1
|
Mowoh DPM, Cole R, Sarvepalli S, Grover K, Abbas M, Khaitan L. Bariatric surgery efficacy in patients with mood disorders. Surgery 2024; 175:943-946. [PMID: 38171967 DOI: 10.1016/j.surg.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/02/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Mood disorders are comorbid in patients with obesity and found in approximately 22.0% to 54.8% of patients who are eligible for bariatric surgery. Given the unclear effect of mood disorders on bariatric surgery outcomes, we aimed this study to assess the impact of mood disorders index bariatric surgery weight loss outcomes. METHODS A retrospective study institutional database of index bariatric surgery patients at University Hospitals Cleveland Medical Center between 2016 and 2018. The primary outcome of body mass index was followed over a 4-year period. The secondary outcomes measured were mortality and suicide rates. Mood disorders defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, included depressive and bipolar disorders obtained from electronic medical records International Classification of Diseases, Tenth Revision, coding. RESULTS A total of 790 patients underwent bariatric surgery between 2016 and 2018. Of these, 15 patients were excluded due to death in the postoperative period or insufficient weight loss data, and a total of 775 patients (620 women and 155 men) were included. Two hundred and ninety-five (38.1%) had an electronic medical record mood disorder diagnosis before surgery, while 480 (61.9%) did not. Both groups had a significant decrease in postoperative body mass index; however, there was no significant difference in the body mass index change between the mood disorder group (mean = 37.63, standard deviation = 9.88) and the control group (mean = 38.72, standard deviation = 9.54; t[294] = 1.40; P = .1634). CONCLUSION Patients with mood disorders are as successful with weight loss after index bariatric surgery as those without mood disorders. There was no significant difference in mortality rates between the mood disorder group and the control group. Hence, mood disorders should not be prohibitive for weight loss surgery.
Collapse
Affiliation(s)
| | - Rachel Cole
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Shravan Sarvepalli
- University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/ShravanSar63428
| | - Karan Grover
- University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/DrGroverSays
| | - Mujjahid Abbas
- University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/M_AbbasMD
| | - Leena Khaitan
- University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/DrLeenaK
| |
Collapse
|
2
|
Tuli S, Lopez Lopez AP, Nimmala S, Pedreira CC, Singhal V, Bredella MA, Misra M. Two-Year Study on the Impact of Sleeve Gastrectomy on Depressive and Anxiety Symptoms in Adolescents and Young Adults with Moderate to Severe Obesity. Obes Surg 2024; 34:568-575. [PMID: 38177554 DOI: 10.1007/s11695-023-07025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE Sleeve gastrectomy (SG), the most commonly performed weight loss surgery in adolescents and young adults with moderate to severe obesity, is highly effective for weight loss. Current literature regarding depressive and anxiety symptomatology following SG in youth is sparse and conflicting. We evaluated changes in depressive and anxiety symptoms in adolescents and young adults with moderate to severe obesity 2 years following SG compared with non-surgical controls (NS) followed for a similar duration. MATERIALS AND METHODS Forty-six youth 13-25 years old with moderate-severe obesity (33 female) were followed for 2 years; 21 underwent SG, and 25 were NS. Subjects underwent anthropometric measurements and completed self-report questionnaires. Beck Depression Inventory-II (BDI-II) was used to assess depressive symptoms and the State-Trait Anxiety Inventory (STAI)-X2 for anxiety symptoms. RESULTS Groups did not differ for age (18.4 ± 0.4 vs. 17.8 ± 0.5 years, p = 0.456). The SG group had a higher mean BMI vs. NS (47.5 (42.1, 52.4) vs. 41.6 (37.8, 46.5) kg/m2; p = 0.011). At 2-year follow-up, SG had greater reductions in weight and BMI vs. NS (p < 0.0001). Groups did not differ for changes in BDI-II and STAI scores (BDI-II: - 1.0 (- 6.0, 10.0) in SG vs. - 1.0 (- 6.0, 3.5) in NS, p = 0.37; STAI: 3.1 ± 3.2 in SG vs. - 1.1 ± 1.5 in NS, p = 0.24). CONCLUSION No change was found in depressive and anxiety symptomatology following surgery despite marked weight reduction over a 2-year period, underscoring the need to better evaluate psychopathology in youth undergoing SG to develop supportive therapeutic strategies. CLINICALTRIALS GOV IDENTIFIER NCT02557438 https://clinicaltrials.gov/ct2/show/NCT02557438?id=NCT02557438&draw=2&rank=1 ; The study was registered on 23 September 2015.
Collapse
Affiliation(s)
- Shubhangi Tuli
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ana Paola Lopez Lopez
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Supritha Nimmala
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Clarissa C Pedreira
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital for Children and Harvard Medical School, 55, Fruit Street, Boston, MA, 02114, USA
- MGH Weight Center, Massachusetts General Hospital, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Division of Pediatric Endocrinology, Massachusetts General Hospital for Children and Harvard Medical School, 55, Fruit Street, Boston, MA, 02114, USA.
| |
Collapse
|
3
|
Aktaş GK, İlgin VE. The Effect of Deep Breathing Exercise and 4-7-8 Breathing Techniques Applied to Patients After Bariatric Surgery on Anxiety and Quality of Life. Obes Surg 2023; 33:920-929. [PMID: 36480101 DOI: 10.1007/s11695-022-06405-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aims to determine the effects of the deep breathing exercise and the 4-7-8 breathing technique applied to patients after bariatric surgery on their anxiety and quality of life. METHODS The research was carried out using the pre-test post-test randomized controlled experimental research design with a control group. A total of 90 patients (30 patients in the deep breathing group, 30 patients in the 4-7-8 breathing group, and 30 patients in the control group) who met the research inclusion criteria were included in the study. While routine care was applied to the control group, 1 group was given deep breathing training, and the other group was given 4-7-8 breathing training. Personal Information Form, the Obesity-Specific Quality of Life Questionnaire, Status, and the State-Trait Anxiety Inventory were used for data collection. RESULTS There was no significant difference between the groups in terms of descriptive characteristics (p > 0.05). It was found that the post-test State Anxiety levels of the 4-7-8 breathing group were lower than the mean scores of the deep breathing group and the control group, and the difference was statistically significant (p < 0.05). It was found that the quality of life scores of the patients in the deep breathing group increased significantly in the post-test compared to the pre-test. CONCLUSION The 4-7-8 breathing technique was found to be beneficial in reducing the anxiety level of patients in clinical practice after bariatric surgery. It was found that deep breathing exercise was also effective in improving the quality of life. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05492929.
Collapse
Affiliation(s)
- Gülfidan Kurt Aktaş
- Ankara City Hospital, University District, 1604. Street No: 9, Ankara, Turkey
| | - Vesile Eskici İlgin
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, 25100, Erzurum, Turkey.
| |
Collapse
|
4
|
Samaan JS, Srinivasan N, Mirocha J, Premkumar A, Toubat O, Qian E, Subramanyam C, Malik Y, Lee N, Sandhu K, Dobrowolsky A, Samakar K. Association of Postoperative Dieting, Exercise, Dietitian, and Surgeon Follow up With Bariatric Surgery Outcomes. Am Surg 2022; 88:2445-2450. [PMID: 35575161 DOI: 10.1177/00031348221101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Although postoperative diet modification, exercise, and regular dietitian and surgeon follow-up are often recommended after bariatric surgery (BS), their impact on weight loss is unclear. A Retrospective chart review was conducted for patients who received sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) between August 2000 and November 2017 with telephone follow-up. Multivariable logistic regression models were used for analyses. There were 514 patients included in our study. Most were female (76.3%), mean age was 46.9 years (Standard Deviation [SD] = 11.8), and mean weight loss was 11.6 (SD = 6.5) BMI points at a mean follow-up of 7 years (SD = 4.3). Current surgeon follow-up OR = 2.08 (P < .01) was positively associated with postoperative weight loss, while current dietitian follow-up=OR .41 (P < .01) was negatively associated. Current weight loss supplement use OR = .45 (P = .03) was associated with reduced willingness to undergo surgery again. Increasing preoperative BMI OR = 1.06 (P = .04) and increasing age OR = 1.04 (P = .02) were associated with improved quality of life (QoL) due to BS. Lack of surgeon follow-up and regular dietician consultation was associated with suboptimal weight loss after BS. Older age was positively associated with improved QoL, while current weight loss supplement use was associated with lower likelihood of undergoing surgery again, both independent of weight loss.
