. Preoperative drug abuse as a strategy of problem solving and mainly body image significantly predicted most of the psychological disorders 1 year after surgery.

CONCLUSION

The study of different psychosocial variables in patients before bariatric surgery is an important aid to predict postoperative psychological functioning. Self-esteem and body image were the most influential factors in the postoperative psychological outcome of morbidly obese patients in our study.

Anxiety and depression in association with morbid obesity: changes with improved physical health after duodenal switch

BACKGROUND

Patients with morbid obesity have an increased risk for anxiety and depression. The "duodenal switch" is perhaps the most effective obesity surgery procedure for inducing weight loss. However, to our knowledge, data on symptoms of anxiety and depression after the duodenal switch are lacking. Furthermore, it has been hypothesized that self-reported physical health is the major predictor of symptoms of depression in patients with morbid obesity. We therefore investigated the symptoms of anxiety and depression before and after the duodenal switch procedure and whether post-operative changes in self-reported physical health were predictive of changes in these symptoms.

METHODS

Data were assessed before surgery (n = 50), and one (n = 47) and two (n = 44) years afterwards. Symptoms of anxiety and depression were assessed by the "Hospital Anxiety and Depression Scale", and self-reported physical health was assessed by the "Short-Form 36" questionnaire. Linear mixed effect models were used to investigate changes in the symptoms of anxiety and depression. Correlation and linear multiple regression analyses were used to study whether changes in self-reported physical health were predictive of post-operative changes in the symptoms of anxiety and depression.

RESULTS

The symptom burden of anxiety and depression were high before surgery but were normalized one and two years afterwards (P < 0.001). The degree of improvement in self-reported physical health was associated with statistically significant reductions in the symptoms of anxiety (P = 0.003) and depression (P = 0.004).

CONCLUSIONS

The novelty of this study is the large and sustained reductions in the symptoms of anxiety and depression after the duodenal switch procedure, and that these changes were closely associated with improvements in self-reported physical health.

Depression and anxiety among US adults: associations with body mass index

BACKGROUND

Obesity is associated with an increased risk of developing a variety of chronic diseases, most of which are associated with psychiatric disorders. We examined the associations of depression and anxiety with body mass index (BMI) after taking into consideration the obesity-related comorbidities (ORCs) and other psychosocial or lifestyle factors.

METHODS

We analyzed the data collected from 177,047 participants (aged>or=18 years) in the 2006 Behavioral Risk Factor Surveillance System. Current depression was assessed by the Patient Health Questionnaire-8 diagnostic algorithm. Lifetime diagnoses of depression, anxiety and ORCs were self-reported. The prevalence of the three psychiatric disorders was age standardized to the 2000 US population. Multivariate-adjusted prevalence ratios were computed to test associations of depression and anxiety with BMI using SUDAAN software.

RESULTS

The age-adjusted prevalence of current depression, lifetime diagnosed depression and anxiety varied significantly by gender. Within each gender, the prevalence of the three psychiatric disorders was significantly higher in both men and women who were underweight (BMI<18.5 kg/m(2)), in women who were overweight (BMI: 25-<30 kg/m(2)) or obese (BMI>or=30 kg/m(2)), and in men who had class III obesity (BMI>or=40 kg/m(2)) than in those with a normal BMI (18.5-<25 kg/m(2)). After adjusting for demographics, ORCs, lifestyle or psychosocial factors, compared with men with a normal BMI, men with a BMI>or=40 kg/m(2) were significantly more likely to have current depression or lifetime diagnosed depression and anxiety; men with a BMI<18.5 kg/m(2) were also significantly more likely to have lifetime diagnosed depression. Women who were either overweight or obese were significantly more likely than women with a normal BMI to have all the three psychiatric disorders.

CONCLUSIONS

Our results demonstrate that disparities in the prevalence of depression and anxiety exist among people with different BMI levels independent of their disease status or other psychosocial or lifestyle factors.

Depression and anxiety: their predictive function for weight loss in obese individuals

OBJECTIVE

To investigate the impact of current mental disorders on weight loss with special consideration of depressive and/or anxiety disorders as well as binge eating behavior in obese individuals undergoing different weight loss treatments.

METHODS

Three different samples of obese individuals were investigated in a prospective, longitudinal study: participants in a conventional weight loss treatment program (CONV TREAT; n = 250), obesity surgery patients (OBES SURG; n = 153), and obese control individuals (OC; n = 128). Current mental disorders and BMI were assessed at baseline and at 4-year follow-up.

RESULTS

OBES SURG patients with a depressive and/or anxiety disorder lost significantly less weight compared with those without a comorbid mental diagnosis. This result was not detected for CONV TREAT participants. A trend to gain weight was seen in OC participants with a depressive and/or anxiety disorder, whereas OC participants without current mental disorders at baseline lost some weight. Binge eating behavior at baseline did not predict weight loss at 4-year followup.

CONCLUSIONS

These results underline the importance of addressing current depressive and anxiety disorders in obese patients, especially when such patients are undergoing obesity surgery.

Changes in depression following gastric banding: a 5- to 7-year prospective study

BACKGROUND

Long-term outcomes of gastric banding regarding depression and predictors of change in depression are still unclear. This prospective, controlled study investigated depression and self-acceptance in morbidly obese patients before and after gastric banding.

METHODS

A total of 248 morbidly obese patients (mean body mass index [BMI] = 46.4, SD = 6.9) seeking gastric banding completed questionnaires for symptoms of depression (Beck Depression Inventory) and self-acceptance. One hundred twenty-eight patients were treated with gastric banding and 120 patients were not. After 5 to 7 years, patients who either had (n = 40) or had not (n = 42) received gastric banding were reassessed.

RESULTS

In the preoperative assessment, 35% of all obese patients suffered from clinically relevant depressive symptoms (BDI score > or =18). The mean depression score was higher and the mean self-acceptance score was lower than those of the normal population. Higher preoperative depression scores were observed among patients living alone and who had obtained low levels of education. After 5 to 7 years, patients with gastric banding had lost significantly more weight than patients without gastric banding (mean BMI loss 10.0 vs. 3.3). Gastric banding patients improved significantly in depression and self-acceptance, whereas no change was found in patients without gastric banding. Symptoms of depression were more reduced in patients who lost more weight, lived together with a partner, and had a high preoperative depression score.

CONCLUSION

Morbid obesity is associated with depressive symptoms and low self-acceptance. Gastric banding results in both long-term weight loss and improvement in depression and self-acceptance.