Patients with psychiatric comorbidity can safely undergo bariatric surgery with equivalent success
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Patients with psychiatric disorder were reported to have a poor outcome in bariatric surgery. Few studies have examined the outcome of laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) in patients with psychiatric history. We aimed to compare excess weight loss (%EWL) in patients with and without psychiatric comorbidities who underwent LSG or LAGB.
Patients undergoing LSG or LAGB were identified from our prospective database. A multidisciplinary team evaluated all patients preoperatively, including a psychological evaluation. Patients with the diagnosis of depression, anxiety, bipolar disorder, and schizophrenia were included in the psychiatric comorbidity group (PSY). Others were included in group NON-PSY. All patients were first screened to be psychologically stable to undergo surgery. Initial BMI and %EWL at 3, 6, and 12 months postoperatively were compared.
A total of 590 patients (81.4 % women), with a median BMI of 43.8 kg/m2 (range 30–99) who underwent LSG (n = 222) or LAGB (n = 368) from January 2006 to June 2013, were identified. Psychiatric comorbidities that were well controlled at the time of surgery were found in 188 patients (31.9 %). Diagnostic criteria for depression were met in 154 patients (26.1 %), 75 patients suffered from anxiety (12.7 %), 9 from bipolar disorder, and 4 from schizophrenia (0.7 %). Initial BMI was not different between the two groups. No significant difference in %EWL between the groups was found during follow-up (44.13 vs. 43.37 %EWL, respectively, at 1 year; p = 0.76). When LSG and LAGB patients were analyzed as subsets, again no difference in %EWL at 1 year was found for PSY vs. NON-PSY (LSG: 51.56 vs. 54.86 %EWL; LAGB: 38.48 vs. 38.45 %EWL, all p = ns). In multivariate analysis, the differences from unadjusted analysis persisted.
These findings demonstrate that a similar %EWL can be achieved in patients undergoing LSG or LAGB despite the presence of well-controlled psychiatric comorbidity.
KeywordsBariatric Abdominal Clinical papers Trials Research Obesity Gut G-I
Drs. Fuchs, Laughter, Harnsberger, Broderick, Berducci, DuCoin, Langert, Jacobsen, Sandler, Perry, and Horgan have no conflicts of interest or financial ties to disclose.
- 3.Look AHEAD Research Group, Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, Coday M, Crow RS, Curtis JM, Egan CM, Espeland MA, Evans M, Foreyt JP, Ghazarian S, Gregg EW, Harrison B, Hazuda HP, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Kitabchi AE, Knowler WC, Lewis CE, Maschak-Carey BJ, Montez MG, Murillo A, Nathan DM, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Regensteiner JG, Rickman AD, Ryan DH, Safford M, Wadden TA, Wagenknecht LE, West DS, Williamson DF, Yanovski SZ (2013) Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 369(2):145–154CrossRefGoogle Scholar
- 4.Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, Clegg AJ (2009) The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess 13(41):1–190, 215–357, iii–ivGoogle Scholar
- 6.American Society for Metabolic and Bariatric Surgery. Bariatric Procedures estimates. http://asmbs.org/2014/03/estimate-of-bariatric-surgery-numbers. Accessed 5 July 2014
- 10.Horgan S, Holterman MJ, Jacobsen GR, Browne AF, Berger RA, Moser F, Holterman AX (2005) Laparoscopic adjustable gastric banding for the treatment of adolescent morbid obesity in the United States: a safe alternative to gastric bypass. J Pediatr Surg 40(1):86–90; discussion 90-1Google Scholar
- 14.Dubovsky SL, Haddenhorst A, Murphy J, Liechty RD, Coyle DA (1985–1986) A preliminary study of the relationship between preoperative depression and weight loss following surgery for morbid obesity. Int J Psychiatry Med 15(2):185–196Google Scholar
- 16.Kalarchian MA, Marcus MD, Levine MD, Courcoulas AP, Pilkonis PA, Ringham RM, Soulakova JN, Weissfeld LA, Rofey DL (2007) Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry 164(2):328–334; quiz 374Google Scholar
- 27.Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J (2008) American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis 4(5 Suppl):S109–S184PubMedCrossRefGoogle Scholar
- 31.Gullick AA, Graham LA, Richman J, Kakade M, Stahl R, Grams J (2014) Association of race and socioeconomic status with outcomes following laparoscopic Roux-en-Y Gastric Bypass. Obes Surg. 2014 Oct 11 [Epub ahead of print]Google Scholar
- 33.Lelwica M, Hoglund E, McNallie J (2009) Spreading the religion of thinness from California to Calcutta: a critical feminist postcolonial analysis. JFSR 25(1):19–41Google Scholar