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Jacobs A, Monpellier VM, Torensma B, Antoniou EE, Janssen IMC, Tollenaar RAEM, Jansen ATM. Influence of mental and behavioral factors on weight loss after bariatric surgery: A systematic review and meta-analysis. Obes Rev 2024; 25:e13729. [PMID: 38450930 DOI: 10.1111/obr.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/16/2023] [Accepted: 01/12/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Multiple factors are related to lower weight loss after bariatric surgery. This review and meta-analysis evaluates the influence of several mental and behavioral factors on weight loss. METHOD Six electronic databases were searched. Percentage excess weight loss (%EWL) was calculated for all moderator and non-moderator groups of the variables: symptoms of depression, anxiety and binge eating, compliance, physical activity, quality of life, and body image. All moderators, surgery types, and follow-up moments were analyzed separately. RESULTS In total, 75 articles were included in the review; 12 meta-analyses were conducted. Higher postoperative compliance to follow-up was associated with 6.86%-13.68% higher EWL. Preoperative binge eating was related to more weight loss at 24- and 36-month follow-up (7.97% and 11.79%EWL, respectively). Patients with postoperative binge eating symptoms had an 11.92% lower EWL. Patients with preoperative depressive symptoms lost equal weight compared to patients without symptoms. CONCLUSION Despite the high heterogeneity between studies, a trend emerges suggesting that the presence of postoperative binge eating symptoms and lower postoperative compliance may be associated with less weight loss after bariatric-metabolic surgery. Additionally, preoperative depressive symptoms and binge eating do not seem to significantly impact weight loss.
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Affiliation(s)
- Anne Jacobs
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Utrecht, The Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Ignace M C Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Utrecht, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Anita T M Jansen
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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2
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Dupont L, Alves A, Bui E, Lee Bion A, Meunier H, Briant A, Parienti JJ, Menahem B. Long-term weight loss outcomes after bariatric surgery: a propensity score study among patients with psychiatric disorders. Surg Endosc 2023; 37:8362-8372. [PMID: 37700014 DOI: 10.1007/s00464-023-10343-z] [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] [Received: 05/05/2023] [Accepted: 07/30/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION To analyze the safety and long-term result of bariatric surgery in patients with psychiatric disorders. MATERIAL AND METHODS From January 2009 to December 2018, n = 961 patients underwent bariatric surgery in a tertiary center. Among them, two groups of patients were created: a group of patients with psychiatric disorders (PG) and a group without psychiatric disorders (CG), using a propensity score matched (PSM). Primary endpoint was long-term outcomes and secondary endpoints were the postoperative morbidity 90 days after surgery, late morbidity, occurrence of psychiatric adverse events, and resolution of obesity-related comorbidities. RESULTS Analysis with PSM permitted to compare 136 patients in each group, with a ratio 1:1. TWL% at 2 years in the PG was 32.7% versus 36.6% in the CG (p = 0.002). Overall surgical morbidity was higher in the PG than the CG (28% vs 17%, p = 0.01). Severe surgical complications were not statistically significant (4% vs 3%, p = 0.44). Psychiatric adverse events were significantly more frequent in the PG than in the CG. The resolution of obesity comorbidities was equivalent for both groups at 2 years. CONCLUSION Substantial weigh loss was reported among patients with psychiatric disorders receiving bariatric surgery at the cost of more non-severe surgical complications. Further, a psychiatric postoperative follow-up visit may be warranted for patients with preoperative psychiatric disorders, given the incidence of psychiatric adverse events.
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Affiliation(s)
- Ludovic Dupont
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France
- UMR INSERM 1086 "Cancers et preventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen Cedex, France
| | - Eric Bui
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France
- Department of Psychiatry, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
- UNICAEN, INSERM, U1237, PhIND «Physiopathology and Imaging of Neurological Disorders», NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, Caen University Hospital and Normandie University, Cyceron, 14000, Caen, France
| | - Adrien Lee Bion
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Hugo Meunier
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Anaïs Briant
- Department of Biostatistics, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Jean-Jacques Parienti
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France
- Department of Biostatistics, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France.
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France.
- UMR INSERM 1086 "Cancers et preventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen Cedex, France.
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la cote de Nacre, 14032, Caen Cedex, France.
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Noria SF, Shelby RD, Atkins KD, Nguyen NT, Gadde KM. Weight Regain After Bariatric Surgery: Scope of the Problem, Causes, Prevention, and Treatment. Curr Diab Rep 2023; 23:31-42. [PMID: 36752995 PMCID: PMC9906605 DOI: 10.1007/s11892-023-01498-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE OF REVIEW Although bariatric surgery is the most effective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further out from surgery. The purpose of this review is to summarize the prevalence, predictors, and causes of weight regain. RECENT FINDINGS Estimating the prevalence of WR is limited by a lack of consensus on its definition. While anatomic failures such as dilated gastric fundus after sleeve gastrectomy and gastro-gastric fistula after Roux-en-Y gastric bypass can lead to WR, the most common causes appear to be dysregulated/maladaptive eating behaviors, lifestyle factors, and physiological compensatory mechanisms. To date, dietary, supportive, behavioral, and exercise interventions have not demonstrated a clinically meaningful impact on WR, and there is limited evidence for pharmacotherapy. Future studies should be aimed at better defining WR to begin to understand the etiologies. Additionally, there is a need for non-surgical interventions with demonstrated efficacy in rigorous randomized controlled trials for the prevention and reversal of WR after bariatric surgery.
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Affiliation(s)
- Sabrena F Noria
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University, N718 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA.
| | - Rita D Shelby
- Department of Plastic and Reconstructive Surgery, University of Miami, Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Katelyn D Atkins
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA, 70808, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine, 3800 W Chapman Ave, Orange, CA, 92868, USA
| | - Kishore M Gadde
- Department of Surgery, University of California Irvine, 3800 W Chapman Ave, Orange, CA, 92868, USA
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4
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Hosseini SV, Kasraei H, Khazraei H, AL-Hurry AMAH. The Effect of Sleeve Gastrectomy on Sexual Hormones and Fertility in Obese Patients in Shiraz. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2021.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seyed Vahid Hosseini
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hengameh Kasraei
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hajar Khazraei
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Abdul Wahab R, Al-Ruwaily H, Coleman T, Heneghan H, Neff K, le Roux CW, Fallon F. The Relationship Between Percentage Weight Loss and World Health Organization-Five Wellbeing Index (WHO-5) in Patients Having Bariatric Surgery. Obes Surg 2022; 32:1667-1672. [PMID: 35305228 PMCID: PMC8986673 DOI: 10.1007/s11695-022-06010-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
Purpose The association between bariatric surgery outcome and depression remains controversial. Many patients with depression are not offered bariatric surgery due to concerns that they may have suboptimal outcomes. The aim of this study was to investigate the relationship between baseline World Health Organization-Five Wellbeing Index (WHO-5) and percentage total weight loss (%TWL) in patients after bariatric surgery. Materials and Methods All patients were routinely reviewed by the psychologist and screened with WHO-5. The consultation occurred 3.5 ± 1.6 months before bariatric surgery. Body weight was recorded before and 1 year after surgery. A total of 45 out of 71 (63.3%) patients with complete WHO-5 data were included in the study. Data analysis was carried out with IBM SPSS Statistics (version 27) to determine the correlation between baseline WHO-5 and %TWL in patients having bariatric surgery. Results Overall, 11 males and 34 females were involved with mean age of 47.5 ± 11.5 and BMI of 46.2 ± 5.5 kg/m2. The %TWL between pre- and 1-year post-surgery was 30.0 ± 8.3% and the WHO-5 Wellbeing Index mean score was 56.5 ± 16.8. We found no correlation between %TWL and the WHO-5 Wellbeing Index (r = 0.032, p = 0.83). Conclusion There was no correlation between the baseline WHO-5 Wellbeing Index and %TWL 1-year post-bariatric surgery. Patients with low mood or depression need to be assessed and offered appropriate treatment but should not be excluded from bariatric surgery only based on their mood. Graphical Abstract ![]()
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Affiliation(s)
- Roshaida Abdul Wahab
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Heshma Al-Ruwaily
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Therese Coleman
- Obesity Complications Clinic, St Vincent's Private Hospital, Merrion Road, Dublin, D04 NE02, Ireland
| | - Helen Heneghan
- Obesity Complications Clinic, St Vincent's Private Hospital, Merrion Road, Dublin, D04 NE02, Ireland
| | - Karl Neff
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland.,Obesity Complications Clinic, St Vincent's Private Hospital, Merrion Road, Dublin, D04 NE02, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland. .,Obesity Complications Clinic, St Vincent's Private Hospital, Merrion Road, Dublin, D04 NE02, Ireland.
