Bariatric surgery in patients with psychiatric comorbidity: Significant weight loss and improvement of physical quality of life

Abstract

Summary Background Patients that have psychiatric comorbidity are thought to lose less weight than the general bariatric population and are therefore sometimes denied surgery. However, there is no scientific evidence for this assumption. The aim of this study is to evaluate the weight loss and health‐related quality of life (HRQoL) in patients with psychiatric disorders who undergo bariatric surgery and compare these patients with a general bariatric population. Method Patients who underwent bariatric surgery in 2015 were included. Patients who received individual counselling and had a current DSM IV axis 1 or 2 diagnosis were included in the psychiatric group (n = 163), all other patients in the generic group (n = 2362).Weight and HRQoL were assessed before and 12‐, 24‐, 36‐ and 48‐months after surgery. Data was analysed using regression analyses. Results The maximum total weight loss (TWL) was 27.4% in the psychiatric group vs 31.0% in the generic group. Difference in %TWL between the psychiatric and generic group was significant from baseline to all follow‐up moments ( P < .001). Improvement of PHS was significantly higher in the generic group from baseline to 12‐month ( P = .002), 24‐month ( P = .0018), 36‐month ( P = .025) and 48‐monthfollow‐up ( P = .003). Change in mental HRQoL was only different comparing baseline to 48‐monthfollow‐up ( P = .014). Conclusion Although weight loss and change in physical HRQoL was lower in patients with pre‐operative psychiatric disorders, results of this group were still excellent. Thus, patients with psychiatric diagnoses benefit greatly from bariatric surgery and these patients should not be denied weight loss surgery.

No association between history of psychiatric treatment and postoperative weight reduction after bariatric surgery

“…Similarly, in the study of 199 patients who were observed for 2–3 years after bariatric surgery, pre-surgery psychiatric disorders were not related to weight change [ 5 ]. On the other hand, in study by Vermeer et al in bariatric patients, in whom 163 had preoperative diagnosis of psychiatric disease and 2362 had no such diagnosis, total weight loss 1 to 4 years after surgery was significantly lower in the psychiatric group [ 17 ]. However, the difference was rather small—about 5% lower weight loss in patients with diagnosis of mental disorders.…”

“…The effectiveness of bariatric treatment is different in various groups and one of the determinants is the presence of mental disorders [ 5 ]. It may negatively affect eating behavior after bariatric surgery and patients’ adherence and as a consequence reduce the effectiveness of bariatric treatment [ 17 , 18 ]. Muller et al found that mental illness has a negative impact on weight loss in bariatric patients in a 4-year follow-up [ 19 ].…”

“…However, the effect, although smaller in patients with mental disorders, does is not necessarily have to be insufficient. Although improvement in body weight and quality of life were smaller, the effect in this group was still beneficial [ 17 ]. In other studies between 22 and 32% patients were taking psychiatric medications before surgery but psychiatric medication use was not associated with poorer effect 1 year after bariatric surgery [ 20 , 21 ].…”