In the Journals

Bariatric surgery does not improve overall mental health in adolescents with obesity

Kajsa Järvholm

Adolescents who underwent bariatric surgery and experienced subsequent substantial weight loss did not see overall mental health improvements at 5 years post-surgery compared with peers who received conventional treatment for obesity, according to results of a prospective cohort study conducted in Sweden and published in The Lancet Child & Adolescent Psychiatry.

“The main take-home message here is that mental health will not improve even after a massive weight loss,” Kajsa Järvholm, PhD, of the Childhood Obesity Unit at Skåne University Hospital in Sweden, told Healio Psychiatry. “It is a commonly held belief in Western societies that weight loss will lead to happiness; however, our data clearly show that this is not the case. Weight loss is beneficial in many ways (eg, reduced health risks, improved physical function), but it will not improve general mental health in young patients in a long-term perspective.”

According to Järvholm and colleagues, adolescents with severe obesity commonly experience mental health problems. However, little research exists on the long-term mental health outcomes for this patient population following bariatric surgery. The researchers conducted the present nonrandomized matched-control study to assess mental health outcomes over 5 years of follow-up after Roux-en-Y gastric bypass surgery among 81 Swedish adolescents who participated in the Adolescent Morbid Obesity Surgery Study. Before treatment, the average BMI for participants was 45. The researchers recruited a control group of 80 adolescents with an average BMI of 42 who received conventional lifestyle obesity management, including family therapy and cognitive behavioral therapy. They obtained data on psychiatric drugs dispensed and specialist treatment for behavioral and mental disorders before treatment and 5 years after from national registers with individual data. Further, those in the surgical group answered several questionnaires before surgery, as well as 1, 2 and 5 years after on mental health problems including self-esteem, mood, binge eating and other eating behaviors.

The researchers found that the proportion of participants prescribed psychiatric drugs was the same between groups prior to study inclusion and after intervention. The groups also had the same proportion of treatment for mental and behavioral disorders, but adolescents who received surgery had more specialized psychiatric treatment in the 5 years after treatment compared with the control group. Few patients discontinued psychiatric treatment after surgery, Järvholm and colleagues noted. Self-esteem improved in the surgical group after 5 years relative to baseline, but overall mood did not. Further, binge eating, emotional eating and uncontrolled eating were all reported less often than before the surgery.

“Many adolescents and their families present for bariatric surgery with an expectation of improved mental health after bariatric surgery,” Järvholm said. “We must inform them that undergoing weight loss surgery can have many benefits, but major improvements in mental health should not be expected. Instead, additional treatment should be offered that will actually address mental health problems, including followup for a longer time period. Most attention to the patient is given during the first year after surgery, but from a psychosocial perspective, it might be better to direct more attention during 2 years and beyond, when the weight loss phase is over and it is more apparent for the patient which aspects of life were improved and which were not improved.”

In a related editorial, Stasia Hadjiyannakis, MD, FRCPC, and Annick Buchholz, PhD, both of Children’s Hospital of Eastern Ontario at the University of Ottawa, underscored the implications of these study findings.

“These findings support the need for long-term mental health services to be integrated within pediatric interdisciplinary teams, for both conventional and surgical weight management, and caution against the suggestion that mental health outcomes will improve following surgical intervention,” they wrote. “The high burden of mental health risk in youth with severe obesity needs to be better understood. – by Joe Gramigna

Disclosures: Järvholm reports grants from Tore Nilsson’s Foundation, SUS Foundations and Donations, Capio Research Foundation and Mary von Sydow’s Foundation, as well as personal fees from NovoNordisk and Merck. Please see the study for all other authors’ relevant financial disclosures. The editorial authors report no relevant financial disclosures.

Kajsa Järvholm

Adolescents who underwent bariatric surgery and experienced subsequent substantial weight loss did not see overall mental health improvements at 5 years post-surgery compared with peers who received conventional treatment for obesity, according to results of a prospective cohort study conducted in Sweden and published in The Lancet Child & Adolescent Psychiatry.

“The main take-home message here is that mental health will not improve even after a massive weight loss,” Kajsa Järvholm, PhD, of the Childhood Obesity Unit at Skåne University Hospital in Sweden, told Healio Psychiatry. “It is a commonly held belief in Western societies that weight loss will lead to happiness; however, our data clearly show that this is not the case. Weight loss is beneficial in many ways (eg, reduced health risks, improved physical function), but it will not improve general mental health in young patients in a long-term perspective.”

According to Järvholm and colleagues, adolescents with severe obesity commonly experience mental health problems. However, little research exists on the long-term mental health outcomes for this patient population following bariatric surgery. The researchers conducted the present nonrandomized matched-control study to assess mental health outcomes over 5 years of follow-up after Roux-en-Y gastric bypass surgery among 81 Swedish adolescents who participated in the Adolescent Morbid Obesity Surgery Study. Before treatment, the average BMI for participants was 45. The researchers recruited a control group of 80 adolescents with an average BMI of 42 who received conventional lifestyle obesity management, including family therapy and cognitive behavioral therapy. They obtained data on psychiatric drugs dispensed and specialist treatment for behavioral and mental disorders before treatment and 5 years after from national registers with individual data. Further, those in the surgical group answered several questionnaires before surgery, as well as 1, 2 and 5 years after on mental health problems including self-esteem, mood, binge eating and other eating behaviors.

The researchers found that the proportion of participants prescribed psychiatric drugs was the same between groups prior to study inclusion and after intervention. The groups also had the same proportion of treatment for mental and behavioral disorders, but adolescents who received surgery had more specialized psychiatric treatment in the 5 years after treatment compared with the control group. Few patients discontinued psychiatric treatment after surgery, Järvholm and colleagues noted. Self-esteem improved in the surgical group after 5 years relative to baseline, but overall mood did not. Further, binge eating, emotional eating and uncontrolled eating were all reported less often than before the surgery.

“Many adolescents and their families present for bariatric surgery with an expectation of improved mental health after bariatric surgery,” Järvholm said. “We must inform them that undergoing weight loss surgery can have many benefits, but major improvements in mental health should not be expected. Instead, additional treatment should be offered that will actually address mental health problems, including followup for a longer time period. Most attention to the patient is given during the first year after surgery, but from a psychosocial perspective, it might be better to direct more attention during 2 years and beyond, when the weight loss phase is over and it is more apparent for the patient which aspects of life were improved and which were not improved.”

In a related editorial, Stasia Hadjiyannakis, MD, FRCPC, and Annick Buchholz, PhD, both of Children’s Hospital of Eastern Ontario at the University of Ottawa, underscored the implications of these study findings.

“These findings support the need for long-term mental health services to be integrated within pediatric interdisciplinary teams, for both conventional and surgical weight management, and caution against the suggestion that mental health outcomes will improve following surgical intervention,” they wrote. “The high burden of mental health risk in youth with severe obesity needs to be better understood. – by Joe Gramigna

Disclosures: Järvholm reports grants from Tore Nilsson’s Foundation, SUS Foundations and Donations, Capio Research Foundation and Mary von Sydow’s Foundation, as well as personal fees from NovoNordisk and Merck. Please see the study for all other authors’ relevant financial disclosures. The editorial authors report no relevant financial disclosures.