Collapse
Affiliation(s)
- Jamil S Samaan
- Department of Medicine, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nitin Srinivasan
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - James Mirocha
- Cedars-Sinai Medical Center, Biostatistics and Bioinformatics Research Center, Los Angeles, CA, USA
| | - Agnes Premkumar
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Omar Toubat
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Elaine Qian
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Chaitra Subramanyam
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Yousaf Malik
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Nayun Lee
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Kulmeet Sandhu
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Adrian Dobrowolsky
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Kamran Samakar
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
5
|
Bramming M, Becker U, Jørgensen MB, Neermark S, Bisgaard T, Tolstrup JS. Bariatric Surgery and Risk of Unemployment and Sickness Absence. Obes Surg 2022; 32:720-728. [PMID: 35091901 DOI: 10.1007/s11695-021-05802-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Obesity is associated with adverse labor market outcomes. We examine whether undergoing bariatric surgery is associated with better labor market outcomes such as lower risks of unemployment and sickness absence. METHODS This is a register-based cohort study of 9126 patients undergoing bariatric surgery from 2005 to 2013 and a reference group of 10,328 individuals with obesity. Age: 18-60 years, body mass index (BMI): 32-60 kg/m2. Participants were either working, unemployed, or on sickness absence at baseline. Inverse probability of treatment weighting was used to account for baseline differences between the two groups. Relative risk ratios of labor market participation were estimated at 1 year, 3 years, and 5 years of follow-up. RESULTS Women who had undergone bariatric surgery had a higher risk of unemployment 1 year (RRR = 1.20 (95% CI: 1.02-1.41)) and 5 years (RRR = 1.23 (95% CI: 1.05-1.44)) after surgery; however, men with bariatric surgery had a lower risk of unemployment after 5 years (RRR = 0.71 (95% CI: 0.55-0.92)). The risk of sickness absence was higher at all follow-up time points for both men and women who had undergone bariatric surgery compared with non-operated references with obesity. CONCLUSIONS Men undergoing bariatric surgery had a lower risk of unemployment 5 years after surgery compared with non-operated men with obesity; however, women presented a higher risk of unemployment after 5 years. The risk of sickness absence was higher for both men and women up to 5 years after undergoing bariatric surgery.
Collapse
Affiliation(s)
- Maja Bramming
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark.,Gastrounit Medical Division, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | - Maja B Jørgensen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark.,Health Promotion and Inequality, Danish Health Authority, 2300, Copenhagen S, Denmark
| | - Søren Neermark
- Gastrounit Medical Division, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.,Center of Planning, Danish Health Authority, 2300, Copenhagen S, Denmark
| | - Thue Bisgaard
- Zealand University Hospital, Region Zealand, 4600, Køge, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark.
| |
Collapse
|
6
|
Fu R, Zhang Y, Yu K, Mao D, Su H. Bariatric surgery alleviates depression in obese patients: A systematic review and meta-analysis. Obes Res Clin Pract 2021; 16:10-16. [PMID: 34802982 DOI: 10.1016/j.orcp.2021.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/31/2021] [Accepted: 11/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND With the rapid increase in the incidence of depression, there have been studies investigating whether bariatric surgery can alleviate this condition. In this study, we aimed to explore the effect of bariatric surgery on depression in obese patients. METHODS We searched the PubMed, Embase, Web of Science and the Cochrane Library databases for studies on bariatric surgery and depression. Then, the clinical significance of bariatric surgery on depression was evaluated based on Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS) or Patient Health Questionnaire (PHQ-9). Subgroup analysis was carried out in terms of surgery types, assessment tool, follow-up time and nationalism. Dichotomous data were analyzed using odds ratio (OR), and continuous data were evaluated using the weighted mean difference (WMD) or standardized mean difference (SMD). RESULTS Overall, 33 studies with a combined total of 12,556 participants met the inclusion criteria. Statistical results were significantly different whether continuous or dichotomous, and depression was improved in obese patients after surgery (SMD = -0.87, p < 0.001; and OR = 0.29, p < 0.001, respectively). In addition, subgroup analysis showed that bariatric surgery improved depression in obese patients regardless of surgery types, assessment tool, follow-up and country. CONCLUSION Bariatric surgery alleviates depression in obese patients. However, further studies are needed to elucidate on the complex effect of between bariatric surgery on depression.
Collapse
Affiliation(s)
- Rongrong Fu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yu Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Kepin Yu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Danyi Mao
- Basic Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hui Su
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
| |
Collapse
|
7
|
Çaynak S, Boyacıoğlu NE, Temel M. Body perception and sexuality of bariatric surgery patients. Perspect Psychiatr Care 2021; 57:1266-1272. [PMID: 33184907 DOI: 10.1111/ppc.12683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study aims to determine how body perception and sexual life are affected in obese individuals who are hospitalized to undergo bariatric surgery. DESIGN AND METHODS Descriptive research design and the cross-sectional method were used. The study was conducted with 53 individuals who consented to participate. The data were analyzed with the SPSS software package. FINDINGS Low body perception and sexual dysfunction were detected, particularly in women. PRACTICE IMPLICATIONS In obesity treatment, the psychological and social problems that individuals experience due to obesity should be handled and evaluated with a multidisciplinary approach.
Collapse
Affiliation(s)
- Sibel Çaynak
- Department of Psychiatric Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Nur E Boyacıoğlu
- Department of Gerontology, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Münire Temel
- Department of Nursing, School of Health, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| |
Collapse
|
8
|
McGlennon TW, Buchwald JN, Pories WJ, Yu F, Roberts A, Ahnfeldt EP, Menon R, Buchwald H. Part 2: Bypassing TBI-Metabolic Surgery and the Link Between Obesity and Traumatic Brain Injury-A Review. Obes Surg 2021; 31:26-35. [PMID: 33405185 DOI: 10.1007/s11695-020-05142-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 01/22/2023]
Abstract
Obesity is a common outcome of traumatic brain injury (TBI) that exacerbates principal TBI symptom domains identified as common areas of post-TBI long-term dysfunction. Obesity is also associated with increased risk of later-life dementia and Alzheimer's disease. Patients with obesity and chronic TBI may be more vulnerable to long-term mental abnormalities. This review explores the question of whether weight loss induced by bariatric surgery could delay or perhaps even reverse the progression of mental deterioration. Bariatric surgery, with its induction of weight loss, remission of type 2 diabetes, and other expressions of the metabolic syndrome, improves metabolic efficiency, leads to reversal of brain lesions seen on imaging studies, and improves function. These observations suggest that metabolic/bariatric surgery may be the most effective therapy for TBI.
Collapse
Affiliation(s)
- T W McGlennon
- Statistics Division, McGlennon MotiMetrics, Maiden Rock, WI, USA
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite, Maiden Rock, WI, USA
| | - Walter J Pories
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Eric P Ahnfeldt
- Uniformed Services University of the Health Sciences, Bethesda, MA, USA
| | - Rukmini Menon
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Henry Buchwald
- University of Minnesota Medical School, Minneapolis, MN, USA.
| |
Collapse
|
9
|
Miller-Matero LR, Hamann A, LaLonde L, Martens KM, Son J, Clark-Sienkiewicz S, Sata M, Coleman JP, Hecht LM, Braciszewski JM, Carlin AM. Predictors of Alcohol Use after Bariatric Surgery. J Clin Psychol Med Settings 2020; 28:596-602. [PMID: 33205321 DOI: 10.1007/s10880-020-09751-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 12/25/2022]
Abstract
Patients undergoing bariatric surgery are at risk for devloping an alcohol use disorder (AUD). The purpose of this study was to investigate pre-surgical psychosocial risk factors for post-surgical alcohol consumption and hazardous drinking. Participants (N = 567) who underwent bariatric surgery between 2014 and 2017 reported their post-surgical alcohol use. Information was collected from the pre-surgical evaluation including history of alcohol use, psychiatric symptoms, and maladaptive eating behaviors (i.e., binge eating, purging, and emotional eating). Younger age and pre-surgical alcohol use predicted post-surgical alcohol use and hazardous drinking. In addition, higher levels of depressive symptoms and maladaptive eating patterns predicted post-surgical binge drinking. Clinicians conducting pre-surgical psychosocial evaluations should be aware of the multiple risk factors related to post-surgical problematic alcohol use. Future research should evaluate whether preventive interventions for high-risk patients decrease risk for post-surgical alcohol misuse.
Collapse
Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA. .,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA.
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA.,Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Leah LaLonde
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA
| | - Kellie M Martens
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA.,Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - John Son
- Wayne State University School of Medicine, Henry Ford Health System, Detroit, MI, USA
| | | | - Monika Sata
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA
| | - Joseph P Coleman
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Leah M Hecht
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA.,Wayne State University School of Medicine, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
10
|
Improvement in patient-reported outcomes in Chinese adults after bariatric surgery: 1-year follow-up of a prospective cohort. Surg Obes Relat Dis 2020; 16:1563-1572. [DOI: 10.1016/j.soard.2020.04.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 11/24/2022]
|
11
|
Stapleton P, Spinks T, Carter B. Psychological Determinants of Continued Obesity One-Year Postbariatric Surgery. Psychol Rep 2020; 123:1044-1063. [PMID: 32659202 DOI: 10.1177/0033294119844983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Bariatric surgery is an effective treatment for obesity; however, an estimated 20% of patients do not experience significant weight loss postsurgery. This study examined the interaction of potential psychological factors and their mediating effects on the emotional eating of individuals one-year postbariatric surgery. METHOD Three-hundred and sixty-six obese individuals (348 females; 95.1%) with a body mass index greater than 30 kg/m2 (M = 39.14; SD = 7.67) completed the Patient Health Questionnaire, the Brief Cope, the Big-Five Mini-Marker of Personality, and the Three-Factor Eating Questionnaire R-18. RESULTS The variance accounted for in emotional eating by age and 12 psychological factors were assessed via a four-step hierarchical multiple regression. Avoidant coping and the personality traits of extraversion, agreeableness, and in contrast to that hypothesized, emotional stability were significant predictors of emotional eating. Avoidant coping partially mediated the relationships of extraversion and emotional stability with emotional eating and fully mediated the relationship of agreeableness. CONCLUSION Certain personality traits may influence the preferred coping style chosen by individuals who experience continued obesity after bariatric surgery. Additional supports and tailored interventions that are matched with the needs of this population may subsequently be necessary to overcome emotional eating and improve weight loss.
