Despite Weight Loss, Mental Health Issues Likely to Persist After Adolescent Bariatric Surgery

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Although bariatric surgery can effectively treat obesity and related physical comorbidities in adolescents, mental health issues often persist in the years after the procedure.

Although bariatric surgery can effectively treat obesity and related physical comorbidities in adolescents, mental health issues often persist in the years after the procedure despite successful weight loss, according to study results published in The Lancet Child & Adolescent Health.

Given a lack of research examining long-term mental health outcomes in pediatric patients who undergo weight-loss surgery, researchers used data from the Adolescent Morbid Obesity Surgery study conducted in Sweden to assess 5-year changes in mental health in young patients with obesity who were treated surgically vs conventionally. Patients were followed up at 1, 2, and 5 years after surgery, and data on weight outcomes, mental health, and eating habits were collected. Patients in the control group were matched for body mass index (BMI), age, and sex.

Overall, 81 patients who underwent Roux-en-Y gastric bypass (mean age at baseline, 16.5 years; mean BMI at baseline, 45.5 kg/m2) were matched to 80 controls (mean age at baseline, 15.8 years; mean BMI at baseline, 42.2 kg/m2) for the analyses.

Rates of psychiatric drug use did not differ significantly between the groups from before baseline to 5-year follow-up, though both groups did experience a longitudinal increase in rate of drug use from before to after treatment. Rates of utilization of either inpatient or outpatient specialized psychiatric care also did not differ between the groups before baseline; however, within 5 years after baseline, the researchers noted that a significantly higher percentage of adolescents who underwent bariatric surgery required specialized psychiatric care (36% vs 21% of matched controls; P =.0410). Of note, in both the conventionally and surgically treated groups, only a small percentage of patients who received psychiatric care before treatment discontinued care after treatment (10% and 7%, respectively).

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With regard to mental health scores, bariatric surgery was associated with improvements in self-esteem at 5-year follow-up (P =.0059), but no improvement was seen for overall mood. At 5 years postoperation, the majority of patients who underwent surgery (72%) scored below the mean value for overall mood in an age-matched control group.

In the surgically treated group, scores for binge and uncontrolled eating were improved at 5 years after surgery (both P <.0001), and small but significant improvements in emotional eating and cognitive restraint were also noted. Percent change in BMI, however, was not significantly related to scores for mental health or eating problems at 5 years postsurgery.

The researchers noted that the variation in conventional treatments in the control group, which ranged from family therapy to cognitive behavioral therapy, was a limitation to the current study.

“From a mental health perspective, the transition from adolescence to young adulthood is a vulnerable time, not least in adolescents with severe obesity,” noted the researchers. “Metabolic and bariatric surgery does not seem to improve this situation; therefore, we suggest that long-term mental health support should be required in [programs] providing adolescent metabolic and bariatric surgery.”

“Communicating to adolescents with severe obesity and their caregivers that mental health problems will not automatically improve after a massive weight-loss appears important in order to encourage realistic expectations in advance of embarking upon a surgical pathway,” they concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Järvholm K, Bruze G, Peltonen M, et al. 5-year mental health and eating pattern outcomes following bariatric surgery in adolescents: a prospective cohort study [published online January 21, 2020]. Lancet Child Adolesc Health. doi:10.1016/ S2352-4642(20)30024-9