Skip to main content

Five-Year Changes in Psychiatric Treatment Status and Weight-Related Comorbidities Following Bariatric Surgery in a Veteran Population

Abstract

Background

Although bariatric surgery is an established treatment for obesity, less is known regarding the long-term effects of surgery on psychiatric function. This paper reports changes in psychiatric treatment status, weight, and weight-related comorbidities over 5 years of follow-up among a population of veterans completing bariatric surgery.

Methods

We assessed 55 veterans undergoing bariatric surgery at a single Veteran Affairs medical center for 5 years post-surgery. Patients completed a pre-surgery clinical interview with a licensed psychologist. Using computerized medical records, we tracked pre- to post-surgery involvement with antidepressants, anxiolytics, psychotherapies, and overall psychiatric treatment visits along with changes in weight and metabolic function.

Results

Rates of antidepressant use and/or involvement with psychotherapy for depression declined from 56.4 % at pre-surgery to 34.6 % at 5 years post-surgery, p = 0.01. Anxiolytic use and/or involvement with psychotherapy for anxiety, however, increased from 23.6 to 32.7 % pre- to 5 years post-surgery. Average psychiatric treatment volume remained similar to pre-surgery status across follow-up. These mixed indicators of psychiatric improvement occurred despite marked metabolic improvements from surgery. Mean percent excess weight loss = 51.7 and 41.3 (1 and 5 years post-surgery, respectively), systolic blood pressure (−6.8 mmHg (14.3)/−6.1 mmHg (12.8), respectively), glucose levels (−18.6 mg/dL (30.2)/−10.0 mg/dL (25.9), respectively), triglycerides (−78.2 mg/dL (96.7)/−69.1 mg/dL (102.2), respectively) and high-density lipoproteins (+7.1 (9.9)/+11.3 (11.3), respectively) levels each improved.

Conclusions

We report evidence of decreased antidepressant use and depression therapies following bariatric surgery, but no improvements on rates of anxiolytic use and anxiety therapies or on overall psychiatric treatment involvement. Despite metabolic improvements, bariatric patients with psychiatric histories may warrant ongoing attention to mental health.

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

Fig. 1

References

  1. Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery. A systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg. 2011;253:484–7.

    PubMed  Article  Google Scholar 

  2. Padwal R, Klarenbach S, Wiebe N, et al. Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Obes Rev. 2011;12:602–21.

    PubMed  Article  CAS  Google Scholar 

  3. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    PubMed  Article  Google Scholar 

  4. Leblanc ES, O’Connor E, Whitlock EP, et al. Effectiveness of primary care-relevant treatments for obesity in adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155:434–47.

    PubMed  Google Scholar 

  5. Shaw K, O’Rourke P, Del Mar C, et al. Psychological interventions for overweight or obesity. Cochrane Database Syst Rev. 2005;2:CD003818.

    PubMed  Google Scholar 

  6. Tian HL, Tian JH, Yang KH, et al. The effects of laparoscopic vs. open gastric bypass for morbid obesity: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011;12:254–60. doi:10.1111/j.1467-789X.2010.00757.x.

    PubMed  Article  CAS  Google Scholar 

  7. Dixon JB, Murphy DK, Segel JE, Finkelstein EA. Impact of laparoscopic adjustable gastric banding on type 2 diabetes. Obes Rev. 2011. doi:10.1111/j.1467-789X.2011.00928.x.

  8. Gill RS, Birch DW, Shi X, et al. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis. 2010;6:707–13.

    PubMed  Article  Google Scholar 

  9. Poirier P, Cornier MA, Mazzone T, et al. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011;19(123):1683–701.

    Article  Google Scholar 

  10. Batsis JA, Romero-Corral A, Collazo-Clavell ML, et al. Effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study. Mayo Clin Proc. 2008;83:897–907.

    PubMed  Google Scholar 

  11. Kalarchian MA, Marcus MD, Levine MD, et al. Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry. 2007;164:328–34.

    PubMed  Article  Google Scholar 

  12. Muhlhans B, Horbach T, de Zwaan M. Psychiatric disorders in bariatric surgery candidates: a review of the literature and results of a German prebariatric surgery sample. Gen Hosp Psychiatry. 2009;31:414–21.

    PubMed  Article  Google Scholar 

  13. Herpertz S, Kielmann R, Wolf AM, et al. Does obesity surgery improve psychosocial functioning? A systematic review. Int J Obes Relat Metab Disord. 2003;27:1300–14.