Collapse
Affiliation(s)
- Peta Stapleton
- School of Psychology, Bond University, Queensland, Australia
| | - Teagan Spinks
- School of Psychology, Bond University, Queensland, Australia
| | - Brett Carter
- School of Psychology, Bond University, Queensland, Australia
| |
Collapse
|
12
|
Spirou D, Raman J, Smith E. Psychological outcomes following surgical and endoscopic bariatric procedures: A systematic review. Obes Rev 2020; 21:e12998. [PMID: 31994311 DOI: 10.1111/obr.12998] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/25/2019] [Accepted: 12/12/2019] [Indexed: 12/16/2022]
Abstract
Obesity is a leading global epidemic. Bariatric surgery is the only treatment demonstrating substantial long-term weight loss and medical benefits. However, there is limited research on the psychological outcomes following surgery. Therefore, the primary aim of this study was to systematically review depression, anxiety, and binge eating outcomes at different time points following bariatric surgery and identify whether bariatric surgery significantly reduces psychological symptoms over time. These outcomes were also examined among endoscopic bariatric procedures as a secondary aim. Forty-eight studies met inclusion criteria. Findings suggested that most patients experience a short-term reduction in anxiety and depression symptoms from pre-surgery. Over time, however, these symptoms increase and may even return to pre-surgery levels. Furthermore, while binge eating was uncommon after surgery, other disordered eating patterns may emerge. Binge eating may also restart over time as the stomach enlarges again. Overall, the complex psychological difficulties faced by individuals with obesity continue after surgery and may contribute to longer-term weight recidivism. More comprehensive and standardised psychological assessment procedures, including clinical interviews and longer-term follow-up, may provide insight into the psychological mechanisms maintaining weight management issues, and may serve as a starting point for improving the long-term success of patients with obesity.
Collapse
Affiliation(s)
- Dean Spirou
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jayanthi Raman
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Evelyn Smith
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| |
Collapse
|
13
|
Clark-Sienkiewicz SM, Hecht LM, Pester B, Martens K, Hamann A, Carlin AM, Miller-Matero LR. Racial Differences in Psychological Symptoms and Eating Behaviors Among Bariatric Surgery Candidates. J Racial Ethn Health Disparities 2020; 8:94-98. [DOI: 10.1007/s40615-020-00761-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/29/2020] [Accepted: 04/13/2020] [Indexed: 12/26/2022]
|
14
|
Legenbauer T, Müller A, de Zwaan M, Herpertz S. Body Image and Body Avoidance Nine Years After Bariatric Surgery and Conventional Weight Loss Treatment. Front Psychiatry 2020; 10:945. [PMID: 31992997 PMCID: PMC6971062 DOI: 10.3389/fpsyt.2019.00945] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/29/2019] [Indexed: 01/18/2023] Open
Abstract
Recently, there has been an increasing focus on body image dissatisfaction (BID), both as a motivational factor for seeking bariatric surgery and as a factor influencing weight loss outcome after surgery. Although associations have been reported between BID, emotional distress and successful weight loss, conclusions are limited due to methodological issues such as non-weight-specific assessment tools for body image and neglect of behavioral components (e.g. body avoidance, BA). The present study seeks to report on BID and BA 9 years after bariatric surgery using a cross-sectional data set from the 9-year follow-up assessment of the Essen-Bochum Obesity Treatment Study (EBOTS). In total, N = 291 participants of the original EBOTS sample were included in the present analyses (N = 78 bariatric surgery patients, SURG; N = 124 patients of a conventional treatment program, CONV; and N = 83 individuals with obesity not seeking treatment, OC). Current body image facets (BID and BA) were captured at the 9-year follow-up assessment via silhouette scales adapted for use in samples with obesity. Moreover, BID was assessed retrospectively to obtain baseline attitudes. Possible influences of eating disorder symptoms and depression/anxiety were controlled for and assessed via standardized self-report measures. The results imply an improvement in BID in the SURG group, but not in the CONV and OC groups. The level of BA in relation to clothing was significantly higher in the CONV group compared to both the SURG and OC group. Current BID as well as BA were positively associated with current body weight as well as depression, anxiety, and levels of disinhibited eating. A positive change from baseline to current levels of BID was associated with successful weight loss, independently of treatment. The findings emphasize the role of the different components of body image after surgery for mental health features, and suggest a robust relationship between BID and weight loss (success). Thus, it might be helpful to address BID in treatment. However, further research, particularly in the form of prospective studies, is necessary to determine the direction of influence.
Collapse
Affiliation(s)
- Tanja Legenbauer
- Department for Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital of the Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
15
|
Cella S, Cipriano A, Giardiello C, Cotrufo P. Relationships Between Self-Esteem, Interoceptive Awareness, Impulse Regulation, and Binge Eating. Path Analysis in Bariatric Surgery Candidates. CLINICAL NEUROPSYCHIATRY 2019; 16:213-220. [PMID: 34908958 PMCID: PMC8650187 DOI: 10.36131/clinicalnpsych2019050604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The current study investigates the hypothesis that the effect of low self-esteem on binge eating in bariatric candidates was mediated by both difficulties in the perception of bodily signals and impulse regulation after accounting for gender, age, and body mass index. METHOD 59 preoperative patients (both male and female) were screened by means of self-report measures of self-esteem, interoceptive deficits, impulse dysregulation, and severity of binge eating. Results: Results indicated that all direct effects were significant, except for the self-esteem on impulse dysregulation and the interoceptive deficits on binge eating. Self-esteem had a significant indirect effect on impulse dysregulation mediated by interoceptive deficits. Impulse dysregulation, in turn, mediates the effect of interoceptive deficits on binge eating. Moreover, the path starting from self-esteem, going first to interoceptive deficits, then going via impulse regulation difficulties to binge eating was significant. RESULTS AND CONCLUSIONS A potential underlying mechanism through which self-esteem is linked to binge eating has been suggested. Obese individuals who perceived themselves as inadequate may carry a stronger burden by the confusion and mistrust related to bodily functioning and, consequently, may act more impulsively, through binge eating.
Collapse
Affiliation(s)
- Stefania Cella
- Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31-81100, Caserta, Italy
| | - Annarosa Cipriano
- Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31-81100, Caserta, Italy
| | | | - Paolo Cotrufo
- Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31-81100, Caserta, Italy
| |
Collapse
|
16
|
Validation of the Yale Food Addiction Scale 2.0 Among a Bariatric Surgery Population. Obes Surg 2019; 29:2923-2928. [DOI: 10.1007/s11695-019-03927-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
17
|
Gill H, Kang S, Lee Y, Rosenblat JD, Brietzke E, Zuckerman H, McIntyre RS. The long-term effect of bariatric surgery on depression and anxiety. J Affect Disord 2019; 246:886-894. [PMID: 30795495 DOI: 10.1016/j.jad.2018.12.113] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/13/2018] [Accepted: 12/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND No previous review has comprehensively assessed long-term changes in anxiety and depressive symptoms in bariatric surgery patients. This systematic review assessed the effects of bariatric surgery on long-term reductions (≥ 24 months) in anxiety and depressive symptom severity in morbidly obese (≥ 35 BMI kg/m2) participants. Short term effects (< 24 months) are briefly reviewed for context. METHODS PsychINFO, Google Scholar and PubMed databases were systematically searched for prospective cohort studies published from inception to 14 June 2018 that evaluated long-term (≥ 24 months) changes in anxiety and depressive symptom severity in bariatric surgery patients with a BMI ≥ 35 kg/m2 using a combination of the following search terms: bariatric surgery (and surgical approaches included under this term), obesity, depression, depressive disorder, anxiety, anxious, psychiatric disorders, mood disorders. RESULTS We reviewed 2058 articles for eligibility; 14 prospective studies were included in the systematic review. 13 studies (93%) reported significant reductions in depressive symptom severity 2-3 years after bariatric surgery. However, all studies recorded statistically significant reductions in depressive symptoms at the conclusion of the study. Similarly, there were reductions in overall anxiety symptom severity at ≥ 24 months follow-up (k = 8 studies, n = 1590 pooled). Pre-operative anxiety or depression scores did not predict outcomes of post-operative BMI. Similarly, post-surgery weight loss did not predict changes in anxiety symptoms. LIMITATIONS Very few studies assessed anxiety or depression as a primary outcome. Therefore, we cannot suggest bariatric surgery as a stand-alone therapeutic tool for anxiety and depression based on our findings. CONCLUSION Currently available evidence suggests that bariatric surgery is associated with long-term reductions in anxiety and depressive symptoms. This supports existing literature showing that metabolic treatments may be a viable therapeutic intervention for mood disorders.
