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5-year mental health and eating pattern outcomes following bariatric surgery in adolescents: a prospective cohort study
Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden; Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
National Institute for Health and Welfare, Helsinki, Finland.
Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.
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2020 (English)In: The Lancet. Child & adolescent health, ISSN 2352-4642, Vol. 4, no 3, p. 210-219Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Mental health problems are prevalent among adolescents with severe obesity, but long-term mental health outcomes after adolescent bariatric surgery are not well known. We aimed to assess mental health outcomes over 5 years of follow-up after Roux-en-Y gastric bypass surgery in adolescents who participated in the Adolescent Morbid Obesity Surgery (AMOS) study.

METHODS: or higher in addition to obesity-related comorbidity; who had previously undergone failed comprehensive conservative treatment; and were of pubertal Tanner stage III or higher, with height growth velocity beyond peak. A contemporary control group, matched for BMI, age, and sex, who underwent conventional obesity treatment, was obtained from the Swedish Childhood Obesity Treatment Register. Data on dispensed psychiatric drugs and specialist treatment for mental disorders were retrieved from national registers with complete coverage. In the surgical group only, questionnaires were used to assess self-esteem (Rosenberg Self-Esteem [RSE] score), mood (Mood Adjective Checklist [MACL]), and eating patterns (Binge Eating Scale [BES] and Three-Factor Eating Questionnaire-R21 [TFEQ]). This study is registered with ClinicalTrials.gov (NCT00289705).

FINDINGS: Between April 10, 2006, and May 20, 2009, 81 adolescents (53 [65%] female) underwent Roux-en-Y gastric bypass surgery, and 80 control participants received conventional treatment. The proportion of participants prescribed psychiatric drugs did not differ between groups in the years before study inclusion (pre-baseline; absolute risk difference 5% [95% CI -7 to 16], p=0·4263) or after intervention (10% [-6 to 24], p=0·2175). Treatment for mental and behavioural disorders did not differ between groups before baseline (2% [-10 to 14], p=0·7135); however, adolescents in the surgical group had more specialised psychiatric treatment in the 5 years after obesity treatment than did the control group (15% [1 to 28], p=0·0410). There were few patients who discontinued psychiatric treatment post-surgery (three [4%] receiving psychiatric drug treatment and six [7%] receiving specialised care for a mental disorder before surgery). In the surgical group, self-esteem (RSE score) was improved after 5 years (mixed model mean 21·6 [95% CI 19·9 to 23·4]) relative to baseline (18·9 [17·4 to 20·4], p=0·0059), but overall mood (MACL score) was not (2·8 [2·7 to 2·9] at 5 years vs 2·7 [2·6 to 2·8] at baseline, p=0·0737). Binge eating was improved at 5 years (9·3 [7·4 to 11·2]) relative to baseline (15·0 [13·5 to 16·5], p<0·0001). Relative changes in BMI were not associated with the presence or absence of binge eating at baseline.

INTERPRETATION: Mental health problems persist in adolescents 5 years after bariatric surgery despite substantial weight loss. Although bariatric surgery can improve many aspects of health, alleviation of mental health problems should not be expected, and a multidisciplinary bariatric team should offer long-term mental health support after surgery.

Place, publisher, year, edition, pages
Elsevier, 2020. Vol. 4, no 3, p. 210-219
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-80318DOI: 10.1016/S2352-4642(20)30024-9ISI: 000514855100016PubMedID: 31978372Scopus ID: 2-s2.0-85078353695OAI: oai:DiVA.org:oru-80318DiVA, id: diva2:1411033
Funder
Swedish Research CouncilVinnovaSwedish Child Diabetes FoundationSwedish Heart Lung FoundationTore Nilsons Stiftelse för medicinsk forskning
Note

Funding Agencies:

Västra Götalandsregionen  

ALF VG-region  

Region Stockholm 

SUS Foundations and Donations

Capio Research Foundation  

Mary von Sydow's Foundation 

Available from: 2020-03-02 Created: 2020-03-02 Last updated: 2024-01-02Bibliographically approved

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