Impact of Preoperative Mental Health on Long-term Weight Loss After Bariatric Surgery

Overview

This prospective cohort study evaluated the influence of preoperative mental health symptoms on weight loss outcomes up to 5 years following Roux-en-Y gastric bypass (RYGB). Findings suggest that specific psychiatric symptoms differentially affect initial and long-term weight loss trajectories, highlighting the importance of comprehensive preoperative mental health assessment.

Background

Obesity is a significant public health issue, with bariatric surgery being the most effective treatment for severe obesity (BMI > 35 kg/m2). Despite its efficacy, 20-30% of patients experience insufficient weight loss or regain after surgery. Mental health disorders such as anxiety, depression, and binge eating are prevalent among bariatric candidates and may influence postoperative weight outcomes, though evidence remains conflicting, especially regarding long-term effects beyond one year.

Data Highlights

Key Findings

• Preoperative depression, anxiety, and disordered eating symptoms were assessed using validated self-report scales (BDI-II, STAI, BITE, AUDIT-C).
• Preoperative psychiatric symptoms were associated with baseline BMI and influenced weight loss outcomes differently at 1 year versus up to 5 years post-RYGB.
• Patients with higher preoperative depressive symptoms showed distinct weight loss trajectories compared to those without such symptoms.
• Binge eating severity correlated with less favorable long-term weight loss outcomes.
• Alcohol use risk was screened but its direct impact on weight loss outcomes was not emphasized.
• A psychiatric profile combining multiple symptom domains may help predict postoperative weight trajectories.

Clinical Implications

Preoperative mental health screening should be integrated into bariatric surgery evaluation to identify patients at risk for suboptimal weight loss. Tailored psychological interventions targeting depression, anxiety, and disordered eating may improve long-term weight outcomes. Multidisciplinary care teams should consider these factors when planning postoperative management and follow-up.

Conclusion

Preoperative mental health symptoms significantly influence both initial and long-term weight loss after RYGB surgery. Comprehensive psychiatric assessment can enhance prediction of weight trajectories and guide personalized interventions to optimize bariatric surgery outcomes.

References

1. SMOB 2023 -- Swiss Society for the Study of Morbid Obesity and Metabolic Disorders Guidelines
2. Beck et al. 1996 -- Beck Depression Inventory II
3. Spielberger et al. 1983 -- State-Trait Anxiety Inventory
4. Henderson et al. 1987 -- Bulimic Investigatory Test, Edinburgh
5. Saunders et al. 1993 -- Alcohol Use Disorders Identification Test-Consumption