| | - Finian Fallon
- Obesity Complications Clinic, St Vincent's Private Hospital, Merrion Road, Dublin, D04 NE02, Ireland
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Preoperative psychological characteristics affecting mid-term outcome after bariatric surgery: a follow-up study. Eat Weight Disord 2021; 26:585-590. [PMID: 32207099 DOI: 10.1007/s40519-020-00892-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between preoperative psychological factors and percentage of total weight loss (%TWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB) to identify possible psychological therapy targets to improve the outcome of bariatric surgery. METHODS Seventy-six patients completed the Hamilton's Anxiety and Depression Scales (HAM-A, HAM-D) and Toronto Alexithymia Scale (TAS-20) the day before surgery (T0). The pre-operative body weight and the %TWL at 3 (T1), 6 (T2), and 24-30 (T3) months were collected. RESULTS At T3, depressed and alexithymic patients showed a lower %TWL compared to non-depressed patients (p = 0.03) and to non-alexithymic patients (p = 0.02), respectively. Finally, patients who had at least one of the three analyzed psychological factors showed less weight loss, at T2 (p = 0.02) and T3 (p = 0.0004). CONCLUSIONS Psychological factors may also affect long-term outcome of bariatric surgery. This study shows an association between alexithymia/depression pre-operative levels and the weight loss at 30 months'follow-up after bariatric surgery. LEVEL OF EVIDENCE Level III, longitudinal cohort study.
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Majidi Zolbanin S, Salehian R, Nakhlband A, Ghanbari Jolfaei A. What Happens to Patients with Bipolar Disorder after Bariatric Surgery? A Review. Obes Surg 2021; 31:1313-1320. [PMID: 33389629 DOI: 10.1007/s11695-020-05187-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
Bipolar disorder (BD) patients are at high risk of obesity, which affects their quality of life (QOL). Since there is a high comorbidity between BD and obesity, most BD patients seek surgical intervention for obesity. Nowadays, bariatric surgery (BS) is considered appropriate for carefully selected patients with BD. Evaluations before performing BS and careful follow-up of patients with the bipolar spectrum are highly recommended. This study reviews the effects of BS on the course of BD and, at the same time, assesses the effect of BD on the consequences of the surgery. Our results showed that the number of studies approving the promising impact of surgery on BD was more than those disapproving it. However, more accurate results require more than 3-year follow-ups.
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Affiliation(s)
- Saeedeh Majidi Zolbanin
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Razieh Salehian
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ailar Nakhlband
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atefeh Ghanbari Jolfaei
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran. .,Psychosomatic Ward, Rasoul Akram Hospital, Tehran, 1445613131, Iran.
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8
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Fialho MCP, Cunha JBD, Arruda SLDM, Nobrega OT, Camargos EF. Evaluation of depression and anxiety symptoms, alcohol consumption, and binge eating in older adults undergoing bariatric surgery: a 6-year follow-up. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION: The literature remains scarce on the late effects of bariatric surgery on the general health of patients who underwent such procedures at an older age. The present study aimed to evaluate depression and anxiety symptoms, risky alcohol consumption, and binge eating in older adults undergoing bariatric surgery. METHODS: This study used current data (from medical records and tests) to conduct a cross-sectional study. A total of 74 individuals aged 60 years and older who underwent bariatric surgery after 55 years of age at a specialist center for obesity management located in Brazil were included and evaluated by the Beck Depression Inventory, Beck Anxiety Inventory, Alcohol Use Disorders Identification Test, and Binge Eating Scale. Demographic and clinical data related to the surgical procedure (weight loss) were also collected. The Cochran-Armitage trend test, Pearson’s χ2 test, and a multiple linear regression model were used as needed. A p < 0.05 was considered significant. RESULTS: The individuals were white (65.70%) and women (78.30%), with a mean age of 65.8 (SD 3.90) years. The mean time elapsed from surgery to evaluation was 75.70 (SD 43.70) months; 10.80% of the participants had moderate to severe depression, 8.10% moderate to severe anxiety, and 5.40% risky or high-risk alcohol consumption. None of the participants had binge eating problems. Weight regain was not associated with depressive symptom severity or risky alcohol consumption, but it was significantly associated (p = 0.034) with few or neither anxiety symptoms. Excess weight loss was not associated with any study variable. CONCLUSION: The results show a low prevalence of mental symptoms in older adults undergoing bariatric surgery compared to data from the literature on younger adults undergoing the same procedure.
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Çalışır S, Çalışır A, Arslan M, İnanlı İ, Çalışkan AM, Eren İ. Assessment of depressive symptoms, self-esteem, and eating psychopathology after laparoscopic sleeve gastrectomy: 1-year follow-up and comparison with healthy controls. Eat Weight Disord 2020; 25:1515-1523. [PMID: 31576497 DOI: 10.1007/s40519-019-00785-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/21/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The aim of this study was to assess depressive symptoms, self-esteem, and eating psychopathology in bariatric surgery patients at the preoperative period (t0) and at the 6-month (t1) and 12-month (t2) follow-ups after laparoscopic sleeve gastrectomy (LSG). A second aim was to investigate associations between these variables and weight loss. METHOD The study participants were 48 bariatric surgery candidates and 50 non-obese controls. Both groups underwent assessment with the Sociodemographic Data Form, Hamilton Depression Rating Scale (HDRS), Eating Disorder Examination Questionnaire (EDE-Q), and Rosenberg Self-esteem Scale (RSES). These assessments were repeated for the patient group at t1 and t2. RESULTS The HDRS, RSES, and EDE-Q scores were higher in the patients before LSG (t0) than in the control group. A significant progressive improvement was identified in the patient HDRS and RSES scores as well as EDE-Q weight and shape subscale scores at t1 and t2. However, the patient EDE-Q total and dietary restraint scores improved at t1 then stabilized. The patient EDE-Q eating concern subscale improved at t1, but then worsened. The patient HDRS scores at t2 were similar to the control group, but the EDE-Q and RSES scores were still higher than the control scores at t2. Regression analyses revealed no association between the preoperative scores and percent changes in postoperative scores for any scale and patient weight loss at t2. CONCLUSION Depressive symptoms, self-esteem, and eating psychopathology showed an improving trend in patients after LSG. However, some aspects of eating psychopathology worsened despite an initial improvement. LEVEL OF EVIDENCE III, prospective cohort and case-control study.
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Affiliation(s)
- Saliha Çalışır
- Department of Psychiatry, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey
| | - Akın Çalışır
- Department of General Surgery, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mehmet Arslan
- Department of Psychiatry, Babaeski State Hospital, 39200, Kırklareli, Turkey.
| | - İkbal İnanlı
- Department of Psychiatry, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey
| | - Ali Metehan Çalışkan
- Department of Psychiatry, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey
| | - İbrahim Eren
- Department of Psychiatry, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey
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Winzer E, Ludvik B, Grabovac I, Kruschitz R, Schindler K, Prager G, Klammer C, Hoppichler F, Marculescu R, Wakolbinger M. Course of depressive symptomatology and its association with serum uric acid in one-anastomosis gastric bypass patients. Sci Rep 2020; 10:18405. [PMID: 33110226 PMCID: PMC7591541 DOI: 10.1038/s41598-020-75407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022] Open
Abstract
The changes in depressive symptomatology during the first year following one-anastomosis gastric bypass (OAGB) were evaluated and its association with uric acid (sUA). Fifty patients were included in this analysis. Beck Depression Inventory (BDI) for measuring depressive symptomatology, blood samples, and anthropometric measurements were assessed before (T0), at 6 (T6), and 12 months (T12) after surgery. There was a significant reduction in BDI total score at T6 (− 5.6 (95% CI − 2.1, − 9.1) points; p = 0.001) and at T12 (− 4.3 (95% CI − 0.9, − 7.9) points; p = 0.011). BMI loss was unrelated to depressive symptomatology. Patients with moderate to severe depressive symptomatology presented lower sUA levels than patients with none or minimal to mild (p = 0.028). ROC analysis revealed that sUA levels below 5.0 at T6 and 4.5 mg/dl at T12 had a prognostic accuracy for depression severity. Furthermore, delta sUA was significantly associated with delta BMI (β = 0.473; p = 0.012) and delta waist circumference (β = 0.531; p = 0.003). These findings support an improvement in depressive symptomatology in the first year postoperatively, however, without relation to BMI loss. Patients with moderate to severe depressive symptomatology presented with lower sUA levels over time. Therefore, sUA could be useful to predict moderate to severe depressive symptomatology in patients undergoing OAGB in clinical practice.
