Skip to main content

Post-traumatic stress disorder (PTSD) is not a contraindication to gastric bypass in veterans with morbid obesity

Abstract

Background

The veteran population is routinely screened for post-traumatic stress disorder (PTSD). The prevalence of obesity in this population continues to increase. We examined whether weight loss outcomes in veterans with PTSD is comparable to results in veterans who do not suffer from PTSD, after gastric bypass. We also examined the effect of bariatric surgery on PTSD symptoms.

Methods

This retrospective review of prospective data compares veterans with and without PTSD who underwent laparoscopic gastric bypass. Differences between the means of age, initial BMI, and percent excess weight loss were compared between the groups using a Student’s t test. Pearson’s χ2 was used to evaluate the relationship between a diagnosis of PTSD, major depressive disorder (MDD), and other Axis I psychiatric disorders. A similar analysis was done to assess for a relationship between PTSD and obesity-related comorbidities, including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, and GERD.

Results

We identified 24 patients who had gastric bypass and a diagnosis of PTSD before surgery and compared them to those without PTSD. Both groups had a similar mean age and initial BMI. There was no significant difference between the percent excess weight lost after 1 year follow-up between the PTSD group (66%) and the non-PTSD group (72%) (p = 0.102). In assessing comorbid conditions, we found a significant association between the diagnosis of PTSD and MDD (p = 0.002), PTSD and other Axis I disorders (p = 0.004), and PTSD and GERD (p = 0.002). However, we saw no significant association between PTSD and DM (p = 0.977), HTN (p = 0.332), and obstructive sleep apnea (OSA) (p = 0.676). The severity of PTSD symptoms fluctuated in the postoperative period.

Conclusions

Veterans with PTSD have comparable weight loss to those without PTSD after gastric bypass. In addition, surgery does not seem to have an adverse effect on PTSD symptoms, although PTSD symptomatology tends to fluctuate over time. Further study in this patient population is warranted.

This is a preview of subscription content, access via your institution.

References

  1. Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, Eid GM, Mattar S, Ramanathan R, Barinas-Mitchel E, Rao RH, Kuller L, Kelley D (2003) Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg 238:467–485

    PubMed  Google Scholar 

  2. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737

    Article  CAS  PubMed  Google Scholar 

  3. Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, Nguyen NT, Li Z, Mojica WA, Hilton L, Rhodes S, Morton SC, Shekelle PG (2005) Meta-analysis: surgical treatment of obesity. Ann Intern Med 142:547–559

    PubMed  Google Scholar 

  4. Sugerman HJ, Kral JG (2006) Evidence-based medicine reports on obesity surgery: a critique. Int J Obes 29:735–745

    Article  Google Scholar 

  5. Nguyen NT, Ho HS, Palmer LS, Wolfe BM (2000) A comparison study of laparoscopic versus open gastric bypass for morbid obesity. J Am Coll Surg 191:149–155

    Article  CAS  PubMed  Google Scholar 

  6. Wittgrove A, Clark GW (2000) Laparoscopic gastric bypass, Roux-en-Y 500 patients: technique and results, with 3–60 month follow-up. Obes Surg 10:233–239

    Article  CAS  PubMed  Google Scholar 

  7. Conference NIH (1991) Gastrointestinal surgery for severe obesity: consensus development conference panel. Ann Intern Med 115:956–961

    Google Scholar 

  8. Marcus MD, Kalarchian MA, Courcoulas AP (2009) Psychiatric evaluation and follow-up of bariatric surgery patients. Am J Psychiatry 166:285–291

    Article  PubMed  Google Scholar 

  9. 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 164:328–334

    Article  PubMed  Google Scholar 

  10. Hsu LK, Benotti PN, Dwyer J, Roberts SB, Saltzman E, Shikora S, Rolls BJ, Rand W (1998) Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med 60:338–346

    CAS  PubMed  Google Scholar 

  11. Averbukh Y, Heshka S, El-Shoreya H, Flancbaum L, Geliebter A, Kamel S, Pi-Sunyer FX, Laferrere B (2003) Depression score predicts weight loss following Roux-en-Y gastric bypass. Obes Surg 13:833–836

