Weight Loss and Timing of J Tube Removal in Biliopancreatic Diversion with Duodenal Switch Patients Who Report Physical or Sexual Abuse

History of abuse and bariatric surgery outcomes: a systematic review

BACKGROUND

Although there is evidence to support the relationship between abuse history and obesity, the association between abuse history and outcomes after bariatric surgery is not well-established. We aimed to summarize the current literature examining this relationship, as well as provide clinical recommendations to optimize postoperative outcomes.

METHODS

PubMed and SCOPUS databases were queried to identify relevant published studies.

RESULTS

Overall, 20 studies were included. Rates of the various types of abuse reported in the bariatric surgery population varied widely across studies, as did the methodology used to assess it. The majority of studies found no significant associations between abuse history and postoperative weight loss outcomes. The literature examining the relationship between abuse history and postoperative psychiatric outcomes was less conclusive.

CONCLUSIONS

Most current evidence demonstrates that abuse history is not associated with weight loss outcomes after bariatric surgery. Literature on postoperative psychiatric outcomes is mixed, and more robust studies are needed to further investigate the relationship between abuse history and postoperative psychiatric outcomes. Importantly, abuse history should not preclude patients from undergoing bariatric surgery. Of note, patients may benefit from careful monitoring for emotional distress and worsening of psychiatric comorbidities after surgery and psychiatric counseling and treatment when indicated.

Childhood maltreatment in bariatric patients and its association with postoperative weight, depressive, and eating disorder symptoms

PURPOSE

The present study aimed to compare prevalence rates of childhood maltreatment between patients with severe obesity undergoing bariatric surgery and patients without a surgical procedure. Second purpose was to calculate the association between childhood maltreatment and outcomes 6 and 12 months after a bariatric procedure.

METHODS

Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ) and compared between 120 bariatric surgery patients and 346 non-surgery patients with severe obesity. For the bariatric surgery subgroup, linear mixed models with repeated measures were used to analyze the predictive value of childhood maltreatment on weight outcomes and psychopathology. Additionally, between- and within-group comparisons were calculated to compare patients with and without childhood maltreatment regarding BMI and weight loss (%TWL, %EWL), depression severity (BDI-II), eating disorder psychopathology (EDE-Q), and suicidal ideation (BSS), at baseline, 6- and 12-month assessment.

RESULTS

Prevalence rates for childhood maltreatment, depression and suicidal ideation were significantly higher in non-surgery compared to bariatric surgery patients. Within the surgery group, no significant interaction effect between childhood maltreatment and time was found. Hence, childhood maltreatment did not impact the course of body weight, depression and eating disorder psychopathology from pre- to post-surgery.

CONCLUSIONS

Significantly higher rates of childhood maltreatment were found within non-surgery patients with obesity in comparison to bariatric surgery patients. Childhood maltreatment did not predict poorer outcomes after surgery. Since history of childhood maltreatment may increase the risk for psychological disturbances, regular screening and, if necessary, psychological support should be offered to both groups.

LEVEL OF EVIDENCE

Evidence obtained from well-designed cohort or case-control analytic studies, Level III.

CLINICAL TRIAL REGISTRATION

Deutsches Register Klinischer Studien-German Clinical Trials Register: DRKS00003976.