Collapse
Affiliation(s)
- Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Simratdeep Kang
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Elisa Brietzke
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Hannah Zuckerman
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada.
| |
Collapse
|
18
|
Psychosomatic and Psychosocial Questions Regarding Bariatric Surgery: What Do We Know, or What Do We Think We Know? ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 63:344-369. [PMID: 29214946 DOI: 10.13109/zptm.2017.63.4.344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
Collapse
|
19
|
Hancock J, Jackson S, Johnson AB. The Long-Term Psychological Impact of Disclosing (Or Not) Laparoscopic Adjustable Gastric Banding Surgery. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2017.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jude Hancock
- Department of Diabetes and Endocrinology, Southmead Hospital, Bristol, United Kingdom
| | - Sue Jackson
- Department of Psychology, University of the West of England, Bristol, United Kingdom
| | - Andrew B. Johnson
- Department of Diabetes & Endocrinology, Southmead Hospital, Bristol, United Kingdom
| |
Collapse
|
20
|
Ho K, Hawa R, Wnuk S, Okrainec A, Jackson T, Sockalingam S. The Psychosocial Effects of Perioperative Complications After Bariatric Surgery. PSYCHOSOMATICS 2018; 59:452-463. [DOI: 10.1016/j.psym.2018.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 11/25/2022]
|
21
|
Esfahani SB, Pal S. Obesity, mental health, and sexual dysfunction: A critical review. Health Psychol Open 2018; 5:2055102918786867. [PMID: 30023076 PMCID: PMC6047250 DOI: 10.1177/2055102918786867] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Obesity has profound medical, psychological, and emotional consequences and is associated with sexual difficulties. Little is known regarding the interrelationship between obesity and sexual functioning from a psychological perspective, and less is known regarding treatment options. This review examines these issues and considers various treatments. Literature searches were conducted to locate original research, reviews, systematic reviews, and meta-analyses of obesity, overweight, sexual function, sexual dysfunction, psychological health, mental health, and weight loss. Research demonstrates an association between obesity, mental health, and sexual functioning, but has failed to identify casual pathways between these conditions. Clarifying such pathways is necessary to inform treatment guidelines for clinical practice.
Collapse
|
22
|
Ribeiro GANDA, Giapietro HB, Belarmino LB, Salgado-Junior W. DEPRESSION, ANXIETY, AND BINGE EATING BEFORE AND AFTER BARIATRIC SURGERY: PROBLEMS THAT REMAIN. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1356. [PMID: 29947690 PMCID: PMC6050001 DOI: 10.1590/0102-672020180001e1356] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND As the number of surgeries increases and the elapsed time of the realization increases as well, the postoperative evaluations would become increasingly necessary. AIM To assess the psychological profile before and after surgery. METHODS Were evaluated 281 patients from the public service of bariatric surgery. In this study, 109 patients completed the evaluations before surgery (T0) and up to 23 months after surgery (T1); 128 completed the evaluations in T0 and between 24 months and 59 months after surgery (T2); and 44 completed the evaluations in T0 and 60 months after surgery (T3). A semi-structured interview, the Beck Depression Inventory (BDI), Beck Anxiety (BAI), and the Binge Eating Scale (BES) were used. RESULTS There was a higher prevalence of female (83%), patients with less than 12 years of education (83%), and patients who have a partner (64%). Analyzing all times of evaluation, regarding anxiety, depression, and binge eating, there was a reduction in all symptoms in T1, pointing to significant improvements in the first 23 months after surgery. Already, in T2 and T3, there was an increase in all indicators of anxiety, depression, and binge eating pointing to the transient impact of weight loss or bariatric surgery on these symptoms. CONCLUSIONS This study shows the importance of the continuous psychological evaluation and needs for the appropriate interventions for these patients who have undergone bariatric surgery, even after weight loss.
Collapse
Affiliation(s)
| | - Helenice Brizolla Giapietro
- Service of Bariatric Surgery, Hospital das Clínicas, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, SP, Brazil
| | - Lídia Barbieri Belarmino
- Service of Bariatric Surgery, Hospital das Clínicas, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, SP, Brazil
| | - Wilson Salgado-Junior
- Service of Bariatric Surgery, Hospital das Clínicas, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, SP, Brazil
| |
Collapse
|
23
|
Fink K, Ross CA. Adverse Childhood Experiences in a Post-bariatric Surgery Psychiatric Inpatient Sample. Obes Surg 2018; 27:3253-3257. [PMID: 28593483 DOI: 10.1007/s11695-017-2767-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sixty-three inpatients in a psychiatric hospital who had previously undergone bariatric surgery were interviewed by the hospital dietitian. The purpose of the study was to determine the frequency of adverse childhood experiences in this population. METHODS Participants completed the Adverse Childhood Experiences (ACE) Scale. RESULTS The average score on the ACE was 5.4 (3.3); 76% of participants reported childhood emotional neglect, 70% childhood verbal abuse, and 64% childhood sexual abuse; only two participants reported no adverse childhood experiences. CONCLUSIONS The participants in the study reported high levels of adverse childhood experiences compared to the general population, which is consistent with prior literature on rates of childhood trauma in post-bariatric surgery patients. The role of adverse childhood experiences in post-bariatric surgery adaptation should be investigated in future research, including in prospective studies.
Collapse
Affiliation(s)
- Kathryn Fink
- Institute for Psychological Trauma, 1701 Gateway, #349, Richardson, TX, 75080, USA
| | - Colin A Ross
- Institute for Psychological Trauma, 1701 Gateway, #349, Richardson, TX, 75080, USA.
| |
Collapse
|
24
|
Health-Related Quality of Life, Anxiety, and Depression in Bariatric Surgery Candidates Compared to Patients from a Psychosomatic Inpatient Hospital. Obes Surg 2018; 27:2378-2387. [PMID: 28285469 DOI: 10.1007/s11695-017-2629-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Past research indicated high psychiatric comorbidity and poor health-related quality of life (HRQOL) in patients seeking surgical treatment for obesity. This study investigated if preoperative bariatric surgery patients perceive equally poor HRQOL and increased levels of anxiety and depression as mentally ill patients. METHODS The study included four groups: 192 bariatric surgery candidates (PRE, 71% women, BMI 48.35 ± 8.98 kg/m2), 96 psychotherapy inpatients with mental disorders (PSY, 77% women, BMI 27.12 ± 9.17 kg/m2), 103 postoperative bariatric surgery patients (POST, 78% women, BMI 30.38 ± 2.88 kg/m2), and a convenience sample of 96 non-clinical volunteers with pre-obesity or obesity grade 1 (CG, 52% women, BMI 29.22 ± 2.64 kg/m2). HRQOL was measured using the 12-item short form health survey (SF-12), and psychopathology was assessed with the hospital anxiety and depression scale (HADS). RESULTS The PRE group exhibited the lowest physical HRQOL, and the PSY group the lowest mental HRQOL. The highest mental/physical HRQOL was reported by the POST group and the CG, without significant differences between these two groups. While the PSY group scored higher on HADS-anxiety scale than the PRE group, neither group differed with regards to symptoms of depression. The lowest levels of HADS-depression were found in the POST group and the CG. CONCLUSIONS The present findings suggest that bariatric surgery candidates may suffer from equally high levels of depression as psychotherapy inpatients, but they perceive better mental well-being. Routine mental health evaluation should incorporate assessments for both psychopathology and HRQOL. TRIAL REGISTRATION DRKS00009901.
Collapse
|
25
|
Abstract
OBJECTIVE The aim of this study is to identify psychosocial variables associated with the relationship between weight loss and change in depressive symptoms following gastric banding surgery. METHODS Ninety-nine adults completed self-report questionnaires assessing depressive symptoms and other psychosocial variables (self-esteem, body image dissatisfaction, perceived physical health, and perceived weight-based stigmatisation) prior to gastric-band surgery and monthly for 6-month post-surgery. RESULTS Weight, depressive symptoms, and other psychosocial variables improved significantly 1-month post-surgery and remained lower to 6 months. Weight loss from baseline to 1- and 6-months post-surgery significantly correlated with change in depressive symptoms. Body image dissatisfaction and self-esteem accounted for some of the variance in change in depressive symptoms from baseline to 1-month and baseline to 6-months post-surgery. CONCLUSIONS Depressive symptoms improved significantly and rapidly after bariatric surgery, and body image dissatisfaction and self-esteem predicted change in depressive symptoms. Interventions targeting body image and self-esteem may improve depressive symptoms for those undergoing weight loss interventions.