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Affiliation(s)
- Eva Winzer
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.,Special Institute for Preventive Cardiology and Nutrition-SIPCAN, Salzburg, Austria
| | - Bernhard Ludvik
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Medicine 1 and Karl Landsteiner Institute for Obesity and Metabolic Diseases, Rudolfstiftung Hospital, Vienna, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.
| | - Renate Kruschitz
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Division of Internal Medicine, General Public Hospital of the Order of Saint Elisabeth, Klagenfurt, Austria
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Carmen Klammer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine, Convent of the Brothers of Saint John of God Linz, Linz, Austria
| | - Friedrich Hoppichler
- Special Institute for Preventive Cardiology and Nutrition-SIPCAN, Salzburg, Austria.,Division of Internal Medicine, General Public Hospital of the Brothers of St. John of God Salzburg, Salzburg, Austria
| | - Rodrig Marculescu
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Wakolbinger
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.,Special Institute for Preventive Cardiology and Nutrition-SIPCAN, Salzburg, Austria.,Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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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]
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12
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Chalopin S, Betry C, Coumes S, Wion N, Reche F, Arvieux C, Borel AL. Benefits and risks of bariatric surgery in patients with bipolar disorders. Surg Obes Relat Dis 2020; 16:798-805. [PMID: 32209316 DOI: 10.1016/j.soard.2020.02.010] [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] [Received: 09/26/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 10/24/2022]
Abstract
The prevalence of bipolar disorders in patients requesting bariatric surgery is estimated to be 1.5% to 3.4%. There are currently no specific recommendations regarding the way bariatric surgery should be managed in the context of bipolar disorder. The aim was to document the benefit-risk of bariatric surgery in patients with bipolar disorders. A systematic literature review was carried out. In addition, results were reported from a survey of current clinical practice in French referent centers for obesity care. Finally, 3 clinical cases from the "Severe Obesity Outcome Network" cohort are described. This systematic review shows there are few studies in the literature regarding the outcomes of bariatric surgery in patients with bipolar disorders and no randomized, controlled trials. Weight loss appeared similar in all patients, but psychiatric complications were sometimes reported in those with bipolar disorders. Almost all 11 referent centers for obesity care that responded had carried out bariatric surgery in patients with stable bipolar disorders. Postsurgical psychiatric destabilization occurred and included, at least, a need to reinforce treatment and follow-up. In the 3 case studies, postsurgical manic or hypomanic decompensation occurred. Thus, although effective in terms of weight loss, bariatric surgery could be a destabilizing factor for those with bipolar disorders. Current practice is to contraindicate surgery in patients with unstable disorders. There are insufficient data to conclude on the benefits and safety of bariatric surgery in patients with stable bipolar disease. Further studies are required to fully determine the benefits and risks.
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Affiliation(s)
- Sarah Chalopin
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France
| | - Cécile Betry
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France
| | - Sandrine Coumes
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France
| | - Nelly Wion
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France
| | - Fabian Reche
- Digestive Surgery, University Hospital Grenoble Alpes, Grenoble, France
| | - Catherine Arvieux
- Digestive Surgery, University Hospital Grenoble Alpes, Grenoble, France
| | - Anne-Laure Borel
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France; Hypoxia Physiopathology (HP2) Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France.
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Alexithymia and weight loss in obese patients underwent laparoscopic sleeve gastrectomy. Eat Weight Disord 2019; 24:129-134. [PMID: 28353096 DOI: 10.1007/s40519-017-0381-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/14/2017] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Obesity is a multifactorial disease characterized by genetic, social, cultural and psychological factors. Currently, bariatric surgery represents the gold-standard intervention to treat morbid obesity in order to counteract associated disabling comorbidities. Several studies showed correlation between post-surgery weight loss and psychological factors. Also, the alexithymia may have a role in affecting post-surgery outcomes in bariatric patients, even if there are no studies investigating its role at 12-month follow-up. The purpose of the present study was to investigate the association between alexithymia and the postoperative weight loss 12 months after laparoscopic sleeve gastrectomy. METHODS Seventy-five patients undergoing laparoscopic sleeve gastrectomy were enrolled. The Toronto Alexithymia Scale (TAS-20) was administered to patients. A postoperative weight loss check was performed at 3 and then 12 months after surgery. RESULTS The TAS-20 total score was negatively correlated with the percent of excess weight loss (%EWL) at the 12-month follow-up (r = -0.24; p = 0.040). The analysis showed that non-alexithymic patients had a greater weight loss at 12 months after surgery compared to both probably alexithymics (71.88 ± 18.21 vs. 60.7 ± 12.5; p = 0.047) and probably alexithymic patients (71.88 ± 18.21 vs. 56 ± 22.8; p = 0.007). The preoperative BMI was a significant covariate [F(1,70) = 6.13 (p = 0.016)]. CONCLUSION In the present study, the patients with higher preoperative BMI and identified as alexithymic showed lower %EWL at 12 months after laparoscopic sleeve gastrectomy. Findings point out the importance to take into consideration possible psychological treatments focused on improving emotional regulations of patients who are seeking bariatric surgery.
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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.
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Huang CW, Tang WJ, Liu YY, Tsai CY, Yeh TS, Liu KH. Predicted weight loss result of laparoscopic sleeve gastrectomy: Review of the first 82 consecutive patients in an Asian bariatric unit. Asian J Surg 2019; 42:373-378. [DOI: 10.1016/j.asjsur.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/20/2018] [Accepted: 06/07/2018] [Indexed: 11/16/2022] Open
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Archid R, Archid N, Meile T, Hoffmann J, Hilbert J, Wulff D, Teufel M, Muthig M, Quante M, Königsrainer A, Lange J. Patients with Schizophrenia Do Not Demonstrate Worse Outcome After Sleeve Gastrectomy: a Short-Term Cohort Study. Obes Surg 2018; 29:506-510. [DOI: 10.1007/s11695-018-3578-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
PURPOSE OF THE REVIEW To update the recent findings on the influence of personality features on postoperative weight loss in patients undergoing bariatric surgery. RECENT FINDINGS Several studies investigated the influence of pre-surgical psychological variables on the outcome of bariatric surgery, but the effective role of personality factors (i.e., both normal personality traits and personality disturbances) in shaping bariatric surgery outcome is still unclear. We analyzed nine recent papers that examined the impact of pre-operative personality traits on postoperative weight loss among individuals undergoing surgery for severe obesity. A personality pattern denoting the ability to self-regulate in spite of the urges or demands of the moment emerged as a robust predictor of good outcome across studies, independently from baseline psychiatric comorbidity and personality disorders.
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Affiliation(s)
- Irene Generali
- School of Psychiatry, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126, Parma, Italy.
| | - Chiara De Panfilis
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Pinto-Bastos A, Conceição E, de Lourdes M, Arrojado F, Brandão I, Machado PPP. Psychological and Behavioral Aspects of Primary and Reoperative Surgery: a 6-Month Longitudinal Study. Obes Surg 2018; 28:3984-3991. [PMID: 30105661 DOI: 10.1007/s11695-018-3452-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Problematic eating behaviors and general psychopathology have been associated with poor weight loss after bariatric surgery. However, little is known about how these aspects impact weight loss outcomes for the increasing number of patients undergoing reoperative surgeries. This study compares disordered eating and weight-related outcomes before and 6 months after surgery in patients undergoing primary (P-Group) and reoperative bariatric surgery (R-Group). METHODS This longitudinal study assessed 122 P-Group and 116 R-Group patients before and 6 months after surgery. The assessment included the eating disorder examination diagnostic items, and a set of self-report measures assessing eating disorder symptomatology, grazing, depression, anxiety, and negative urgency. RESULTS Preoperatively, no differences were found between the R- and P-Groups in terms of disordered eating-related variables (except for shape concern, which was higher for the R-Group). At 6 months after surgery, the R-Group revealed significantly higher values for restraint (F(1,219) = 5.84, p = 0.016), shape (F(1,219) = 5.59, p = 0.019), weight concerns (F(1,219) = 13.36, p = 0.000), depression (F(1,219) = 7.17, p = 0.008), anxiety (F(1,219) = 6.94, p = - 0.009), and compulsive grazing (F(1,219) = 6.13, p = 0.014). No significant pre- or post-surgery predictors of weight loss were found for the P-Group (χ2 = 0.70, p = 0.872). In the R-Group, post-surgery anxiety (Waldχ2(1) = 6.19, p = 0.01) and the post-surgery number of days with grazing in the previous month (Waldχ2(1) = 3.90, p = 0.04) were significant predictors of weight loss. CONCLUSION At 6 months after surgery, the R-Group presented more problematic eating and general psychological distress, which may put these patients at greater risk of poorer long-term weight outcomes.
