Preoperative Psychiatric Diagnoses Not Associated With Bariatric Surgery Outcomes

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The most prevalent diagnoses were anxiety, depression, attention-deficit/hyperactivity disorder, and eating disorder.
The most prevalent diagnoses were anxiety, depression, attention-deficit/hyperactivity disorder, and eating disorder.

Psychiatric diagnoses are prevalent among adolescents with severe obesity, but are not associated with weight loss outcomes, according to study data published in Pediatrics.

Adolescents (n=222) referred for psychological evaluation at 1 institution for bariatric surgery between 2009 and 2017 completed semistructured clinical interviews to assess the presence of psychiatric diagnoses. Researchers performed comparison analyses between patients who did not receive bariatric surgery (n=53) and those who did (n=169). Longitudinal modeling was used to assess the association between preoperative diagnoses with weight loss outcomes between 3 and 12 months after surgery.

Of the total cohort, 71% of participants qualified for at least 1 psychiatric diagnosis and 34% had 2 or more diagnoses. The most prevalent diagnoses were anxiety (26%), depression (42%), attention-deficit/hyperactivity disorder (22%), and eating disorder (8%). Comorbid anxiety and depressive disorders accounted for 49% of those who had comorbid diagnoses. White participants were more likely to have an anxiety diagnosis (P =.04) or an eating disorder (P =.04), but race and/or ethnicity were not associated with depression, attention-deficit/hyperactivity disorder, or the number of diagnoses (all P >.05). Boys were more likely to have attention-deficit/hyperactivity disorder diagnoses (P =.001), but sex was not associated significantly with other diagnostic categories (all P >.05). The percentage of excess body mass index loss (%EBMIL) was 37.0% at 3 months, 45.9% at 6 months, 50.8% at 9 months, and 52.9% at 12 months postsurgery, respectively. %EBMIL from presurgery to 3-month follow-up and the rate of change in %EBMIL between 3 and 9 months postsurgery were positive predictors of %EMBIL at 12 months postsurgery. However, the presence or absence or number of psychiatric diagnoses before surgery was not associated with postsurgery weight loss outcomes.

As such, psychiatric diagnoses may not be a contraindication to weight loss surgery, although the presurgical psychological evaluation serves as an important opportunity to identify problems and provide appropriate therapeutic interventions for these patients.

Reference

Mackey ER, Wang J, Harrington C, Nadler EP. Psychiatric diagnoses and weight loss among adolescents receiving sleeve gastrectomy. Pediatrics. 2018;142(1):e20173432.

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