Collapse
|
26
|
Legenbauer T, Müller A, de Zwaan M, Fischer C, Burgmer R, Herpertz S. The Impact of Self-Reported Impulsivity on the Course of Weight Is Mediated by Disinhibited Eating. EUROPEAN EATING DISORDERS REVIEW 2017; 26:38-45. [PMID: 29067753 DOI: 10.1002/erv.2563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 11/11/2022]
Abstract
This study investigates the impact of impulsivity and the mediating role of disinhibited eating behaviour (DEB) on weight and weight trajectories in a large data set including obese non-treatment seeking individuals (obese control, n = 138) and obese individuals who were either receiving a conventional treatment program (n = 227) or bariatric surgery (n = 123). Data was assessed one, 4 and 9 years after baseline including self-reports for impulsivity and DEB. Results suggest a significant association between impulsivity and body mass index, which is partially mediated by DEB. Longitudinally, the influence of impulsivity on the course of weight after 9 years was fully mediated by DEB in obese control but not in the treatment groups. The results indicate an interplay between impulsivity and DEB with respect to obesity. Further research is needed to clarify how the mediation works and when it exerts its effect, in order to identify those that might profit from a specific (impulsivity-reducing) training. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
Collapse
Affiliation(s)
- Tanja Legenbauer
- LWL University Hospital for Child and Adolescent Psychiatry, Ruhr University Bochum, Hamm, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Charlotte Fischer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ramona Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
27
|
Rodríguez-Hurtado J, Ferrer-Márquez M, Fontalba-Navas A, García-Torrecillas JM, Olvera-Porcel MC. Influence of psychological variables in morbidly obese patients undergoing bariatric surgery after 24 months of evolution. Cir Esp 2017; 95:378-384. [PMID: 28750780 DOI: 10.1016/j.ciresp.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/13/2017] [Accepted: 06/17/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Bariatric surgery is considered a more effective means of achieving weight loss than non-surgical options in morbid obesity. Rates of failure or relapse range from 20 to 30%. The study aims to analyse the influence of psychological variables (self-esteem, social support, coping strategies and personality) in the maintenance of weight loss after bariatric surgery. METHODS A cohort study was conducted involving 64 patients undergoing bariatric surgery for 24 months. At the end of the follow-up period, patients were divided into 2sub-cohorts classified as successes or failures. Success or favorable development was considered when the value of percent excess weight loss was 50 or higher. RESULTS No statistically significant differences were observed between the 2groups in any variable studied. All patients had high self-esteem (87,3 those who failed and 88,1 those who are successful) and social support (90,2 and 90,9). Patients who succeed presented higher scores for cognitive restructuring (57,1) and were more introverted (47,1), while those who failed scored more highly in desiderative thinking (65,7) and were more prone to aggression (50,7) and neuroticism (51,7). CONCLUSIONS High self-esteem and social support does not guarantee successful treatment. The groups differed in how they coped with obesity but the data obtained do not justify the weight evolution. In the absence of psychopathology, personality trait variability between patients is insufficient to predict the results.
Collapse
Affiliation(s)
| | | | - Andrés Fontalba-Navas
- Subdirección Médica, Área de Gestión Sanitaria Norte de Málaga, Antequera, Málaga, España
| | | | | |
Collapse
|
28
|
Abstract
OBJECTIVE The aim of this study was to examine risk of self-harm, hospitalization for depression and death by suicide after gastric bypass surgery (GBP). SUMMARY OF BACKGROUND DATA Concerns regarding severe adverse psychiatric outcomes after GBP have been raised. METHODS This nationwide, longitudinal, self-matched cohort encompassed 22,539 patients who underwent GBP during 2008 to 2012. They were identified through the Swedish National Patient Register, the Prescribed Drug Register, and the Causes of Death Register. Follow-up time was up to 2 years. Main outcome measures were hazard ratios (HRs) for post-surgery self-harm or hospitalization for depression in patients with presurgery self-harm and/or depression compared to patients without this exposure; and standardized mortality ratio (SMR) for suicide post-surgery. RESULTS A diagnosis of self-harm in the 2 years preceding surgery was associated with an HR of 36.6 (95% confidence interval [CI] 25.5-52.4) for self-harm during the 2 years of follow up, compared to GBP patients who had no self-harm diagnosis before surgery. Patients with a diagnosis of depression preceding GBP surgery had an HR of 52.3 (95% CI 30.6-89.2) for hospitalization owing to depression after GBP, compared to GBP patients without a previous diagnosis of depression. The SMR for suicide after GBP was increased among females (n = 13), 4.50 (95% CI 2.50-7.50). The SMR among males (n = 4), was 1.71 (95% CI 0.54-4.12). CONCLUSIONS The increased risk of post-surgery self-harm and hospitalization for depression is mainly attributable to patients who have a diagnosis of self-harm or depression before surgery. Raised awareness is needed to identify vulnerable patients with history of self-harm or depression, which may be in need of psychiatric support after GBP.
Collapse
|
29
|
Systematic Review and Meta-Analysis of Occupational Outcomes after Bariatric Surgery. Obes Surg 2016; 27:774-781. [DOI: 10.1007/s11695-016-2367-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
30
|
Çelik Erden S, Seyit H, Yazısız V, Türkyılmaz Uyar E, Akçakaya RÖ, Beşirli A, Alış H, Karamustafalıoğlu O, Yücel B. Binge Eating Disorder Prevalence in Bariatric Surgery Patients: Evaluation of Presurgery and Postsurgery Quality of Life, Anxiety and Depression Levels. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Hakan Seyit
- Şişli Etfal Research and Training Hospital, İstanbul, Turkey
| | - Veli Yazısız
- Şişli Etfal Research and Training Hospital, İstanbul, Turkey
| | | | | | - Aslı Beşirli
- Şişli Etfal Research and Training Hospital, İstanbul, Turkey
| | - Halil Alış
- Şişli Etfal Research and Training Hospital, İstanbul, Turkey
| | | | - Başak Yücel
- Şişli Etfal Research and Training Hospital, İstanbul, Turkey
| |
Collapse
|
31
|
Gulliford MC, Charlton J, Booth HP, Fildes A, Khan O, Reddy M, Ashworth M, Littlejohns P, Prevost AT, Rudisill C. Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundBariatric surgery is known to be an effective treatment for extreme obesity but access to these procedures is currently limited.ObjectiveThis study aimed to evaluate the costs and outcomes of increasing access to bariatric surgery for severe and morbid obesity.Design and methodsPrimary care electronic health records from the UK Clinical Practice Research Datalink were analysed for 3045 participants who received bariatric surgery and 247,537 general population controls. The cost-effectiveness of bariatric surgery was evaluated in severe and morbid obesity through a probabilistic Markov model populated with empirical data from electronic health records.ResultsIn participants who did not undergo bariatric surgery, the probability of participants with morbid obesity attaining normal body weight was 1 in 1290 annually for men and 1 in 677 for women. Costs of health-care utilisation increased with body mass index category but obesity-related physical and psychological comorbidities were the main drivers of health-care costs. In a cohort of 3045 adult obese patients with first bariatric surgery procedures between 2002 and 2014, bariatric surgery procedure rates were greatest among those aged 35–54 years, with a peak of 37 procedures per 100,000 population per year in women and 10 per 100,000 per year in men. During 7 years of follow-up, the incidence of diabetes diagnosis was 28.2 [95% confidence interval (CI) 24.4 to 32.7] per 1000 person-years in controls and 5.7 (95% CI 4.2 to 7.8) per 1000 person-years in bariatric surgery patients (adjusted hazard ratio was 0.20, 95% CI 0.13 to 0.30;p < 0.0001). In 826 obese participants with type 2 diabetes mellitus who received bariatric surgery, the relative rate of diabetes remission, compared with controls, was 5.97 (95% CI 4.86 to 7.33;p < 0.001). There was a slight reduction in depression in the first 3 years following bariatric surgery that was not maintained. Incremental lifetime costs associated with bariatric surgery were £15,258 (95% CI £15,184 to £15,330), including costs associated with bariatric surgical procedures of £9164 per participant. Incremental quality-adjusted life-years (QALYs) were 2.142 (95% CI 2.031 to 2.256) per participant. The estimated cost per QALY gained was £7129 (95% CI £6775 to £7506). Estimates were similar across gender, age and deprivation subgroups.LimitationsIntervention effects were derived from a randomised trial with generally short follow-up and non-randomised studies of longer duration.ConclusionsBariatric surgery is associated with increased immediate and long-term health-care costs but these are exceeded by expected health benefits to obese individuals with reduced onset of new diabetes, remission of existing diabetes and lower mortality. Diverse obese individuals have clear capacity to benefit from bariatric surgery at acceptable cost.Future workFuture research should evaluate longer-term outcomes of currently used procedures, and ways of delivering these more efficiently and safely.FundingThe National Institute for Health Research (NIHR) Health Services and Delivery Research programme. Martin C Gulliford and A Toby Prevost were supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospitals. Peter Littlejohns was supported by the South London Collaboration for Leadership in Applied Health Research and Care. The funders did not engage in the design, conduct or reporting of the research.