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Affiliation(s)
- Ana Pinto-Bastos
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal
| | - Eva Conceição
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal.
| | - Marta de Lourdes
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal
| | - Filipa Arrojado
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal
| | - Isabel Brandão
- Faculty of Medicine, University of Porto, Centro Hospitalar de São João, Porto, Portugal
| | - Paulo P P Machado
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal
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Alabi F, Guilbert L, Villalobos G, Mendoza K, Hinojosa R, Melgarejo JC, Espinosa O, Sepúlveda EM, Zerrweck C. Depression Before and After Bariatric Surgery in Low-Income Patients: the Utility of the Beck Depression Inventory. Obes Surg 2018; 28:3492-3498. [DOI: 10.1007/s11695-018-3371-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Mack I, Ölschläger S, Sauer H, von Feilitzsch M, Weimer K, Junne F, Peeraully R, Enck P, Zipfel S, Teufel M. Does Laparoscopic Sleeve Gastrectomy Improve Depression, Stress and Eating Behaviour? A 4-Year Follow-up Study. Obes Surg 2017; 26:2967-2973. [PMID: 27178406 DOI: 10.1007/s11695-016-2219-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric surgery procedure and currently the second most performed technique worldwide. Follow-up data on depression, stress and eating behaviour are scarce. The aim of this longitudinal study was to investigate the medium-term effects of LSG on mental health and eating behaviour and their influence on weight loss by using a comprehensive interview-based assessment. METHODS Seventy-five individuals, who had undergone LSG at a university hospital, were included in the study. Symptoms of disordered eating were assessed using a structured clinical interview (eating disorder examination) and the Three-Factor Eating Questionnaire with depressive symptoms and stress assessed via the Patient Health Questionnaire. RESULTS Mean interval from LSG to follow-up (FU) examination was 48 ± 13.3 months. The total body weight loss was 24.2 ± 12.0 %. Depressive symptom scores improved from pre-operative to FU (9 [IQR 5-14] vs. 6 [IQR 2-10], p = 0.002) as did stress scores (8.7 ± 4.6 vs. 6.3 ± 4.7, p = 0.001). At FU, 11 % of patients reported loss-of-control eating and 39 % grazing, paralleled by increased body mass index, stress and depressive symptoms. Prior to LSG, nine patients fulfilled the diagnostic criteria of binge eating disorder but only one at FU. CONCLUSIONS Post-surgical mental health appears to be highly relevant in terms of weight loss maintenance. It is likely that the surgical outcome could be positively influenced if patients at risk of developing mental health issues or eating disorders were identified and monitored in order to offer targeted interventions.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
| | - Sabrina Ölschläger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Maximilian von Feilitzsch
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Riyad Peeraully
- Department of Paediatric Surgery, Queen's Medical Centre, Nottingham, UK
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Surgery type and psychosocial factors contribute to poorer weight loss outcomes in persons with a body mass index greater than 60 kg/m2. Surg Obes Relat Dis 2017; 13:2021-2026. [DOI: 10.1016/j.soard.2017.09.513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 09/02/2017] [Accepted: 09/11/2017] [Indexed: 01/20/2023]
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Fisher CJ, Heinberg LJ, Lapin B, Aminian A, Sullivan AB. Depressive Symptoms in Bariatric Surgery Patients with Multiple Sclerosis. Obes Surg 2017; 28:1091-1097. [PMID: 29086184 DOI: 10.1007/s11695-017-2977-y] [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: 11/25/2022]
Abstract
BACKGROUND Bariatric surgery has been shown to be a safe and effective intervention for patients with comorbid obesity and multiple sclerosis (MS); however, this sub-population may be at heightened risk for pre- and postoperative depressive symptoms. OBJECTIVE This current exploratory study aims to describe the prevalence and nature of depressive symptoms in a sample of patients with MS who undergo bariatric surgery. METHODS Medical records were retrospectively reviewed to identify patients who received bariatric surgery and had a diagnosis of MS (n = 31) and a control sample of non-surgical MS patients with severe obesity (n = 828). Longitudinal outcome measures included the Patient Health Questionnaire-9 (PHQ-9) and Multiple Sclerosis Performance Scale (MSPS). RESULTS There were no significant differences in PHQ-9 total and item scores between groups at baseline. PHQ-9 scores significantly improved at years 1 (p < 0.01) and 2 (p = 0.03) post-bariatric surgery when compared to non-surgical controls. Higher BMI (p = 0.03) and worse overall quality of life (p < 0.01) were associated with worsening of PHQ-9 scores in the bariatric group. When compared to controls, the bariatric group demonstrated improved MSPS scores on a trend level 1 year post-surgery (p = 0.08). CONCLUSIONS Consistent with the literature on more general bariatric surgery populations, current findings highlight the possible early benefits of bariatric surgery for reducing depressive symptoms in this population when compared to controls. Importantly, results should be viewed as preliminary and additional research is needed to examine bariatric surgery and associations with depressive symptoms and performance in the MS population.
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Affiliation(s)
- Carolyn J Fisher
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA.
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA.
| | - Leslie J Heinberg
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Brittany Lapin
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Amy B Sullivan
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
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Heinberg LJ, Marek R, Haskins IN, Bucak E, Nor Hanipah Z, Brethauer S. 30-day readmission following weight loss surgery: can psychological factors predict nonspecific indications for readmission? Surg Obes Relat Dis 2017; 13:1376-1381. [DOI: 10.1016/j.soard.2017.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 01/13/2023]
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Fisher D, Coleman KJ, Arterburn DE, Fischer H, Yamamoto A, Young DR, Sherwood NE, Trinacty CM, Lewis KH. Mental illness in bariatric surgery: A cohort study from the PORTAL network. Obesity (Silver Spring) 2017; 25:850-856. [PMID: 28440047 DOI: 10.1002/oby.21814] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/06/2017] [Accepted: 01/29/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare bariatric surgery outcomes according to preoperative mental illness category. METHODS Electronic health record data from several US healthcare systems were used to compare outcomes of four groups of patients who underwent bariatric surgery in 2012 and 2013. These included the following: people with (1) no mental illness, (2) mild-to-moderate depression or anxiety, (3) severe depression or anxiety, and (4) bipolar, psychosis, or schizophrenia spectrum disorders. Groups were compared on weight loss trajectory using generalized estimating equations using B-spline bases and on all-cause emergency department visits and hospital days using zero-inflated Poisson and negative binomial regression up to 2 years after surgery. Models were adjusted for demographic and health covariates, including baseline healthcare use. RESULTS Among 8,192 patients, mean age was 44.3 (10.7) years, 79.9% were female, and 45.6% were white. Fifty-seven percent had preoperative mental illness. There were no differences between groups for weight loss, but patients with preoperative severe depression or anxiety or bipolar, psychosis, or schizophrenia spectrum disorders had higher follow-up levels of emergency department visits and hospital days compared to those with no mental illness. CONCLUSIONS In this multicenter study, mental illness was not associated with differential weight loss after bariatric surgery, but additional research could focus on reducing acute care use among these patients.
