MedicalResearch.com Interview with:
Aaron J. Dawes, MD
Fellow, VA/RWJF Clinical Scholars Program
Division of Health Services Research
University of California Los Angeles
Los Angeles, CA 90024
Medical Research: What is the background for this study? What are the main findings?
Dr. Dawes: We reviewed the published literature to answer three basic questions about bariatric surgery and mental health conditions.
First, how common are mental health conditions among patients being referred for or undergoing bariatric surgery?
- Second, do patients who carry a diagnosis of one of these conditions lose less weight after surgery than patients without these conditions?
- And, third, what happens to the clinical course of mental health conditions after patients undergo surgery? Do they get better, worse, or stay the same?
We found that mental health conditions are surprisingly common among bariatric patients, especially depression and binge eating disorder, which occur at almost twice the rate among bariatric patients than in the general U.S. population. We also found no strong evidence to suggest that patients with depression lose less weight after surgery and some evidence that the condition may actually improve after surgery. Eleven of the twelve studies on the topic found either lower rates or fewer symptoms of depression, at least during the first 3 years post-operatively.
Medical Research: What should clinicians and patients take away from your report?
Dr. Dawes: I think the biggest takeaway from our study has to do with how we think about mental health conditions in the setting of bariatric surgery. Most clinicians might not be surprised to hear that mental health conditions are more common among bariatric patients. However, I think many would be surprised to hear that certain conditions, such as depression and binge eating disorder, are twice as common in this group. Given this dramatic difference in prevalence, we believe that physicians performing bariatric surgery or referring patients for surgery need to be especially cognizant of their patients’ mental health needs and connect affected patients with appropriate mental health resources.
Moreover, I think there is a general sense that having a mental health condition might preclude a patient from undergoing bariatric surgery. While there are certainly times in which this may be the case, our study found that patients with depression, for example, have roughly the same outcomes from the operation and the same weight loss as patients without depression. Rather than automatically ruling patients out for surgery based of these diagnoses, it would be better to evaluate patients on an individualized basis and to think about mental health conditions as obesity-related comorbidities that need to be managed peri-operatively—just as we would with comorbid physical health conditions, like diabetes, hypertension, or sleep apnea.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Dawes: Although our study was not designed to determine whether or not surgery causes improvements in depression, we did find a large and consistent association between the two. Anecdotally, this association makes sense—patients may feel better about themselves after losing weight and becoming more active—but we were particularly surprised at the consistency and the magnitude of the improvements. Our data cannot tell us whether surgery was responsible for these improvements, but it does suggest that certain obesity-related mental health conditions may, in fact, respond to surgery as has been shown with many obesity-related physical health conditions. Obviously, we are not suggesting that surgery should be considered as a treatment for depression and other mechanisms—such as, psychosocial factors, biochemical changes, or selection—may be at work. Still, we were intrigued by the idea that mental health many improve for some patients after surgery and hope that future work can be directed at exploring this important relationship.
Dr. Aaron Dawes (2016). Mental Health May Improve For Some Patients After Bariatric Surgery