It seems to be a logical conclusion: Weight loss in severely obese teenagers will result in better mental health outcomes in addition to the more obvious health benefits. However, a new Swedish study published in The Lancet Child & Adolescent Health indicates that this may not be the case for adolescents who undergo bariatric surgery to aid in that weight loss.1
The researchers looked at adolescents who had participated in the Adolescent Morbid Obesity Surgery (AMOS) study and undergone Roux-en-Y gastric bypass surgery. The participants were aged 13 to 18 years and had a body mass index (BMI) of 40 kg/m2 or higher, or 35 kg/m2 or higher as well as an obesity-related comorbidity. The adolescents also had failed comprehensive conservative treatment. Using the Swedish Childhood Obesity Treatment Register, the researchers linked the participants with a control group who had undergone conventional obesity treatment and were matched by BMI, sex, and age. The surgical arm had 81 teenagers and the control arm had 80 teenagers.
Bypass patients still feel psychologic effects
The proportion of prescribed psychiatric drugs showed no difference between the 2 groups in both the years before the study (prebaseline: absolute risk difference, 5% [95% confidence interval (CI), −7 to 16], P=0.4263) and after the surgery (absolute risk difference, 10% [95% CI, −6 to 24], P=0.2175). Before the study, no difference was seen in the treatment for mental and behavioral disorders (absolute risk difference, 2% [95% CI, −10 to 14], P=0.7135). In the 5 years after the surgery, the intervention group did have more specialized psychiatric treatment than the control group (absolute risk difference, 15% [95% CI, 1-28], P=0.0410). Postsurgery, 3 teenagers discontinued psychiatric drug treatment and 6 stopped receiving specialized care for mental disorders.
Overall mood as indicated by the Mood Adjective Checklist (MACL) score showed no improvement after 5 years in teenagers who underwent surgery (mixed model mean [MMM], 2.8 [95% CI, 2.7-2.9] at 5 years vs MMM, 2.7 [95% CI, 2.6-2.8] at baseline, P=0.0737) than in the controls. However, self-esteem (Rosenberg Self-Esteem [RSE] score) did show improvement after 5 years (MMM, 21.6 [95% CI, 19.9-23.4]) relative to baseline (MMM, 18.9 [95% CI, 17.4-20.4], P=0.0059). Improvement in binge eating behavior at 5 years also was seen (MMM, 9.3 [95% CI, 7.4-11.2]) relative to baseline (MMM, 15.0 [95% CI, 13.5-16.5], P<0.0001).
The researchers said their findings indicate that although Roux-en-Y gastric bypass surgery offers many health benefits, including substantial weight loss, but improved mental health does not appear to be a benefit. To ensure that teenagers also reap mental health benefits, surgical teams that perform bariatric surgeries should include long-term mental health care as one element of care.
1. Järvholm K, Bruze G, Peltonen M, et al. 5-year mental health and eating pattern outcomes following bariatric surgery in adolescents: a prospective cohort study. Lancet Child Adolesc Health. January 21, 2020. Epub ahead of print.