Impact of Mental Health Background and Nutrition Intake on Medium-Term Weight Loss in Japanese Patients Undergoing Laparoscopic Sleeve Gastrectomy

Abstract

<b><i>Objectives:</i></b> Bariatric surgery is the most effective weight loss therapy, and recently laparoscopic sleeve gastrectomy (LSG) is gaining popularity worldwide. On the other hand, patients undergoing bariatric surgery have a high prevalence of mental disorders. A Japanese nationwide survey reported high prevalence of mental disorders in patients with low percent total weight loss (%TWL) and also in those with high %TWL. The aim of this study was to investigate the relationship of 1-year %TWL with background mental health status, 3-year outcomes, and nutrition intake in Japanese patients after LSG. <b><i>Methods:</i></b> This study was a single-center retrospective database analysis. A total of 89 Japanese patients who underwent LSG and were followed for 3 years were enrolled (mean age 41.9 years, baseline body mass index 44.9, baseline glycosylated hemoglobin, HbA<sub>1c</sub>, 7.0%). The patients were divided into 3 groups according to 1-year %TWL as follows: ≤19.9% (insufficient group), 20.0–34.9% (average group) and ≥35.0% (excessive group). Psychosocial and nutritional status as well as physical data were collected from all patients. <b><i>Results:</i></b> The prevalence of mental disorders was 51.7%, and 1-year %TWL was 28.1% in all patients. No significant differences were observed in the changes in body weight and HbA<sub>1c</sub> between patients with and those without mental disorders. The prevalence of mental disorders was particularly high in the insufficient and excessive groups. In the insufficient group, mood disorders and mental retardation/developmental disorders were frequent, and snacking and eating out habits were often observed. In the excessive group, the frequencies of mood disorders and binge eating were high, and a decrease in skeletal muscle mass due to low protein intake was observed. Furthermore, weight regain was shown 12 months after LSG in both groups. In the average group, there were fewer problems in weight loss outcomes, mental health, nutrition intake and body composition. <b><i>Conclusions:</i></b> Psychosocial and nutritional problems were often found not only in patients with insufficient weight loss, but also in those with seemingly “excellent” weight reduction. To improve long-term weight loss outcome and future health, a multidisciplinary approach focusing on mental health and nutrition is essential for patients undergoing bariatric surgery.

Do Emotion Dysregulation, Alexithymia and Personality Dimensions Explain the Association Between Attention-Deficit/Hyperactivity Disorder and Binge Eating Among Bariatric Surgery Candidates?

“…According to a review conducted by Sarwer and Heinberg (2020), up to 50% of these patients reported preoperative disordered eating, particularly loss of control over eating. Findings about the impact of comorbidities on weight loss differ, with some studies reporting that preoperative mental illness and BE were not associated with lower weight loss (Friedman et al, 2019;Saiki et al, 2020), and others showing that these comorbidities affected postoperative outcomes (Marek et al, 2017;Müller et al, 2019;Sarwer and Heinberg, 2020). In a study with a sample of bariatric surgery patients, Williamson et al (2018) found a significant ADHD by emotion self-regulation interaction on weight loss.…”

Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity

“…If the former is the main issue, re-operation should be considered. When the latter is the case, inadequate protein intake, snacking habits, and consumption of soft drinks are reported to adversely affect weight loss effect of the surgery [ 51 , 194 ]. With regard to alcohol consumption, patients should be encouraged to drink in moderation, because the risk of alcoholism increases after surgery [ 197 ].…”

“…Furthermore, because surgery shrinks the stomach, patients become incapable of eating large amounts of food, which often result in grazing, a common cause of weight regain [ 229 ]. It has also been pointed out that patients with mental disorders tend to polarize into two groups after surgery: those without any drastic weight loss and those with excessive weight loss [ 51 ]. Therefore, it is recommended that the medical team stuff (mainly physicians and surgeons) simulate these postoperative changes such as psychiatric symptoms and eating behavior changes after surgery [ 226 , 230 ].…”

“…It is relatively common for patients considering surgery to discover for the first time that they have a mental disorder [23]. It has also been reported that patients with insufficient weight loss after surgery often have personality traits such as poor spontaneity and a strong tendency toward avoidance [51]. However, it has also been revealed that behavioral and psychosocial problems such as treatment adherence, eating behavior, emotional control, and social support positively affect the postoperative clinical course [52][53][54].…”

“…The prevalence of mental disorders in Japanese patients indicated for metabolic surgery has been reported to be 26–52% [ 23 , 48 , 51 ]. Of these, mood disorders, including depression and bipolar disorder, are the most common, accounting for 25–30% of all cases of mental disorder, followed by anxiety disorder, intellectual disorder, and eating disorder [ 48 , 51 ]. It is relatively common for patients considering surgery to discover for the first time that they have a mental disorder [ 23 ].…”