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Mental illness

Mental health does not affect weight loss after bariatric surgery

Study compares bariatric surgery outcomes according to preoperative mental illness

People with pre-existing mental health conditions had nearly identical results in weight loss after bariatric surgery, compared to those with no known mental health conditions. According to the study authors the study is the first large scale study of its kind to examine the relationship of preoperative mental illness to weight loss and health care use after bariatric surgery.

“Many clinicians are hesitant to consider bariatric surgery in the mentally ill population due to the assumption that they will not fare well. This research counters those assumptions, showing no difference, on average, in weight loss in the mentally ill versus non-mentally ill population,” said The Obesity Society spokesperson, Dr Scott Kahan, Director of National Center for Weight and Wellness. “No prior research has evaluated this research question in a large and detailed study group. While all potential surgical patients should receive a thorough evaluation prior to considering surgery, this research suggests that there appears to be no outright reason to deny consideration of bariatric surgery in patients with mental illness who otherwise are good surgical candidates.”

In the paper, ‘Mental illness in bariatric surgery: A cohort study from the PORTAL network’, published in the journal Obesity, the researchers reviewed electronic health record (EHR) data from over 8,000 adults with and without mental illness, from several health care systems across the US in 2012-2013, to study weight loss and health care use patterns after bariatric surgery including post-surgery emergency department visits and hospitalization days. The study divided patients with mental illness into three groups: (1) mild to moderate depression or anxiety, (2) severe depression or anxiety and (3) bipolar, psychosis or schizophrenia spectrum disorders.

In the study, groups were compared on weight loss by using generalized estimating equations using B-spline bases, and on all-cause emergency department (ED) visits and hospital days using zero-inflated Poisson and negative binomial regression, up to two years after surgery.

In total, 8,192 patients (mean age was 44.3 (10.7) years, 79.9% were female, 45.6% were white) were included in the study. Fifty-seven percent of the patients had preoperative mental illness. However, the researchers found that were no differences between groups for weight loss (Figure 1), 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.

Figure 1: Percent total weight loss (%TWL) trajectories following bariatric surgery, by preoperative mental illness category and surgical type. Panels a and b display the modeled %TWL trajectory for vertical sleeve gastrectomy and Roux-en-Y gastric bypass patients, respectively, assuming mean values on continuous baseline covariates and modal values for categorical covariates. The curves within each graph represent the mental illness categorizations as we characterized them: no mental illness, mild-to-moderate depression or anxiety, severe depression, or anxiety or bipolar/psychosis/schizophrenia. There were no significant differences in %TWL trajectory between mental health categories

“Our findings suggest that this powerful weight loss tool can be equally effective for different groups of patients regardless of pre-existing mental health conditions,” said Dr Kristina Henderson Lewis, Assistant Professor, Department of Epidemiology & Prevention Division of Public Health Sciences at Wake Forest Baptist Medical Center.

She cautioned that the majority of patients in this study came from systems where patients are psychologically screened prior to surgery, supporting the use of such screening to identify clinically-stable patients. Importantly, patients with pre-operative mental illness were observed to have higher use of the emergency department and hospital after bariatric surgery, a finding that may have clinical implications and requires further study.

In an accompanying editorial, ‘Mental illness and bariatric surgery’, published in Obesity, Dr James Mitchell, Chester Fritz Distinguished Professor Emeritus, The University of North Dakota, Fargo, North Dakota, discusses the impact of pre-surgery mental illness on post-surgery weight loss, as well as post-surgery emergency department visits and hospitalization. He points out that while more research is needed on this topic, “The most important finding is that those with mental illness, even in its more severe forms, can experience significant weight loss after bariatric procedures that is similar to the weight loss seen in the non-mentally ill patients. The current findings suggest that health care providers need to strongly consider bariatric surgical procedures for their severely obese mentally ill patients who are in a period of relative stability.”

To access this paper, please click here

To access the accompanying editorial, please click here

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