Mental Health and Weight Regain Post-Bariatric Surgery: An Association

Cameron Sowter, A/Prof Nicholas Williams

Introduction:

Mental health illnesses (MHI) rates are significantly higher within obese populations, reflecting a dynamic interplay. Bariatric-metabolic surgery (BMS) remains the most effective intervention for obese adults. Influence of pre-operative comorbidities on post-operative long-term outcomes, particularly weight regain (WR) are continual matters of debate, with conflicting evidence. Weight regain may lead to deterioration of gained metabolic improvements, lack of comorbidity resolution and declines in health-related quality of life.

Aim:

To investigate if pre-existing MHI is associated with WR in BMS patients.

Method/Description:

Participants were retrospectively recruited from a major regional centre. Weight data was obtained pre-operatively, and at regular post-operative intervals until five years. Weight regain definitions of TWL15 and TWL20 were used. Mental health illnesses were screened for at initial consultations and via referrals. Participants with less than two years follow-up or revisional procedures were excluded. Chi-square tests were conducted to provide statistical evidence of associations between pre-existing MHI data and each WR definition.

Results:

1631 participants were included, mean age of 43.5 (SD 11.24) and n=1132 participants (79.8%) female. Mental health illnesses were present in n=522 participants (32.0%) prior to BS. 219 and 112 participants were positive for WR at TWL15 and TWL20 respectively. Mental health illnesses were associated with increased rates of TWL15 and TWL20, statistically significant at TWL15 (p<0.05).

Discussion:

The observed association between MHI and WR suggests patients with MHI are more vulnerable to negative outcomes following BMS. Further research sub-categorising MHI and exploration of greater degrees of WR is recommended. Clinically, this sub-group of BMS patients may benefit from close follow-up to enhance maintenance of weight loss.

Conclusion:

Patients with pre-existing MHI are at increased risk of WR. Additional interventions and psychosocial support implemented in both the pre- and post-operative stages, may optimise outcomes long-term. And protect against deterioration of metabolic improvements gained from BMS.