Collapse
Affiliation(s)
- Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Helen P Booth
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Alison Fildes
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Omar Khan
- Department of Surgery, St George’s University Hospital NHS Foundation Trust, London, UK
| | - Marcus Reddy
- Department of Surgery, St George’s University Hospital NHS Foundation Trust, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Peter Littlejohns
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - A Toby Prevost
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Caroline Rudisill
- Department of Social Policy, London School of Economics and Political Science, London, UK
| |
Collapse
|
32
|
Switzer NJ, Debru E, Church N, Mitchell P, Gill R. The Impact of Bariatric Surgery on Depression: a Review. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0492-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
33
|
Miller-Matero LR, Tobin ET, Clark S, Eshelman A, Genaw J. Pursuing bariatric surgery in an urban area: Gender and racial disparities and risk for psychiatric symptoms. Obes Res Clin Pract 2016; 10:56-62. [DOI: 10.1016/j.orcp.2015.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 03/10/2015] [Accepted: 03/22/2015] [Indexed: 10/23/2022]
|
34
|
Larjani S, Spivak I, Hao Guo M, Aliarzadeh B, Wang W, Robinson S, Sockalingam S, Aarts MA. Preoperative predictors of adherence to multidisciplinary follow-up care postbariatric surgery. Surg Obes Relat Dis 2015; 12:350-6. [PMID: 26806726 DOI: 10.1016/j.soard.2015.11.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 10/31/2015] [Accepted: 11/09/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Long-term multidisciplinary care after bariatric surgery is important for weight maintenance and management of co-morbidities. Despite this, the rate of attendance to follow-up appointments is universally low. OBJECTIVE To identify patient factors that contribute to adherence to follow-up care after bariatric surgery. SETTING Three university-affiliated hospitals in Canada METHODS A cohort study of 388 patients who underwent bariatric surgery from January 2011 to December 2011 was performed. This program mandates multidisciplinary follow-up care at 3, 6, and 12 months, and annually thereafter. Patients' socioeconomic, psychosocial, and medical and psychiatric co-morbidities were recorded prospectively. Adherence to follow-up care was defined as having attended the majority of clinic visits (3 or 4 out of 4); all other patients were considered nonadherent. RESULTS The mean age of patients was 45.0 years, 81.2% were female, and the majority underwent a gastric bypass (91.8%) versus a sleeve gastrectomy (8.2%); 62.1% of patients were adherent to follow-up appointments. Patients older than 25 years had a higher adherence rate than those who were younger (63.2% versus 37.5%, P = .040). Patients with full-time or part-time employment had a significantly higher adherence rate than those who were unemployed or retired (65.6% versus 50.0%, P = .017, odds ratio 1.9). Patients with obstructive sleep apnea (OSA) before surgery had higher follow-up adherence than those without OSA (62.2% versus 37.8%, P = .044). In multivariate analysis, employment remained an independent predictor of follow-up adherence (P = .017). CONCLUSION Employment was the strongest predictor of attendance to follow-up clinic. Patients with OSA and older patients were also more likely to return consistently for scheduled follow-up.
Collapse
Affiliation(s)
- Soroush Larjani
- The University of Toronto Bariatric Collaborative, Toronto, Canada; Division of General Surgery, Toronto East General Hospital, Toronto, Canada
| | - Israel Spivak
- The University of Toronto Bariatric Collaborative, Toronto, Canada
| | - Ming Hao Guo
- The University of Toronto Bariatric Collaborative, Toronto, Canada
| | - Babak Aliarzadeh
- The University of Toronto Bariatric Collaborative, Toronto, Canada
| | - Wei Wang
- The University of Toronto Bariatric Collaborative, Toronto, Canada
| | - Sandra Robinson
- The University of Toronto Bariatric Collaborative, Toronto, Canada
| | - Sanjeev Sockalingam
- The University of Toronto Bariatric Collaborative, Toronto, Canada; Department of Psychiatry, University Health Network, Toronto, Canada
| | - Mary-Anne Aarts
- The University of Toronto Bariatric Collaborative, Toronto, Canada; Department of Psychiatry, University Health Network, Toronto, Canada.
| |
Collapse
|
35
|
Järvholm K, Karlsson J, Olbers T, Peltonen M, Marcus C, Dahlgren J, Gronowitz E, Johnsson P, Flodmark CE. Two-year trends in psychological outcomes after gastric bypass in adolescents with severe obesity. Obesity (Silver Spring) 2015; 23:1966-72. [PMID: 26227556 DOI: 10.1002/oby.21188] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to evaluate changes in mental health over 2 years in adolescents undergoing gastric bypass. METHODS Eighty-eight adolescents (65% girls) aged 13 to 18 years were assessed at baseline and 1 and 2 years after surgery. Generic and obesity-specific questionnaires were used to evaluate outcomes in mental health, also in relation to age- and gender-specific norms. RESULTS Symptoms of anxiety (P = 0.001), depression (P = 0.001), anger (P = 0.001), and disruptive behavior (P = 0.022) were significantly reduced at 2 years after surgery, as were obesity-related problems (P < 0.001). Self-esteem (P < 0.001), self-concept (P < 0.001), and overall mood (P = 0.025) improved significantly. Improvements were mainly observed during the first year after surgery. The second year was characterized by stabilization. Symptoms of anxiety, depression, anger, disruptive behavior, and self-concept were at normative levels after surgery. However, 19% of the adolescents had depressive symptoms in the clinical range. CONCLUSIONS A substantial improvement in mental health in adolescents over the first 2 years after gastric bypass was found. Most adolescents had a level of mental health and self-concept similar to norms, but a marked subgroup showed substantial depressive symptoms 2 years after surgery.
Collapse
Affiliation(s)
- Kajsa Järvholm
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
- Department of Psychology, Lund University, Lund, Sweden
| | - Jan Karlsson
- Centre for Health Care Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Torsten Olbers
- Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Markku Peltonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Gronowitz
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Johnsson
- Department of Psychology, Lund University, Lund, Sweden
| | | |
Collapse
|
36
|
Increased intravenous morphine self-administration following Roux-en-Y gastric bypass in dietary obese rats. Brain Res Bull 2015; 123:47-52. [PMID: 26304761 DOI: 10.1016/j.brainresbull.2015.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 12/30/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) surgery is a commonly performed and very effective method to achieve significant, long-term weight loss. Opioid analgesics are primarily used to manage postoperative pain as fewer alternative medication options are available for bariatric surgery patients than for the general population. Recent clinical studies support a greater risk for substance use following bariatric surgery, including an increased use of opioid medications. The present study is the first to study morphine self-administration in a rat model of RYGB. High fat diet-induced obese (HFD-DIO) rats underwent RYGB (n=14) or sham-surgery with ad libitum HFD (SHAM, n=14) or a restricted amount that resulted in weight matched to the RYGB cohort (SHAM-WM, n=8). An additional normal-diet (ND, n=7), intact (no surgery) group of rats was included. Two months after the surgeries, rats were fitted with jugular catheters and trained on a fixed ratio-2 lick task to obtain morphine intravenously. Both morphine-seeking (number of licks on an empty spout to obtain morphine infusion) and consumption (number of infusion) were significantly greater in RYGB than any control group beginning on day 3 and reached a two-fold increase over a period of two weeks. These findings demonstrate that RYGB increases motivation for taking morphine and that this effect is independent of weight loss. Further research is warranted to reveal the underlying mechanisms and to determine whether increased morphine use represents a risk for opioid addiction following RYGB. Identifying risk factors preoperatively could help with personalized postoperative care to prevent opioid abuse and addiction.
Collapse
|
37
|
Burgmer R, Legenbauer T, Müller A, de Zwaan M, Fischer C, Herpertz S. Psychological outcome 4 years after restrictive bariatric surgery. Obes Surg 2015; 24:1670-8. [PMID: 24682804 DOI: 10.1007/s11695-014-1226-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Extreme obesity is associated with severe psychiatric and somatic comorbidity and impairment of psychosocial functioning. Bariatric surgery is the most effective treatment not only with regard to weight loss but also with obesity-associated illnesses. Health-related psychological and psychosocial variables have been increasingly considered as important outcome variables of bariatric surgery. However, the long-term impact of bariatric surgery on psychological and psychosocial functioning is largely unclear. The aim of this study was to evaluate the relationship between the course of weight and psychological variables including depression, anxiety, health-related quality of life (HRQOL), and self-esteem up to 4 years after obesity surgery.By standardized questionnaires prior to (T1) and 1 year (T2), 2 years (T3), and 4 years (T4) after surgery, 148 patients (47 males (31.8 %), 101 females (68.2 %), mean age 38.8 ± 10.2 years) were assessed.On average, participants lost 24.6 % of their initial weight 1 year after surgery, 25.1 % after 2 years, and 22.3 % after 4 years. Statistical analysis revealed significant improvements in depressive symptoms, physical dimension of quality of life, and self-esteem with peak improvements 1 year after surgery. These improvements were largely maintained. Significant correlations between weight loss and improvements in depression, physical aspects of HRQOL (T2, T3, and T4), and self-esteem (T3) were observed.Corresponding to the considerable weight loss after bariatric surgery, important aspects of mental health improved significantly during the 4-year follow-up period. However, parallel to weight regain, psychological improvements showed a slow but not significant decline over time.