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Affiliation(s)
- David Fisher
- The Permanente Medical Group, Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | | | - Heidi Fischer
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Ayae Yamamoto
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Deborah R Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | | | | | - Kristina H Lewis
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
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Erickson ZD, Kwan CL, Gelberg HA, Arnold IY, Chamberlin V, Rosen JA, Shah C, Nguyen CT, Hellemann G, Aragaki DR, Kunkel CF, Lewis MM, Sachinvala N, Sonza PA, Pierre JM, Ames D. A Randomized, Controlled Multisite Study of Behavioral Interventions for Veterans with Mental Illness and Antipsychotic Medication-Associated Obesity. J Gen Intern Med 2017; 32:32-39. [PMID: 28271424 PMCID: PMC5359155 DOI: 10.1007/s11606-016-3960-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Weight gain and other metabolic sequelae of antipsychotic medications can lead to medication non-adherence, reduced quality of life, increased costs, and premature mortality. Of the approaches to address this, behavioral interventions are less invasive, cost less, and can result in sustained long-term benefits. OBJECTIVE We investigated behavioral weight management interventions for veterans with mental illness across four medical centers within the Veterans Affairs (VA) Healthcare System. DESIGN We conducted a 12-month, multi-site extension of our previous randomized, controlled study, comparing treatment and control groups. PARTICIPANTS Veterans (and some non-veteran women) diagnosed with mental illness, overweight (defined as having a BMI over 25), and required ongoing antipsychotic therapy. INTERVENTIONS One group received "Lifestyle Balance" (LB; modified from the Diabetes Prevention Program) consisting of classes and individual nutritional counseling with a dietitian. A second group received less intensive "Usual Care" (UC) consisting of weight monitoring and provision of self-help. MAIN MEASURES Participants completed anthropometric and nutrition assessments weekly for 8 weeks, then monthly. Psychiatric, behavioral, and physical assessments were conducted at baseline and months 2, 6, and 12. Metabolic and lipid laboratory tests were performed quarterly. KEY RESULTS Participants in both groups lost weight. LB participants had a greater decrease in average waist circumference [F(1,1244) = 11.9, p < 0.001] and percent body fat [F(1,1121) = 4.3, p = 0.038]. Controlling for gender yielded statistically significant changes between groups in BMI [F(1,1246) = 13.9, p < 0.001]. Waist circumference and percent body fat decreased for LB women [F(1,1243) = 22.5, p < 0.001 and F(1,1221) = 4.8, p = 0.029, respectively]. The majority of LB participants kept food and activity journals (92%), and average daily calorie intake decreased from 2055 to 1650 during the study (p < 0.001). CONCLUSIONS Behavioral interventions specifically designed for individuals with mental illness can be effective for weight loss and improve dietary behaviors. "Lifestyle Balance" integrates well with VA healthcare's patient-centered "Whole Health" approach. ClinicalTrials.gov identifier NCT01052714.
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Affiliation(s)
- Zachary D Erickson
- Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Crystal L Kwan
- Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Hollie A Gelberg
- Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Irina Y Arnold
- Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Valery Chamberlin
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA
| | - Jennifer A Rosen
- Department of Pharmacy at VA Northern California Healthcare System, Martinez, CA, USA
- University of the Pacific School of Pharmacy, Stockton, CA, USA
- University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | - Chandresh Shah
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA
| | - Charles T Nguyen
- Department of Mental Health at VA Medical Center, Long Beach, CA, USA
| | - Gerhard Hellemann
- Semel Institute for Neuroscience & Human Behavior at University of California-Los Angeles, Los Angeles, CA, USA
| | - Dixie R Aragaki
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA
- Physical Medicine and Rehabilitation Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Charles F Kunkel
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA
- Physical Medicine and Rehabilitation Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Melissa M Lewis
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA
| | - Neena Sachinvala
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA
| | - Patrick A Sonza
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA
| | - Joseph M Pierre
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA
| | - Donna Ames
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA.
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA.
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Using the presurgical psychological evaluation to predict 5-year weight loss outcomes in bariatric surgery patients. Surg Obes Relat Dis 2017; 13:514-521. [DOI: 10.1016/j.soard.2016.11.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 02/05/2023]
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Friedman KE, Applegate K, Portenier D, McVay MA. Bariatric surgery in patients with bipolar spectrum disorders: Selection factors, postoperative visit attendance, and weight outcomes. Surg Obes Relat Dis 2016; 13:643-651. [PMID: 28169206 DOI: 10.1016/j.soard.2016.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND As many as 3% of bariatric surgery candidates are diagnosed with a bipolar spectrum disorder. OBJECTIVES 1) To describe differences between patients with bipolar spectrum disorders who are approved and not approved for surgery by the mental health evaluator and 2) to examine surgical outcomes of patients with bipolar spectrum disorders. SETTING Academic medical center, United States. METHODS A retrospective record review was conducted of consecutive patients who applied for bariatric surgery between 2004 and 2009. Patients diagnosed with bipolar spectrum disorders who were approved for surgery (n = 42) were compared with patients with a bipolar spectrum disorder who were not approved (n = 31) and to matched control surgical patients without a bipolar spectrum diagnosis (n = 29) on a variety of characteristics and surgical outcomes. RESULTS Of bariatric surgery candidates diagnosed with a bipolar spectrum disorder who applied for surgery, 57% were approved by the psychologist and 48% ultimately had surgery. Patients with a bipolar spectrum disorder who were approved for surgery were less likely to have had a previous psychiatric hospitalization than those who were not approved for surgery. Bariatric surgery patients diagnosed with a bipolar spectrum disorder were less likely to attend follow-up care appointments 2 or more years postsurgery compared to matched patients without bipolar disorder. Among patients with available data, those with a bipolar spectrum disorder and matched patients had similar weight loss at 12 months (n = 21 for bipolar; n = 24 for matched controls) and at 2 or more years (mean = 51 mo; n = 11 for bipolar; n = 20 for matched controls). CONCLUSION Patients diagnosed with a bipolar spectrum disorder have a high rate of delay/denial for bariatric surgery based on the psychosocial evaluation and are less likely to attend medical follow-up care 2 or more years postsurgery. Carefully screened patients with bipolar disorder who engage in long-term follow-up care may benefit from bariatric surgery.
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Affiliation(s)
- Kelli E Friedman
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Department of Psychiatry & Behavioral Science, Duke University Medical Center, Durham, NC, USA
| | - Katherine Applegate
- Department of Psychiatry & Behavioral Science, Duke University Medical Center, Durham, NC, USA
| | - Dana Portenier
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Megan A McVay
- Department of Psychiatry & Behavioral Science, Duke University Medical Center, Durham, NC, USA.
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Jantaratnotai N, Mosikanon K, Lee Y, McIntyre RS. The interface of depression and obesity. Obes Res Clin Pract 2016; 11:1-10. [PMID: 27498907 DOI: 10.1016/j.orcp.2016.07.003] [Citation(s) in RCA: 155] [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: 02/18/2016] [Revised: 06/03/2016] [Accepted: 07/18/2016] [Indexed: 12/24/2022]
Abstract
Depression and obesity are both highly prevalent and are leading public health problems. These foregoing disorders independently have great impact on morbidity and mortality affecting patients' health and well-being as well as on the socioeconomic aspect of functional impairment and healthcare expenditure. Results from epidemiological studies, clinical trials and recent meta-analyses support the association between mood disorders and obesity as both frequently co-occur in all races of populations examined. It is now well-established through longitudinal studies that obesity is a risk factor for mood disorders and vice versa. In the current review, we aim to address the evidence regarding 4 questions: (1) does obesity moderate response to antidepressants among patients with depressive disorders?, (2) does the presence of depressive disorders moderate the progression or outcome of obesity?, (3) does treatment of obesity moderate outcomes among patients with depressive disorders?, and (4) does treatment of depressive disorders moderate outcomes of obesity? In order to improve the interpretability of the results we confined the evaluations to studies where patients met the criteria for depressive disorders or obesity (i.e. BMI>30). Extant evidence supports the association between obesity and adverse health outcomes among individuals with depressive disorders. In addition, the treatment of one condition (i.e. obesity or depressive disorders) appears to improve the course of the other condition. It might be beneficial to check for the other condition in patients presenting with one condition and treatment should be administered to treat both conditions.
