No abstract

Twenty-one grossly obese patients were studied before and repeatedly after gastroplasty. Eighteen months after surgery, three groups of patients were identified which had similar preoperative weights but showed significantly different patterns of weight loss. About one third of the patients were considered unsuccessful (less than 20% weight loss). Psychological assessment, using the meta-contrast technique, showed that signs of regressive defense and of immature identity decreased postoperatively. Mild to moderate depressive reactions were found in two thirds of the patients postoperatively and were significantly more frequent among the successful patients. Acute depressive episodes, severe enough to require professional intervention, occurred in four patients, three of whom belonged to the successful group. No correlation could be found between surgical complications or metabolic alterations after gastroplasty and postoperative depression, implying that these factors do not primarily influence the patient's postoperative psychological status. Rather, we suggest that the marked weight loss as such leads to problems of adaptation which in turn may trigger depressive reactions.

We have studied effects of weight reduction after gastroplasty on glucose and lipid metabolism in 15 grossly obese subjects. Their body weight decreased from 127 +/- 13 to 97 +/- 14 kg 6 months after surgery and remained essentially stable 8 months later. There was a marked improvement of lipid and carbohydrate metabolism with significant reductions in blood glucose, plasma insulin and glucagon levels, and in glucose tolerance. Lipoprotein lipase activity in adipose tissue was in the upper reference range and lipoprotein lipase activity in postheparin plasma tended to be low. Plasma triglyceride, cholesterol and low-density lipoprotein cholesterol concentrations decreased significantly, while high-density lipoprotein cholesterol levels tended to rise. Concomitantly, there was an increase in triglyceride clearance rate. Most of these changes were significantly correlated to the reduction in body weight/body fat, indicating that the metabolic improvements are due to body fat reduction as such.

No abstract

No abstract