Collapse
Affiliation(s)
- Ramona Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany,
| | | | | | | | | | | |
Collapse
|
38
|
Anderson JG, Suchicital L, Lang M, Kukic A, Mangione L, Swengros D, Fabian J, Friesen MA. The Effects of Healing Touch on Pain, Nausea, and Anxiety Following Bariatric Surgery: A Pilot Study. Explore (NY) 2015; 11:208-16. [DOI: 10.1016/j.explore.2015.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 10/24/2022]
|
39
|
Herpertz S, Müller A, Burgmer R, Crosby RD, de Zwaan M, Legenbauer T. Health-related quality of life and psychological functioning 9 years after restrictive surgical treatment for obesity. Surg Obes Relat Dis 2015; 11:1361-70. [PMID: 26164111 DOI: 10.1016/j.soard.2015.04.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/11/2015] [Accepted: 04/14/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bariatric surgery leads to initial weight loss that is associated with improvement in mental health; however, long-term effects are uncertain. OBJECTIVE To investigate the impact of restrictive surgical treatment for obesity on weight loss, psychological functioning, and quality of life 9 years after surgery. SETTING University hospitals and obesity centers, Germany. METHODS 152 patients undergoing restrictive surgical treatment (SURG), 249 individuals participating in a conventional weight loss treatment (CONV), and 128 obese control participants without weight loss treatment (OC) were studied using a prospective longitudinal cohort design. After 9 years, 55% of SURG patients, 51% of CONV patients, and 65% of OC participants were reassessed. Body mass index, anxiety, depression, self-esteem, and health-related quality of life (HRQOL) were explored. RESULTS The SURG group had significantly greater weight loss and improvements in physical HRQOL at all postbaseline assessments. Although SURG patients experienced initial improvements in depression, anxiety, self-esteem, and mental aspects of HRQOL, these improvements deteriorated at the 9-year assessment and were comparable to or worse than presurgical levels. CONCLUSIONS Bariatric surgery is an effective treatment for obesity and is linked to maintained improvement of physical aspects of HRQOL. Weight reduction after surgery is also associated with significant initial improvement in mental health that may erode over time. Therefore, psychosocial screening should be included at follow-ups, with referral to mental health professionals as appropriate.
Collapse
Affiliation(s)
- Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital of the Ruhr University Bochum, Bochum, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.
| | - Ramona Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital of the Ruhr University Bochum, Bochum, Germany
| | - Ross D Crosby
- Neuropsychiatric Research Institute and University of North Dakota, School of Medicine and Health Sciences, Fargo, North Dakota
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Tanja Legenbauer
- Department of Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr University Bochum, Hamm, Germany
| |
Collapse
|
40
|
Impact of bariatric surgery on clinical depression. Interrupted time series study with matched controls. J Affect Disord 2015; 174:644-9. [PMID: 25577158 DOI: 10.1016/j.jad.2014.12.050] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/19/2014] [Accepted: 12/20/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obesity is associated with depression. This study aimed to evaluate whether clinical depression is reduced after bariatric surgery (BS). METHODS Obese adults who received BS procedures from 2002 to 2014 were sampled from the UK Clinical Practice Research Datalink. An interrupted time series design, with matched controls, was conducted from three years before, to a maximum of seven years after surgery. Controls were matched for body mass index (BMI), age, gender and year of procedure. Clinical depression was defined as a medical diagnosis recorded in year, or an antidepressant prescribed in year to a participant ever diagnosed with depression. Adjusted odds ratios (AOR) were estimated. RESULTS There were 3045 participants (mean age 45.9; mean BMI 44.0kg/m(2)) who received BS, including laparoscopic gastric banding in 1297 (43%), gastric bypass in 1265 (42%), sleeve gastrectomy in 477 (16%) and six undefined. Before surgery, 36% of BS participants, and 21% of controls, had clinical depression; between-group AOR, 2.02, 95%CI 1.75-2.33, P<0.001. In the second post-operative year 32% had depression; AOR, compared to time without surgery, 0.83 (0.76-0.90, P<0.001). By the seventh year, the prevalence of depression increased to 37%; AOR 0.99 (0.76-1.29, P=0.959). LIMITATIONS Despite matching there were differences in depression between BS and control patients, representing the highly selective nature of BS. CONCLUSIONS Depression is frequent among individuals selected to undergo bariatric surgery. Bariatric surgery may be associated with a modest reduction in clinical depression over the initial post-operative years but this is not maintained.
Collapse
|
41
|
Does the Degree of Ptosis Predict the Degree of Psychological Morbidity in Bariatric Patients Undergoing Reconstruction? Plast Reconstr Surg 2014; 134:942-950. [DOI: 10.1097/prs.0000000000000695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
42
|
Translating obesity: Navigating the front lines of the “war on fat”. Am J Hum Biol 2014; 27:61-8. [DOI: 10.1002/ajhb.22623] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/04/2014] [Accepted: 08/24/2014] [Indexed: 01/12/2023] Open
|
43
|
Aasprang A, Andersen JR, Våge V, Kolotkin RL, Natvig GK. Five-year changes in health-related quality of life after biliopancreatic diversion with duodenal switch. Obes Surg 2014; 23:1662-8. [PMID: 23722527 PMCID: PMC3769581 DOI: 10.1007/s11695-013-0994-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Long-term data of health-related quality of life (HRQL) after biliopancreatic diversion with duodenal switch (BPDDS) procedure are lacking. The aim of this study was to evaluate changes in HRQL from baseline to 5 years after BPDDS. Methods Fifty morbidly obese patients were followed for 5 years after BPDDS procedure. The sample consisted of 27 women and 23 men, the mean age was 37.8 years, and the mean body mass index (BMI) was 51.7 units. HRQL was measured with the Short Form 36 questionnaire (SF-36). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS). Linear mixed model was used to investigate the change scores. The SF-36 scores and HADS scores of the sample were also compared with a Norwegian population norm, adjusted for age, gender, and BMI. Results Mental summary scores (MCS) and physical summary scores (PCS) were very low preoperatively but significantly improved (P < 0.05) 5 years after surgery. The PCS was comparable to the population norm, while MCS was lower. Depression improved significantly from baseline to the 5-year follow-up (P = 0.004), but anxiety did not (P = 0.595). Conclusions This study demonstrates a sustained weight loss and improved, although somewhat fading, HRQL scores 5 years after BPDDS. The study also shows that BPDDS is associated with a sustained reduction in depression symptoms but not in anxiety symptoms.
Collapse
Affiliation(s)
- Anny Aasprang
- Faculty of Health Studies, Sogn og Fjordane University College, Vievegen 2, 6800, Førde, Norway,
| | | | | | | | | |
Collapse
|
44
|
Loss of control eating and weight outcomes after bariatric surgery: a study with a Portuguese sample. Eat Weight Disord 2014; 19:103-9. [PMID: 24065351 DOI: 10.1007/s40519-013-0069-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/03/2013] [Indexed: 01/09/2023] Open
Abstract
The present study aim is to investigate the frequency of loss of control eating (LOC) episodes in three groups with different assessment times: one before, one at short and one at long-term after bariatric surgery; as well as to explore the association of postoperative problematic eating behaviors and weight outcomes and psychological characteristics. This cross-sectional study compared a group of preoperative bariatric surgery patients (n = 176) and two postoperative groups, one at short-term with <2 years follow-up (n = 110), and one at long-term >2 years follow-up (n = 53). Assessments included the EDE diagnostic interview and a set of self-report measures assessing eating disordered symptomatology, depression, and body image. We found the presence of LOC in 26.7 and 16.9 % of the pre-operative and long-term patients, respectively, and in about 11.8% of the short-term patients. One patient (0.9%) reported objective binge eating episodes at short-time, but subjective binge eating episodes were present in about 10% of the patients in all groups. LOC eating was related with the highest BMIs, the least weight loss, most weight regain, and most psychological impairment in the long-term assessments, but not at short-term. Despite the lower frequencies of disordered eating behavior in the short-term group, patients reporting LOC seem to represent a subgroup of individuals with poorest outcomes after surgery and most psychological distress.