    PubMed  Article  CAS  Google Scholar 

  14. van Hout GC, Boekestein P, Fortuin FA, et al. Psychosocial functioning following bariatric surgery. Obes Surg. 2006;16:787–94.

    PubMed  Article  Google Scholar 

  15. Schowalter M, Benecke A, Lager C, et al. Changes in depression following gastric banding: a 5- to 7-year prospective study. Obes Surg. 2008;18:314–20.

    PubMed  Article  Google Scholar 

  16. de Zwaan M, Enderle J, Wagner S, et al. Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. J Affect Disord. 2011;133:61–8.

    PubMed  Article  Google Scholar 

  17. Cunningham JL, Merrell CC, Sarr M, Somers KJ, McAlpine D, Reese M, et al. Investigation of antidepressant medication usage after bariatric surgery. Obes Surg. 2012;22(4):530–5.

    PubMed  Article  Google Scholar 

  18. Hayden MJ, Dixon JB, Dixon ME, et al. Characterization of the improvement in depressive symptoms following bariatric surgery. Obes Surg. 2011;21:328–35.

    PubMed  Article  Google Scholar 

  19. Lier HO, Biringer E, Hove O, et al. Quality of life among patients undergoing bariatric surgery: associations with mental health—a 1 year follow-up study of bariatric surgery patients. Health Qual Life Outcomes. 2011;9:79.

    PubMed  Article  Google Scholar 

  20. Segal JB, Clark JM, Shore AD, et al. Prompt reduction in use of medications for comorbid conditions after bariatric surgery. Obes Surg. 2009;19:1646–56.

    PubMed  Article  Google Scholar 

  21. Jordan BK, Schlenger WE, Hough R, et al. Lifetime and current prevalence of specific psychiatric disorders among Vietnam veterans and controls. Arch Gen Psychiatry. 1991;48:207–15.

    PubMed  Article  CAS  Google Scholar 

  22. Karlsson J, Taft C, Rydén A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obesity. 2007;31:1248–61.

    Article  CAS  Google Scholar 

  23. Legenbauer T, Petrak F, de Zwaan M, et al. Influence of depressive and eating disorders on short- and long-term course of weight after surgical and nonsurgical weight loss treatment. Compr Psychiatry. 2011;52:301–11.

    PubMed  Article  Google Scholar 

  24. Assimakopoulos K, Karaivazoglou K, Panayiotopoulos S, et al. Bariatric surgery is associated with reduced depressive symptoms and better sexual function in obese female patients: a one-year follow-up study. Obes Surg. 2011;21:362–6.

    PubMed  Article  Google Scholar 

  25. Ertelt TW, Mitchell JE, Lancaster K, et al. Alcohol abuse and dependence before and after bariatric surgery: a review of the literature and report of a new data set. Surg Obes Relat Dis. 2008;4:647–50.

    PubMed  Article  Google Scholar 

  26. Suzuki J, Haimovici F, Chang G. Alcohol use disorders after bariatric surgery. Obes Surg. 2012;22(2):201–7.

    PubMed  Article  Google Scholar 

  27. Rutledge T, Adler S, Friedman R. A prospective assessment of psychosocial factors among bariatric versus non-bariatric surgery candidates. Obes Surg. 2011;21:1570–9. doi:10.1007/s11695-010-0287-8.

    PubMed  Article  Google Scholar 

  28. Nelson KM, Starkebaum GA, Reiber GE. Veterans using and uninsured veterans not using Veterans Affairs (VA) health care. Public Health Rep. 2007;122:93–100.

    PubMed  Google Scholar 

  29. Mitchell JE, Steffen KJ, de Zwaan M, et al. Congruence between clinical and research-based psychiatric assessment in bariatric surgical candidates. Surg Obes Relat Dis. 2010;6:628–34.

    PubMed  Article  CAS  Google Scholar 

Download references

Conflict of Interest

No grant support was employed in the completion of this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas Rutledge.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rutledge, T., Braden, A.L., Woods, G. et al. Five-Year Changes in Psychiatric Treatment Status and Weight-Related Comorbidities Following Bariatric Surgery in a Veteran Population. OBES SURG 22, 1734–1741 (2012). https://doi.org/10.1007/s11695-012-0722-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-012-0722-0

Keywords

  • Bariatric surgery
  • Obesity
  • Antidepressants
  • Anxiolytics
  • Veterans
  • Psychotherapy