Do Patients with Obesity and Mental Illness Do Worse Following Bariatric Surgery?
LewisFirst, MD, MS, Editor in Chief, Pediatrics
Children and teenagers who experience obesity can have a variety of comorbidities—mental
health issues being included in those comorbidities. In fact, some believe that the
presence of depression, anxiety, and even attention deficit hyperactivity disorder,
might contribute to poor weight loss outcomes post-operatively following bariatric
surgery such as a sleeve gastrectomy. Fortunately, Mackey et al. (10.1542/peds.2017-3432) opted to look into the problem of mental health issues in patients being considered
for sleeve gastrectomy compared to patients who were obese with mental health issues
but not seeking bariatric surgery. The authors compared 169 patients referred for
surgical evaluation with a mental health concern with 53 also referred with mental
health issues who did not seek surgery at one institution over a period of 8 years.
The results may surprise you in that the presence or absence of a mental health problem
or problems did not influence weight loss outcomes post-operatively. Given that 71%
of the teenagers in this study were diagnosed with a psychiatric illness, this study
gives those teenagers the good news that if they wish to undergo bariatric surgery,
they can succeed as much as those without a psychiatric illness. While this study
does not look at what happened to these patients who did get surgery in terms of their
mental health in the year following surgery, it will be interesting to see whether
the surgery changes the prevalence of mental health issues such as depression and
anxiety post-op that were present pre-op. The answer to that will hopefully weigh
heavily on investigators who can longitudinally track not only their weight loss post-op
but also the prevalence of co-morbidities like mental illness following bariatric
surgery. If there is improvement, it may further add to the potential benefit of considering
this method of treating obesity in young people.