Collapse
|
45
|
Lyons K, Meisner BA, Sockalingam S, Cassin SE. Body Image After Bariatric Surgery: A Qualitative Study. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Kathleen Lyons
- Department of Psychology, Ryerson University, Toronto, Canada
| | - Brad A. Meisner
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | | | | |
Collapse
|
46
|
Wimmelmann CL, Dela F, Mortensen EL. Psychological predictors of mental health and health-related quality of life after bariatric surgery: a review of the recent research. Obes Res Clin Pract 2013; 8:e314-24. [PMID: 25091352 DOI: 10.1016/j.orcp.2013.11.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/27/2013] [Accepted: 11/07/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Improvement of mental health and health-related quality of life (HRQOL) is an important success criterion for bariatric surgery. In general, mental health and HRQOL improve after surgery, but some patients experience negative psychological reactions postoperatively and the influence of pre-surgical psychological factors on mental wellbeing after surgery is unclear. The aim of the current article therefore is to review recent research investigating psychological predictors of mental health and HRQOL outcome. METHODS We searched PubMed, PsycInfo and Web of Science for studies investigating psychological predictors of either mental health or HRQOL after bariatric surgery. Original prospective studies published between 2003 and 2012 with a sample size >30 and a minimum of 1 year follow-up were included. RESULTS Only 10 eligible studies were identified. The findings suggest that preoperative psychological factors including psychiatric symptoms, body image and self-esteem may be important for mental health postoperatively. Predictors of postoperative HRQOL seem to include personality, severe psychiatric disorder at baseline and improvement of depressive symptoms. In addition, psychiatric symptoms that persist after surgery and inappropriate eating behaviour postoperatively are likely to contribute to poor health-related quality of life outcome. CONCLUSION Certain psychological factors appear to be important for mental health and HRQOL after bariatric surgery. However, the literature is extremely sparse and further research is highly needed.
Collapse
Affiliation(s)
- Cathrine L Wimmelmann
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Flemming Dela
- Systems Biology Research Section, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Erik L Mortensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
47
|
Ahmed AT, Warton EM, Schaefer CA, Shen L, McIntyre RS. The effect of bariatric surgery on psychiatric course among patients with bipolar disorder. Bipolar Disord 2013; 15:753-63. [PMID: 23909994 PMCID: PMC3844030 DOI: 10.1111/bdi.12109] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 03/29/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Bariatric surgery is the most effective therapy for severe obesity. People with bipolar disorder have increased risk of obesity, yet are sometimes considered ineligible for bariatric surgery due to their bipolar disorder diagnosis. This study aimed to determine if bariatric surgery alters psychiatric course among stable patients with bipolar disorder. METHODS A matched cohort study (2006-2009) with mean follow-up of 2.17 years was conducted within Kaiser Permanente Northern California, a group practice integrated health services delivery organization that provides medical and psychiatric care to 3.3 million people. Participants were 144 severely obese patients with bipolar disorder who underwent bariatric surgery, and 1,440 control patients with bipolar disorder, matched for gender, medical center, and contemporaneous health plan membership. Controls met referral criteria for bariatric surgery. Hazard ratio for psychiatric hospitalization, and change in rate of outpatient psychiatric utilization from baseline to Years 1 and 2, were compared between groups. RESULTS A total of 13 bariatric surgery patients (9.0%) and 153 unexposed to surgery (10.6%) had psychiatric hospitalization during follow-up. In multivariate Cox models adjusting for potential confounding factors, the hazard ratio of psychiatric hospitalization associated with bariatric surgery was 1.03 [95% confidence interval (CI): 0.83-1.23]. In fully saturated multivariate general linear models, change in outpatient psychiatric utilization was not significantly different for surgery patients versus controls, from baseline to Year 1 (-0.4 visits/year, 95% CI: -0.5 to 0.4) or baseline to Year 2 (0.4 visits/year, 95% CI: -0.1 to 1.0). CONCLUSIONS Bariatric surgery did not affect psychiatric course among stable patients with bipolar disorder. The results of this study suggest that patients with bipolar disorder who have been evaluated as stable can be considered for bariatric surgery.
Collapse
Affiliation(s)
- Ameena T Ahmed
- Department of Internal Medicine, The Permanente Medical Group, San Francisco
| | | | | | - Ling Shen
- Kaiser Permanente Division of Research, Oakland CA, USA
| | - Roger S McIntyre
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
48
|
Coulman KD, Abdelrahman T, Owen-Smith A, Andrews RC, Welbourn R, Blazeby JM. Patient-reported outcomes in bariatric surgery: a systematic review of standards of reporting. Obes Rev 2013; 14:707-20. [PMID: 23639053 DOI: 10.1111/obr.12041] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/20/2013] [Accepted: 04/01/2013] [Indexed: 12/01/2022]
Abstract
Bariatric surgery is increasingly being used to treat severe obesity, but little is known about its impact on patient-reported outcomes (PROs). For PRO data to influence practice, well-designed and reported studies are required. A systematic review identified prospective bariatric surgery studies that used validated PRO measures. Risk of bias in randomized controlled trials (RCTs) was assessed, and papers were examined for reporting of (i) who completed PRO measures; (ii) missing PRO data and (iii) clinical interpretation of PRO data. Studies meeting all criteria were classified as robust. Eighty-six studies were identified. Of the eight RCTs, risk of bias was high in one and unclear in seven. Sixty-eight different PRO measures were identified, with the Short Form (SF)-36 questionnaire most commonly used. Forty-one (48%) studies explicitly stated measures were completed by patients, 63 (73%) documented missing PRO data and 50 (58%) interpreted PRO data clinically. Twenty-six (30%) met all criteria. Although many bariatric surgery studies assess PROs, study design and reporting is often poor, limiting data interpretation and synthesis. Well-designed studies that include agreed PRO measures are needed with reporting to include integration with clinical outcomes to inform practice.
Collapse
Affiliation(s)
- K D Coulman
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK; Department of Bariatric and Upper GI Surgery, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
| | | | | | | | | | | |
Collapse
|
49
|
Mitchell JE, Crosby R, de Zwaan M, Engel S, Roerig J, Steffen K, Gordon KH, Karr T, Lavender J, Wonderlich S. Possible risk factors for increased suicide following bariatric surgery. Obesity (Silver Spring) 2013; 21:665-72. [PMID: 23404774 PMCID: PMC4372842 DOI: 10.1002/oby.20066] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 08/02/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE There is a growing research literature suggesting that there may be elevated risk of suicide following bariatric surgery. Most of the data reported thus far has been cross-sectional and observational, and very little is known about the possible specific causal variables involved. DESIGN AND METHODS The purpose of this report is to review this literature and to review possible risk factors for increased suicidal risk following bariatric surgery, to delineate future research directions. RESULTS First a variety of medical, biological, and genetic factors, including the persistence or recurrence of medical comorbidities after bariatric surgery, the disinhibition and impulsivity secondary to changes in the absorption of alcohol, hypoglycemia, as well as pharmacokinetic changes that may affect the absorption of various medications including antidepressant medications are reviewed. Also reviewed are possible mediating factors involving changes in various peptidergic systems such as GLP-1 and Ghrelin. A number of psychosocial issues that might be involved are discussed, including lack of improvement in quality of life after surgery, continued or recurrent physical mobility restrictions, persistence or recurrence of sexual dysfunction and relationship problems, low self-esteem, and a history of child maltreatment. Inadequate weight loss or weight regain are also discussed. CONCLUSIONS A number of possible contributing factors have been identified. Possible theoretical models involved and directions for research are suggested.
Collapse
|
50
|
Patient predictors of follow-up care attendance in Roux-en-Y gastric bypass patients. Surg Obes Relat Dis 2012; 9:956-62. [PMID: 23295164 DOI: 10.1016/j.soard.2012.11.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/28/2012] [Accepted: 11/28/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Multidisciplinary care after bariatric surgery is important for long-term safety and optimal weight loss, yet many patients do not attend follow-up appointments. We sought to identify demographic, psychosocial, and weight-related variables that were associated with medical and behavioral health appointment attendance after bariatric surgery. METHODS A retrospective chart review was conducted with consecutive patients (n=538) obtaining first-time Roux-en-Y gastric bypass surgery between August 2009 and August 2010. Demographic and psychosocial data were compared between high (>50%) and low (≤50%) medical appointment attendees and high (>50%) and low (≤50%) behavioral health group attendees in their first postoperative year. Percentage excess weight loss at 6 months after surgery was evaluated as a predictor of 12-month appointment attendance. RESULTS High medical appointment attendees were more likely to be older, be Caucasian, and have lower phobic anxiety than low medical appointment attendees. High behavioral health attendees had shorter travel distance to the clinic and lower levels of hostility, anxiety, and phobic anxiety compared with low attendees. In multivariate analyses, race/ethnicity and phobic anxiety remained significant predictors of medical attendance, while travel distance to clinic predicted behavioral health attendance. Six-month percent excess weight loss predicted medical appointment attendance at 12 months. CONCLUSION The identified predictors of poor attendance at medical and behavioral bariatric surgery follow-up appointments should inform efforts to increase follow-up and improve surgical outcomes.
Collapse
|