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Affiliation(s)
- Nattinee Jantaratnotai
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand.
| | - Kanokwan Mosikanon
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
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Sogg S, Lauretti J, West-Smith L. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis 2016; 12:731-749. [DOI: 10.1016/j.soard.2016.02.008] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 12/20/2022]
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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]
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Madeira E, Madeira M, Guedes EP, Mafort TT, Neto LV, de Oliveira Moreira R, de Pinho PRA, Lopes AJ, Farias MLF. Assessment of Predictive Response Factors to Intragastric Balloon Therapy for the Treatment of Obesity. J Laparoendosc Adv Surg Tech A 2016; 26:168-73. [PMID: 26844373 DOI: 10.1089/lap.2015.0305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obesity is a worldwide epidemic that is difficult to control with non-invasive treatments, which usually present poor results. In this context, the intragastric balloon (IGB) is an important tool that presents a mean body weight loss (BWL) estimated at approximately 12%, although individual responses are highly variable. OBJECTIVES This study assesses whether there are factors that can predict responses to IGB therapy either before or early after placement of the device. MATERIALS AND METHODS A total of 50 obese patients underwent insertion of IGB placed endoscopically, and patients were monitored for 6 months. The evaluated predictive factors involved general characteristics and psychological, social, and dyspeptic aspects, and the preliminary results obtained in the first month after balloon placement. RESULTS The mean weight loss was 11.5%, and 48% of the participants presented BWL >10%. Among the factors analyzed before IGB placement, only advanced age (P = .04) and higher scores obtained in the social relationships domain of a shorter version of the World Health Organization's Quality of Life questionnaire (P = .02) were significant. Analysis of the factors evaluated after IGB placement revealed that the BWL amounts observed in week 2 (P = .001) and week 4 (P < .001) and the intensity of dyspeptic symptoms in week 2 (P < .001) were positive predictive factors. CONCLUSIONS The assessment of predictive factors may help to manage patients with IGB.
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Affiliation(s)
- Eduardo Madeira
- 1 Postgraduate Programme in Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Miguel Madeira
- 1 Postgraduate Programme in Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Erika Paniago Guedes
- 1 Postgraduate Programme in Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Thiago Thomaz Mafort
- 2 Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Leonardo Vieira Neto
- 1 Postgraduate Programme in Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Rodrigo de Oliveira Moreira
- 3 Endocrinology Department, The Capriglione Luiz State Institute of Diabetes and Endocrinology , Rio de Janeiro, Brazil
| | | | - Agnaldo José Lopes
- 2 Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Maria Lucia Fleiuss Farias
- 1 Postgraduate Programme in Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
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Marek RJ, Ben-Porath YS, Heinberg LJ. Understanding the role of psychopathology in bariatric surgery outcomes. Obes Rev 2016; 17:126-41. [PMID: 26783067 DOI: 10.1111/obr.12356] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 09/28/2015] [Accepted: 10/16/2015] [Indexed: 12/01/2022]
Abstract
Bariatric surgery is the most effective treatment for morbid obesity; however, a subset of patients who undergo this procedure regain weight or achieve suboptimal weight loss results. A large number of studies have examined whether psychological variables play a role in weight loss surgery outcome. Although presurgical psychopathology has been found to be associated with suboptimal results in some studies, this literature is equivocal. These inconsistent findings are reviewed and considered in the context of contemporary models of psychopathology. More specifically, the review focuses on the limitations of atheoretical, descriptive diagnostic systems and examines whether comorbidity within the mood/anxiety disorders, impulse control/substance use disorders and thought disorders can account for the inconsistent findings reported to date. Contemporary models of psychopathology are highlighted and linked to the Research Domain Criteria, which have been advanced by the National Institute of Health. Means for assessing psychological constructs congruent with these models are reviewed. Recommendations are made for standardizing approaches to investigating how psychopathology contributes to suboptimal bariatric surgery outcomes.
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Affiliation(s)
- R J Marek
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Y S Ben-Porath
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - L J Heinberg
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
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Edwards-Hampton SA, Wedin S. Preoperative psychological assessment of patients seeking weight-loss surgery: identifying challenges and solutions. Psychol Res Behav Manag 2015; 8:263-72. [PMID: 26604844 PMCID: PMC4639515 DOI: 10.2147/prbm.s69132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Preoperative psychosocial assessment is the standard of care for patients seeking weight-loss surgery (WLS). However, the assessment procedure varies widely by surgery site. Comprehensive assessments can provide a wealth of information that assists both the patient and the treatment team, anticipate and prepare for challenges associated with extensive behavioral and lifestyle changes that are required postsurgery. In this review, we provide an overview of the purpose of the preoperative psychosocial assessment and domains to be included. Challenges commonly identified in the assessment are discussed, including maladaptive eating behaviors, psychiatric comorbidities, and alcohol use. Potential solutions and approaches to these challenges are provided. Additionally, patient populations requiring special consideration are presented to include adolescents, those with cognitive vulnerabilities, and aging adults.
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Affiliation(s)
- Shenelle A Edwards-Hampton
- Department of General Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Sharlene Wedin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Ogden J, Hollywood A, Pring C. The impact of psychological support on weight loss post weight loss surgery: a randomised control trial. Obes Surg 2015; 25:500-5. [PMID: 25200170 PMCID: PMC4346662 DOI: 10.1007/s11695-014-1428-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The purpose of the present study is to evaluate the impact of a health psychology-led bariatric rehabilitation service (BRS) on patient weight loss following bariatric surgery at 1 year. Methods A single-site open-randomised parallel group control trial based at St. Richard’s Hospital in Chichester in the UK. Patients (n = 162) were recruited immediately prior to Roux-en-Y gastric bypass and randomly allocated to receive either treatment as usual (n = 80) or the BRS (n = 82). The BRS involved three 50-min one-to-one sessions with a health psychologist and provided information, support and mentoring pre and post surgery addressing psychological issues such as dietary control, self esteem, coping and emotional eating. Weight loss was assessed at 1 year. The key outcome variable was BMI and change in BMI. Results Follow-up weight was available for 145 patients. Intention-to-treat analysis (n = 162) using last measured weights showed that mean change in BMI by 1 year post surgery was −16.49. There was no significant difference between the two groups (control group = −16.37, 95 % CI = 15.15–17.57; intervention = −16.6, 95 % CI = 15.42–17.81; ηp2 = 0.001). Similarly, explanatory analysis (n = 145) showed a mean change in BMI of −17.17. The difference between the two groups was not significant (control group = −16.9, 95 % CI = 15.78–18.18; intervention = −17.35, 95 % CI = 18.5–16.16; ηp2 = 0.001). Conclusions Psychological support pre and post bariatric surgery had no impact on weight loss as measured by BMI and change in BMI by 1 year. It is argued that psychological support should be targeted to patients who start to demonstrate weight regain at a later stage. Trial registration: ClinicalTrials.gov NCT01264120.
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Affiliation(s)
- Jane Ogden
- Department of Psychology, University of Surrey, Guildford, GU2 7XH, UK,
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35
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Grothe KB, Mundi MS, Himes SM, Sarr MG, Clark MM, Geske JR, Kalsy SA, Frye MA. Bipolar disorder symptoms in patients seeking bariatric surgery. Obes Surg 2015; 24:1909-14. [PMID: 24752620 DOI: 10.1007/s11695-014-1262-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
BACKGROUND Mood disorders are common among patients seeking bariatric surgery although little data exist regarding the prevalence of bipolar symptoms in this population and how they influence surgical outcomes. Our aim was to describe baseline rates of bipolar symptoms and their relationship to psychological factors and completing surgery in a sample of adults seeking bariatric surgery at an academic medical center. METHODS We retrospectively reviewed the relationship of bipolar symptoms to demographic characteristics, baseline weight, psychological factors, and bariatric surgery completion. RESULTS Nine hundred thirty-five patients completed the preoperative psychological evaluation. Six percent of the preoperative sample screened positive for symptoms of bipolar disorder. Patients with bipolar symptoms endorsed more robust psychopathology, trauma history, and problematic eating behaviors than patients without bipolar symptoms. Twenty-two percent of the patients with bipolar symptoms underwent bariatric surgery (n = 12), yet only 13 % were denied bariatric surgery for psychiatric reasons, suggesting that other variables may influence the completion of bariatric surgery for these patients. CONCLUSION Prevalence rates of bipolar symptoms may be greater in patients seeking bariatric surgery compared with the general population, and few patients with bipolar symptoms actually undergo bariatric surgery. Psychological factors differentiate patients with bipolar symptoms who undergo bariatric surgery vs those who do not.
