In the Journals

Psychiatric diagnoses did not predict teens' weight loss after bariatric surgery

Eleanor Mackey
Eleanor Mackey

Teenagers with severe obesity who undergo laparoscopic sleeve gastrectomy frequently have mental health diagnoses, including high rates of anxiety, depression and eating disorders; however, these mental health diagnoses did not affect BMI lost 12 months after surgery.

"Adolescents are different from adults and need to be treated and counseled by specialists who have expertise in severe obesity in this age group," Eleanor Mackey, PhD, a psychologist with the Obesity Program's IDEAL clinic at Children's National Health System, told Infectious Diseases in Children. "The good news is that surgery in adolescents appears to result in significant weight loss regardless of age, gender, ethnicity or presence of psychiatric diagnoses."

"We already knew that many children and adolescents with severe obesity have psychiatric diagnoses such as anxiety or depressive disorders, and it is still important to identify and treat all health and psychological concerns," she said. "Treating the whole child and getting them on a healthier overall path to adulthood is the primary focus of our work."

To examine the number of adolescents with severe obesity who also have a psychiatric diagnosis compared with those who do not undergo surgery, and to assess the relationship between psychiatric diagnoses received before surgery and weight loss achieved 3 and 12 months after surgery, Mackey and colleagues conducted semistructured clinical interviews of teenagers who were given a referral for mental health evaluation at an institution for bariatric surgery. These referrals were given between 2009 and 2017, and this information was used to determine the prevalence and number of diagnoses.

The researchers then compared the prevalence and number of psychiatric diagnoses in teenagers who did not undergo surgery with those who did undergo surgery. The relationship between weight loss outcomes 3 months and 12 months following surgery and preoperative psychiatric diagnoses were assessed using longitudinal modeling.

Of the 222 adolescents referred for psychological evaluation at the bariatric surgery institution, 169 underwent surgery and 53 did not. A range of zero to five diagnoses was present in this population (mean = 1.3; SD, 1.1), with 71% of teenagers having at least one mental health diagnosis. Over one-third (34%) had two or more diagnoses.

The most commonly diagnosed conditions included anxiety (26%), depression (42%), ADHD (22%) and eating disorders (8%). Small numbers of oppositional defiant disorder (n = 5), bipolar disorder (n = 4), autism spectrum disorder (n = 2), substance abuse (n = 2), intermittent explosive disorder (n = 2), schizophrenia (n = 1) and conduct disorders (n = 1) were observed.

When an χ2 analysis was conducted, no differences were observed between the rates or the number of psychiatric diagnoses between teenagers who underwent bariatric surgery and those who did not. Furthermore, race, ethnicity and sex were not linked to whether the adolescent received bariatric surgery.

When weight loss was examined at 3 months after surgery, excess BMI decreased by 37% on average (95% CI, 34.1%-39.5%). The percentage of excess BMI lost after 6 months was 45.9% (95% CI, 41.7%-51.3%), 50.8% after 9 months (95% CI, 44.6%-59.9%) and 52.9% after 12 months (95% CI, 45.9%-63.1%). No psychiatric diagnoses, the number of diagnoses or the patient demographics significantly contributed to the percentage of excess BMI lost 12 months after surgery.

"The findings of the study suggest that regardless of demographic or socioeconomic background, having a psychiatric diagnosis of any type before an adolescent has a vertical sleeve gastrectomy does not seem to make the treatment any more or less effective," Mackey said. "The presence of these mental health concerns should not stop providers from referring to a surgical consult when they see an adolescent who is not responding to other treatments and who has a BMI of 35 or greater with associated health problems or a BMI of 40 or greater."

"However, the high rates of psychiatric diagnoses in this population indicates their need for multidisciplinary specialty care from providers who are familiar with the unique challenges of this population, who can work together to treat the whole child, and who can establish him or her on a path to overall health and wellness," she added. – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

Eleanor Mackey
Eleanor Mackey

Teenagers with severe obesity who undergo laparoscopic sleeve gastrectomy frequently have mental health diagnoses, including high rates of anxiety, depression and eating disorders; however, these mental health diagnoses did not affect BMI lost 12 months after surgery.

"Adolescents are different from adults and need to be treated and counseled by specialists who have expertise in severe obesity in this age group," Eleanor Mackey, PhD, a psychologist with the Obesity Program's IDEAL clinic at Children's National Health System, told Infectious Diseases in Children. "The good news is that surgery in adolescents appears to result in significant weight loss regardless of age, gender, ethnicity or presence of psychiatric diagnoses."

"We already knew that many children and adolescents with severe obesity have psychiatric diagnoses such as anxiety or depressive disorders, and it is still important to identify and treat all health and psychological concerns," she said. "Treating the whole child and getting them on a healthier overall path to adulthood is the primary focus of our work."

To examine the number of adolescents with severe obesity who also have a psychiatric diagnosis compared with those who do not undergo surgery, and to assess the relationship between psychiatric diagnoses received before surgery and weight loss achieved 3 and 12 months after surgery, Mackey and colleagues conducted semistructured clinical interviews of teenagers who were given a referral for mental health evaluation at an institution for bariatric surgery. These referrals were given between 2009 and 2017, and this information was used to determine the prevalence and number of diagnoses.

The researchers then compared the prevalence and number of psychiatric diagnoses in teenagers who did not undergo surgery with those who did undergo surgery. The relationship between weight loss outcomes 3 months and 12 months following surgery and preoperative psychiatric diagnoses were assessed using longitudinal modeling.

Of the 222 adolescents referred for psychological evaluation at the bariatric surgery institution, 169 underwent surgery and 53 did not. A range of zero to five diagnoses was present in this population (mean = 1.3; SD, 1.1), with 71% of teenagers having at least one mental health diagnosis. Over one-third (34%) had two or more diagnoses.

The most commonly diagnosed conditions included anxiety (26%), depression (42%), ADHD (22%) and eating disorders (8%). Small numbers of oppositional defiant disorder (n = 5), bipolar disorder (n = 4), autism spectrum disorder (n = 2), substance abuse (n = 2), intermittent explosive disorder (n = 2), schizophrenia (n = 1) and conduct disorders (n = 1) were observed.

When an χ2 analysis was conducted, no differences were observed between the rates or the number of psychiatric diagnoses between teenagers who underwent bariatric surgery and those who did not. Furthermore, race, ethnicity and sex were not linked to whether the adolescent received bariatric surgery.

When weight loss was examined at 3 months after surgery, excess BMI decreased by 37% on average (95% CI, 34.1%-39.5%). The percentage of excess BMI lost after 6 months was 45.9% (95% CI, 41.7%-51.3%), 50.8% after 9 months (95% CI, 44.6%-59.9%) and 52.9% after 12 months (95% CI, 45.9%-63.1%). No psychiatric diagnoses, the number of diagnoses or the patient demographics significantly contributed to the percentage of excess BMI lost 12 months after surgery.

"The findings of the study suggest that regardless of demographic or socioeconomic background, having a psychiatric diagnosis of any type before an adolescent has a vertical sleeve gastrectomy does not seem to make the treatment any more or less effective," Mackey said. "The presence of these mental health concerns should not stop providers from referring to a surgical consult when they see an adolescent who is not responding to other treatments and who has a BMI of 35 or greater with associated health problems or a BMI of 40 or greater."

"However, the high rates of psychiatric diagnoses in this population indicates their need for multidisciplinary specialty care from providers who are familiar with the unique challenges of this population, who can work together to treat the whole child, and who can establish him or her on a path to overall health and wellness," she added. – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.