    Article  PubMed  Google Scholar 

  12. Toussi R, Fujioka K, Coleman KJ (2009) Pre- and postsurgery behavioral compliance, patient health, and postbariatric surgical weight loss. Obesity (Silver Spring) 17:996–1002

    Article  Google Scholar 

  13. Hudson JI, Pope HG Jr, Wurtman J, Yurgelun-Todd D, Mark S, Rosenthal NE (1988) Bulimia in obese individuals; relationship to normal-weight bulimia. J Nerv Ment Dis 176:144–152

    Article  CAS  PubMed  Google Scholar 

  14. Marcus MD, Moulton MM, Greeno CG (1995) Binge eating onset in obese patients with binge eating disorder. Addict Behav 20:747–755

    Article  CAS  PubMed  Google Scholar 

  15. Yanovski SZ, Nelson JE, Dubbert BK, Spitzer RL (1993) Association of binge eating disorder and psychiatric comorbidity in obese subjects. Am J Psychiatry 150:1472–1479

    CAS  PubMed  Google Scholar 

  16. SAGES Guidelines Committee (2008) SAGES guideline for clinical application of laparoscopic bariatric surgery. Surg Endosc 22:2281–2300

    Article  Google Scholar 

  17. Bauchowitz AU, Gonder-Frederick LA, Olbrisch ME, Azarbad L, Ryee MY, Woodson M, Miller A, Schirmer B (2005) Psychosocial evaluation of bariatric surgery candidates: a survey of present practices. Psychosom Med 67:825–832

    Article  PubMed  Google Scholar 

  18. APA (1994) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DC

    Google Scholar 

  19. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry 52:1048–1060

    CAS  PubMed  Google Scholar 

  20. Clark MM, Balsiger BM, Sletten CD, Dahlman KL, Ames G, Williams DE, Abu-Lebdeh HS, Sarr MG (2003) Psychosocial factors and 2-year outcome following bariatric surgery for weight loss. Obes Surg 5:739–745

    Article  Google Scholar 

  21. Susce MT, Villanueva N, Diaz FJ, de Leon J (2005) Obesity and associated complications in patients with severe mental illnesses: a cross-sectional survey. J Clin Psychiatry 66:167–173

    Article  PubMed  Google Scholar 

  22. Coodin S (2001) Body mass index in persons with schizophrenia. Can J Psychiatry 46:549–555

    CAS  PubMed  Google Scholar 

  23. Keck PE Jr, McElroy SL (2003) Bipolar disorder, obesity, and pharmacotherapy-associated weight gain. J Clin Psychiatry 64:1426–1435

    Article  PubMed  Google Scholar 

  24. ADA, APA, AACE, NAASO (2004) Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 27:596–601

    Article  Google Scholar 

  25. Kolotkin RL, Corey-Lisle PK, Crosby RD, Swanson JM, Tuomari AV, L’italien GJ, Mitchell JE (2008) Impact of obesity on health-related quality of life in schizophrenia and bipolar disorder. Obesity (Silver Spring) 16:749–754

    Article  Google Scholar 

  26. Kalarchian MA, Marcus MD, Levine MD, Soulakova JN, Courcoulas AP, Wisinski SC (2008) Relationship of psychiatric disorders to 6-month outcomes after gastric bypass. Surg Obes Relat Dis 4:544–549

    Article  PubMed  Google Scholar 

  27. Grilo CM, White MA, Masheb RM, Rothschild BS, Burke-Martindale CH (2006) Relation of childhood sexual abuse and other forms of maltreatment to 12-month postoperative outcome in extremely obese gastric bypass patients. Obes Surg 16:454–460

    Article  PubMed  Google Scholar 

  28. Yehuda R (2002) Post-traumatic stress disorder. N Engl J Med 346:108–114

    Article  CAS  PubMed  Google Scholar 

  29. Breslau N, Davis GC, Schultz LR (2003) Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Arch Gen Psychiatry 60:289–294

    Article  PubMed  Google Scholar 

  30. Jackson JC, Hart RP, Gordon SM, Hopkins RO, Girard TD, Ely EW (2007) Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem. Crit Care 11:R27