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Affiliation(s)
- Karen B Grothe
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA,
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McPhee J, Khlyavich Freidl E, Eicher J, Zitsman JL, Devlin MJ, Hildebrandt T, Sysko R. Suicidal Ideation and Behaviours Among Adolescents Receiving Bariatric Surgery: A Case-Control Study. EUROPEAN EATING DISORDERS REVIEW 2015; 23:517-23. [PMID: 26377705 DOI: 10.1002/erv.2406] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/21/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This study examined the prevalence and correlates of suicidal ideation and behaviour (SI/B) among adolescents receiving bariatric surgery. METHOD Charts of 206 adolescents receiving bariatric surgery were reviewed. Cases with SI/B (current/lifetime reported at baseline or event occurring in the programme n = 31, 15%) were case matched on gender, age and surgery type to 31 adolescents reporting current or past psychiatric treatment and 31 adolescents denying lifetime SI/B or psychiatric treatment. RESULTS Before surgery, adolescents with SI/B reported significantly lower total levels of health-related quality of life (p = 0.01) and greater depressive symptoms (p = 0.004) in comparison with candidates who never received psychiatric treatment. No significant differences were found between groups for the change in depressive symptoms or body mass index following surgery. CONCLUSIONS As in studies of adults, a notable subset of adolescents receiving bariatric surgery indicated pre-operative or post-operative SI/B. It is critical that clinicians evaluate and monitor adolescent patients undergoing bariatric surgery for risk of SI/B.
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Affiliation(s)
- Jeanne McPhee
- Columbia Centre for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, NY, USA
| | - Eve Khlyavich Freidl
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, NY, USA.,Columbia University Clinic for Anxiety and Related Disorders, Division of Child Psychiatry, College of Physicians and Surgeons of Columbia University, NY, USA
| | - Julia Eicher
- Centre for Adolescent Bariatric Surgery, Department of Surgery, Columbia University Medical Centre, NY, USA
| | - Jeffrey L Zitsman
- Centre for Adolescent Bariatric Surgery, Department of Surgery, Columbia University Medical Centre, NY, USA
| | - Michael J Devlin
- Columbia Centre for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, NY, USA
| | - Tom Hildebrandt
- Eating and Weight Disorders Programme, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Robyn Sysko
- Eating and Weight Disorders Programme, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
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37
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Marek RJ, Tarescavage AM, Ben-Porath YS, Ashton K, Merrell Rish J, Heinberg LJ. Using presurgical psychological testing to predict 1-year appointment adherence and weight loss in bariatric surgery patients: predictive validity and methodological considerations. Surg Obes Relat Dis 2015; 11:1171-81. [DOI: 10.1016/j.soard.2015.03.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/06/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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38
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Patients with psychiatric comorbidity can safely undergo bariatric surgery with equivalent success. Surg Endosc 2015; 30:251-8. [DOI: 10.1007/s00464-015-4196-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/26/2015] [Indexed: 12/19/2022]
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39
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Marek RJ, Ben-Porath YS, Sellbom M, McNulty JL, Heinberg LJ. Validity of Minnesota Multiphasic Personality Inventory – 2 – Restructured Form (MMPI-2-RF) scores as a function of gender, ethnicity, and age of bariatric surgery candidates. Surg Obes Relat Dis 2014; 11:627-34. [PMID: 25487292 DOI: 10.1016/j.soard.2014.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/03/2014] [Accepted: 10/03/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Presurgical psychological screening is used to identify factors that may impact postoperative adherence and surgical outcomes in bariatric surgery candidates. Minnesota Multiphasic Personality Inventory - 2 Restructured Form (MMPI-2-RF) findings have demonstrated utility for this task. OBJECTIVES To explore whether there are clinically meaningful gender, ethnicity, or age differences in presurgical MMPI-2-RF scores and the validity of these scores in bariatric surgery candidates. METHODS The sample was composed of 872 men and 2337 women. Ethnicity/race groups included 2,204 Caucasian, 744 African American, and 96 Hispanic individuals. A sample of 165 were not included in the ethnicity/race analyses because they were of another descent. Ages groups included 18-35 year olds (n = 454), 36-49 year olds (n = 1154), 50-64 year olds, (n = 1246), and 65 years old or older (n = 355). Validity data, obtained via a retrospective chart review, were available for a subset patients (n = 1,268) who were similarly distributed. Step-down hierarchical regression analyses were conducted to assess for differential validity. RESULTS Bariatric surgery candidates produced comparable MMPI-2-RF scores in all subsamples, indicating that the test norms generalize across demographic groups. Validity findings were also generally comparable, indicating that MMPI-2-RF scores have the same interpretive implications in demographically diverse subgroups of bariatric surgery candidates. CONCLUSIONS The MMPI-2-RF can assist in presurgical psychological screening of demographically diverse bariatric surgery candidates.
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Affiliation(s)
- Ryan J Marek
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | | | - Martin Sellbom
- Research School of Psychology, Australian National University, Canberra, Australia
| | - John L McNulty
- Department of Psychology, University of Tulsa, Tulsa, Oklahoma
| | - Leslie J Heinberg
- Cleveland Clinic Lerner College of Medicine, Department of Medicine, Cleveland, Ohio.
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Abstract
PURPOSE OF REVIEW Bariatric surgery has been consistently shown to be effective in long-term marked weight loss and in bringing significant improvement to medical comorbidities such as metabolic syndrome. Empirical data suggest a high prevalence of psychiatric disorders among bariatric surgery candidates. In this review, we focus on the studies published recently with a high impact on our understanding of the role of psychiatry in bariatric surgery. RECENT FINDINGS This article reviews the specific psychopathologies before surgery, changes in psychopathologies after surgery, suicide risk related to bariatric surgery, factors associated with weight loss, and recommendations for presurgical and postsurgical assessment and management. Research indicates a decrease in certain psychiatric symptoms after weight loss with bariatric surgery. However, the risk of suicide and unsuccessful weight loss in some bariatric surgery patients make monitoring following surgery as important as careful assessment and management before surgery. Specific considerations for youth and older populations and future potential research foci are discussed. SUMMARY Recent publications suggest new directions for psychiatric evaluation and interventions for bariatric surgery patients. Future research on outcomes of specific populations, effectiveness of psychopharmacotherapy, and underlying pathophysiology are warranted for the advancement of treating bariatric surgery patients.
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Davis SS. Clinical Challenges of Bariatric Surgery for Patients with Psychiatric Disorders. Commentary on: "Lithium Toxicity Following Roux-en-Y Gastric Bypass" 1.. Bariatr Surg Pract Patient Care 2014; 9:84-85. [PMID: 24963466 DOI: 10.1089/bari.2014.9961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Scott Davis
- Associate Professor of Surgery, Emory University Hospital , Atlanta, Georgia
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Malik S, Mitchell JE, Engel S, Crosby R, Wonderlich S. Psychopathology in bariatric surgery candidates: a review of studies using structured diagnostic interviews. Compr Psychiatry 2014; 55:248-59. [PMID: 24290079 PMCID: PMC3985130 DOI: 10.1016/j.comppsych.2013.08.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/08/2013] [Accepted: 08/04/2013] [Indexed: 12/15/2022] Open
Abstract
Psychiatric disorders are not uncommon among severely obese patients who present for bariatric surgery. This paper (1) reviews the results of the published studies using the structured interviews to assess psychopathology in bariatric surgery candidates; (2) compares the prevalence rates of psychiatric disorders across these studies with the data from other population samples; and (3) assesses whether sociodemographic variables appear to affect these prevalence rates. We searched online resources, PubMed, PsychINFO and reference lists of all the relevant articles to provide an overview of evidence so far and highlight some details in the assessment and comparisons of different samples in different countries. The prevalence estimates in the non-treatment obese group did not appear to differ substantially from the general population group in the US or the Italian population samples, although they were relatively higher for the German population. However, the rates of psychopathology in the bariatric surgery candidates were considerably higher than the other two population groups in all the samples. Overall, the most common category of lifetime Axis I disorders in all the studies was affective disorders, with anxiety disorders being the most common category of current Axis I disorders. Certain demographic characteristics are also associated with higher rates of psychopathology, such as, female gender, low socioeconomic status, higher BMI. Overall, methodological and sociodemographic differences make these studies difficult to compare and these differences should be taken into account when interpreting the results.
