Severely obese subjects, especially younger women with poor body image, are at high risk for depression. We found sustained improvement with weight loss. These findings also support the hypothesis that severe obesity causes or aggravates depression.

Placement of the Lap-Band system provides safe and effective control of severe obesity. The effect on weight loss is durable and is associated with major improvement in health and quality of life. It has the potential to provide a broadly acceptable option for this common and serious disease.

Objective:To assess the quality of life (QOL) in severely obese subjects before and after Lap-Band gastric restrictive surgery and identify factors that may influence change. Research Methods and Procedures: All patients, over a 3-year period, attending for preoperative assessment (n ϭ 459) or annual review after surgery (n ϭ 641) have completed the Short Form-36 (SF-36) health survey. Eight domain and physical component summary (PCS) and mental component summary (MCS) scores were calculated. Scores were analyzed in groups based on time after surgery and compared with community normal (CN) values. Paired preoperative and 1-year scores (n ϭ 218) data were used to find predictors of QOL change. Results: All preoperative mean scores (n ϭ 459) were lower than CN values, with greater impairment in the PCS (36.8 Ϯ 9.5 vs. CN: 51.3 Ϯ 8.3, p Ͻ 0.001) than in the MCS (45.7 Ϯ 8.2 vs. CN: 48.8 Ϯ 9.5, p Ͻ 0.001) scores. After 1 year, scores were closer to CN scores (PCS: 52.4 Ϯ 8.2 and MCS: 48.4 Ϯ 7.7), and these remained closer for 4 years. Preoperative obesity comorbidity, especially physical disability, was the best predictor of poor preoperative SF-36 scores and of improvement in scores at 1 year. The percentage of excess weight loss at 1 year (46 Ϯ 16%) was of little predictive value of improved QOL. Discussion: Severely obese subjects have poor health-related QOL as measured by the SF-36 health survey. LapBand surgery for this group has provided a dramatic and sustained improvement in all measures of the SF-36. Improvement is greater in those with greater preoperative disability, and the extent of weight loss is not a good predictor of improved QOL.

II-2.

Important physical factors have been found to influence the rate of weight loss. Those with increased age, pain, physical disability and insulin resistance have a great deal to gain from weight loss. Although this study has identified factors that are associated with less weight loss, we have not found any factor that predicts an unacceptably low weight loss and thus provides a contraindication to Lap-Band placement. The findings of this study allow us to set more realistic goals for the rate of weight loss in specified sub-groups of our patients.