    Article  PubMed  Google Scholar 

  31. Shalev AY, Freedman S, Peri T, Brandes D, Sahar T, Orr SP, Pitman RK (1998) Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry 155:630–637

    CAS  PubMed  Google Scholar 

  32. Shea MT, Zlotnick C, Dolan R, Warshaw MG, Phillips KA, Brown P, Keller MB (2000) Personality disorders, history of trauma, and posttraumatic stress disorder in subjects with anxiety disorders. Compr Psychiatry 41:315–325

    Article  CAS  PubMed  Google Scholar 

  33. Mills KL, Teesson M, Ross J, Peters L (2006) Trauma, PTSD, and substance use disorders: findings from the Australian National Survey of Mental Health and Well-Being. Am J Psychiatry 163:652–658

    Article  PubMed  Google Scholar 

  34. Horowitz MJ, Wilner N, Kaltreider N, Alvarez W (1980) Signs and symptoms of posttraumatic stress disorder. Arch Gen Psychiatry 37:85–92

    CAS  PubMed  Google Scholar 

  35. McFarlane AC (1989) The aetiology of post-traumatic morbidity: predisposing, precipitating and perpetuating factors. Br J Psychiatry 154:221–228

    Article  CAS  PubMed  Google Scholar 

  36. Bremner JD, Southwick SM, Johnson DR, Yehuda R, Charney DS (1993) Childhood physical abuse and combat-related posttramatic stress disorder in Vietnam veterans. Am J Psychiatry 150:235–239

    CAS  PubMed  Google Scholar 

  37. Dixon JB, Dixon ME, O’Brien PE (2003) Depression in association with severe obesity: changes with weight loss. Arch Intern Med 163:2058–2065

    Article  PubMed  Google Scholar 

  38. Magruder KM, Frueh BC, Knapp RG, Johnson MR, Vaughan JA III, Carson TC, Powell DA, Hebert R (2004) PTSD symptoms, demographic characteristics, and functional status among veterans treated in VA primary care clinics. J Trauma Stress 17:293–301

    Article  PubMed  Google Scholar 

  39. Buddeberg-Fischer B, Klaghofer R, Sigrist S, Buddeberg C (2004) Impact of psychosocial stress and symptoms on indication for bariatric surgery and outcome in morbidly obese patients. Obes Surg 14:361–369

    Article  PubMed  Google Scholar 

  40. Archibald HC, Tuddenham RD (1965) Persistent stress reaction after combat: a 20-year follow-up. Arch Gen Psychiatry 12:475–481

    CAS  PubMed  Google Scholar 

  41. Zaidi LY, Foy DW (1994) Childhood abuse experiences and combat-related PTSD. J Trauma Stress 7:33–42

    Article  CAS  PubMed  Google Scholar 

  42. Maldonado JR, Page K, Koopman C, Butler LD, Stein H, Spiegel D (2002) Acute stress reactions following the assassination of Mexican presidential candidate Colosio. J Trauma Stress 15:401–405

    Article  PubMed  Google Scholar 

  43. Hrabosky JI, Masheb RM, White MA, Rothschild BS, Burke-Martindale CH, Grilo CM (2006) A prospective study of body dissatisfaction and concerns in extremely obese gastric bypass patients: 6- and 12-month postoperative outcomes. Obes Surg 16:1615–1621

    Article  PubMed  Google Scholar 

  44. Jiang W, Gagliardi JP, Raj P, Silvertooth EJ, Christopher EJ, Krishnan KRR (2006) Acute psychotic disorder after gastric bypass surgery: differential diagnosis and treatment. Am J Psychiatry 163:15–19

    Article  PubMed  Google Scholar 

Download references

Disclosures

The authors have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dan Eisenberg.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ikossi, D.G., Maldonado, J.R., Hernandez-Boussard, T. et al. Post-traumatic stress disorder (PTSD) is not a contraindication to gastric bypass in veterans with morbid obesity. Surg Endosc 24, 1892–1897 (2010). https://doi.org/10.1007/s00464-009-0866-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-009-0866-8

Keywords

  • Bariatric
  • Obesity
  • PTSD
  • Veterans
  • Post-traumatic stress disorder
  • Gastric bypass