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Affiliation(s)
- Sarah Malik
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota 58103 USA,Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, 58102, USA
| | - James E. Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota 58103 USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, 58102, USA,Corresponding Author: (J.E. Mitchell)
| | - Scott Engel
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota 58103 USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, 58102, USA
| | - Ross Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota 58103 USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, 58102, USA
| | - Steve Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota 58103 USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, 58102, USA
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Predicting One and Three Month Postoperative Somatic Concerns, Psychological Distress, and Maladaptive Eating Behaviors in Bariatric Surgery Candidates with the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). Obes Surg 2014; 24:631-9. [DOI: 10.1007/s11695-013-1149-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Deliopoulou K, Konsta A, Penna S, Papakostas P, Kotzampassi K. The impact of weight loss on depression status in obese individuals subjected to intragastric balloon treatment. Obes Surg 2013; 23:669-75. [PMID: 23299506 DOI: 10.1007/s11695-012-0855-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although depression is considered to be significantly related to morbid obesity disorder, no information exists on the evolution of depression status after weight loss, in particular when an intragastric balloon is used. This prospective 6-month study examines both the effect on depression status and the relation of weight loss to depression in morbidly obese patients treated by intragastric balloon. METHODS One hundred consecutive females fulfilling criteria for balloon treatment were assessed for depression and divided into two groups (65 depressed, 35 non-depressed). Obesity-related parameters were comparable. RESULTS During the treatment period, the depression status of the mildly, moderately, and severely depressed patients improved from 40, 32.3, and 27.7 % to 20, 7.7, and 1.5 %, respectively, with 70.8 % finally exhibiting no depression at all. During the same period, body weight, BMI, body fat, and excess weight loss (EWL) were comparable between all groups, the range of BMI affecting neither the depression score nor the reduction of obesity parameters. However, there was a significant [percentage of EWL >30] weight loss difference in favor of those who were less severely depressed initially. CONCLUSION The degree of weight loss observed in obese depressed females-being comparable to that achieved by non-depressed females-after intragastric balloon insertion was found to positively affect their depression status.
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Affiliation(s)
- Kyriaki Deliopoulou
- Department of Surgery, Aristotle's University of Thessaloniki, Thessaloniki, Greece
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45
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Marek RJ, Ben-Porath YS, Windover A, Tarescavage AM, Merrell J, Ashton K, Lavery M, Heinberg LJ. Assessing Psychosocial Functioning of Bariatric Surgery Candidates with the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). Obes Surg 2013; 23:1864-73. [DOI: 10.1007/s11695-013-1024-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Sysko R, Zandberg LJ, Devlin MJ, Annunziato RA, Zitsman JL, Walsh BT. Mental Health Evaluations for Adolescents Prior to Bariatric Surgery: A Review of Existing Practices and a Specific Example of Assessment Procedures. Clin Obes 2013; 3:62-72. [PMID: 24073019 PMCID: PMC3781169 DOI: 10.1111/cob.12019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Best practice guidelines for adolescents considering bariatric surgery recommend a pre-operative mental health evaluation. However, only general information about these assessments appears in the literature, which makes consistency of administration challenging. This review proposes a specific empirically-derived format for pre-surgical mental health evaluations and summarizes currently available data on the psychiatric functioning of adolescents seeking bariatric surgery. DESIGN Studies of mental health evaluations for adults preparing for bariatric surgery are reviewed, as is the limited literature relevant to adolescent evaluations. A specific and detailed example of an evaluation (clinical interview, self-report questionnaires, cognitive assessment) used for younger patients at a major metropolitan hospital center is presented, followed by data from an initial group of adolescents completing this evaluation. SUBJECTS 200 adolescents (n=139 female; age: 14-18 y, BMI: 35.4-83.3 kg/m2) presenting for bariatric surgery. RESULTS A notable subset of adolescents reported current Axis I conditions (31.5%) and current mental health treatment (29.5%), but reports of current illicit drug use (1.5%) and regular alcohol use (0.5%) were relatively rare. Procedures for using the completed evaluation and post-surgery monitoring of psychosocial issues are discussed. CONCLUSIONS Adolescents considering weight loss surgery should receive comprehensive pre-surgical mental health evaluations, but additional data are needed to develop specific recommendations the use of these evaluations in post-operative care.
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Affiliation(s)
- Robyn Sysko
- Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, NY
| | | | - Michael J. Devlin
- Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, NY
| | | | - Jeffrey L. Zitsman
- Center for Adolescent Bariatric Surgery, Department of Surgery, Division of Pediatric Surgery, Columbia University Medical Center, New York, NY
| | - B. Timothy Walsh
- Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, NY
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Rudolph A, Hilbert A. Post-operative behavioural management in bariatric surgery: a systematic review and meta-analysis of randomized controlled trials. Obes Rev 2013; 14:292-302. [PMID: 23294936 DOI: 10.1111/obr.12013] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 12/12/2022]
Abstract
Recent research has provided evidence that bariatric surgery maximizes long-term weight loss in patients with severe obesity. However, a substantial number of patients experience poor weight loss outcome and weight regain over time. Post-operative behavioural management may facilitate long-term weight control in bariatric surgery population. The objective of this systematic review and meta-analysis was to determine the effects of post-operative behavioural management on weight loss following bariatric surgery. Eligible articles were systematically searched in electronic databases. Among the 414 citations, five randomized controlled trials, two prospective and eight retrospective cohort trials analysing behavioural lifestyle interventions and support groups fulfilled the inclusion criteria. The main finding is that behavioural management had a positive effect on weight loss following surgery. In 13 studies, patients receiving behavioural management had greater weight loss than patients receiving usual care or no treatment. A meta-analysis of five randomized controlled trials suggests greater weight loss in patients with behavioural lifestyle interventions compared with control groups. Post-operative behavioural management has the potential to facilitate optimal weight loss following bariatric surgery, but conclusions were limited by the small and heterogeneous samples of studies. A more rigorous empirical evaluation on its clinical significance is warranted to improve effectiveness of bariatric surgery.
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Affiliation(s)
- A Rudolph
- Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Department of Medical Psychology and Medical Sociology, Behavioral Medicine, University of Leipzig, Leipzig, Germany.
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Abstract
Bipolar disorder (BD) is associated with obesity, overweight, and abdominal obesity, and BD individuals with obesity have a greater illness burden. Factors related to BD, its treatment, and the individual may all contribute to BD's association with obesity. Management strategies for the obese BD patient include use of medications with better metabolic profiles, lifestyle interventions, and adjunctive pharmacotherapy for weight loss. Obesity-related psychiatric and medical comorbidities should also be assessed and managed. Bariatric surgery may be an option for carefully selected patients. Greater research into the theoretical underpinnings and clinical management of the BD-obesity connection is needed.
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Affiliation(s)
- Susan L McElroy
- Lindner Center of HOPE, 4075 Old Western Road, Mason, OH 45040, USA.
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Heinberg LJ. Comment on: Optimizing long-term weight control after bariatric surgery: a pilot study. Surg Obes Relat Dis 2012; 8:715-6. [DOI: 10.1016/j.soard.2011.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 05/06/2011] [Indexed: 11/16/2022]
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Abstract
BACKGROUND The clinical significance of sleeve gastrectomy (SG) as a primary bariatric intervention is still under debate. This article aims to systematically analyze excessive weight loss (EWL) in patients after SG. METHODS A systematic literature search on SG from the period January 2003 to December 2010 was performed. Data described from systematic reviews dealing with gastric bypass procedures was used as comparator. RESULTS The final study included 123 papers describing 12,129 patients. Most of the papers describe EWL at 12 months (43.9% of all papers). For SG, the maximum EWL occurred 24 and 36 months postoperatively with a mean EWL of 64.3% (minimum 46.1%, maximum 75.0%) and 66.0% (minimum 60.0%, maximum 77.5%), respectively. At 12 months, the mean EWL in patients receiving SG was significantly lower when compared to patients who underwent gastric bypass (SG 56.1%, gastric bypass 68.3%; p < 0.01, two-sided Wilcoxon test). Although patients with gastric bypass still had higher EWL rates at 24 months compared to patients after SG, these differences were not significant (SG 61.3%, gastric bypass 69.6%; p = 0.09, two-sided Wilcoxon rank-sum test). Reoperations after SG are necessary in 6.8% (range 0.7-25%) of cases with patients receiving SG as a stand alone procedure and in 9.6-28.5% of cases with patients undergoing SG as a planned first stage procedure. CONCLUSIONS SG is an effective bariatric procedure with a lasting effect on EWL. Compared with gastric bypasses, there is no difference in EWL at the time point of 24 months.
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