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Mental illness does not predict weight loss after bariatric surgery
In patients with obesity, preoperative mental illness did not predict differential weight loss up to 2 years after bariatric surgery, according to findings published in Obesity.
In a study of more than 8,000 patients who underwent bariatric surgery, researchers also found that preoperative mental illness was predictive of greater acute care use, including more ED visits, beginning as soon as 3 months after surgery and persisting through 2 years of follow-up.
“Mental illness is highly prevalent among bariatric surgery patients, with estimates ranging from 23% to 68% of patients affected preoperatively,” Kristina H. Lewis, MD, MPH, assistant professor of epidemiology and prevention at Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues wrote. “Opinions vary regarding whether such patients are good candidates for bariatric surgery, reflecting uncertainty about their long-term weight loss and risk for complications.”
Fisher and colleagues analyzed electronic health records from 8,192 patients in the PORTAL overweight and obesity cohort, a collaborative data effort across seven integrated health insurance and care-delivery systems in the United States (mean age, 44 years; 79.9% women; 45.6% white). Included patients had a BMI of at least 30 kg/m² (mean BMI, 43.7 kg/m²), underwent Roux-en-Y gastric bypass or vertical sleeve gastrectomy between 2010 and 2013 and had at least 6 months of preoperative enrollment. Researchers assessed all psychiatric diagnoses and medications up to 2 years before surgery for the cohort; preoperative mental illness status was categorized as either no mental illness, mild to moderate depression or anxiety, severe depression or anxiety, or bipolar, psychotic and schizophrenia spectrum disorder. Primary outcome was change in body weight after surgery expressed as total weight loss percentage and change in BMI from baseline; secondary outcomes included access of acute health care after surgery.
Within the cohort, 57% had preoperative mental illness, 44% had mild to moderate depression or anxiety, 6% had severe depression or anxiety, and 6% had bipolar, psychotic and schizophrenia spectrum disorder.
Researchers observed no between-group differences for weight loss, but patients with preoperative severe depression or anxiety or bipolar, psychosis and schizophrenia spectrum disorders had higher follow-up levels of ED visits and hospital days compared with those with no mental illness. Among patients with no mental illness, mean total weight loss percentage at 12 months after surgery was 31.6% after Roux-en-Y gastric bypass and 25% after vertical sleeve gastrectomy; results were similar for those with preoperative mental illness.
Compared with patients who had no mental illness, patients with bipolar, psychotic and schizophrenia spectrum disorder were 40% less likely to have no ED visits at 3 months after surgery; this pattern continued at 1 and 2 years’ follow-up, the researchers reported. Among patients with any ED visits, those with a bipolar, psychotic and schizophrenia spectrum disorder had 70% more visits vs. those with no mental illness at 1 and 2 years after surgery.
“Study findings should not be taken as an indication to liberalize mental health clearance criteria to unstable patients,” the researchers wrote. “Our finding of increased acute care use in patients with mental illness should be considered during the process of consenting patients for surgery and also postoperatively.”
In commentary accompanying the study, James E. Mitchell, MD, the Chester Fritz distinguished professor emeritus at the University of North Dakota in Fargo, wrote that the most important finding was that those with mental illness, even in its more severe forms, can experience significant weight loss after bariatric surgery that is similar to weight loss seen in patients without mental illness.
“Given the severity of medical complications associated with severe obesity, 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,” Mitchell wrote. “Such a diagnosis can no longer be considered a viable exclusion criterion.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.