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Psychiatric disorders, adolescents and surgery

Psychiatric disorders should not disqualify adolescents from surgery

(Credit: Obesity Action Coalition)
There was no difference in outcome between those with diagnosed psychiatric disorders and those without at three and 12 months post-surgery.

Psychiatric disorders, a common comorbidity of severe obesity, especially for youth, should not disqualify an adolescent with severe obesity from bariatric surgery. According to a study published in Pediatrics, identifying anxiety, depressive disorders, ADHD, and eating disorders, while still a crucial pre-surgical evaluation step, had no predictive value for how much post-surgical weight loss an adolescent would achieve.

The study. ‘Psychiatric Diagnoses and Weight Loss Among Adolescents Receiving Sleeve Gastrectomy’, published in Pediatrics, is the first to look at a large, diverse sample of adolescent patients with severe obesity to understand the relationship between weight loss outcomes and pre-surgical psychiatric disorders. Some conventional wisdom held that these types of disorders could influence a patient's ability to adhere to the pre- and post-surgical guidelines and as a result might contraindicate surgical intervention.

"This procedure actually seems to be equally beneficial across ages, race/ethnicity and presence or absence of psychiatric disorders for weight loss," said Dr Eleanor Mackey, lead author of the study and a psychologist with the Obesity Program's IDEAL clinic at Children's National Health System. "Unlike other interventions that may be influenced by cultural or socioeconomic factors, surgical intervention appears to offer all kids the same opportunity to succeed. Most important, there's no scientific basis for denying an adolescent this procedure based simply on the presence of a psychiatric disorder. This does not mean adolescents should not be evaluated and treated for these disorders, which themselves have a significant impact on functioning and quality of life, but in terms of weight loss after surgery, the presence of psychiatric disorders is not predictive of outcomes."

In total, 222 adolescents who were referred for psychological evaluation at Children's National for bariatric surgery (2009–2017) completed semi-structured clinical interviews to assess the presence and number of psychiatric diagnoses. Comparison analyses were conducted between those who did not end up receiving surgery (n=53) and those who underwent laparoscopic sleeve gastrectomy (n=169) Using longitudinal modelling, the researchers assessed the association of preoperative diagnoses with weight loss outcomes between three and 12 months after surgery.

They reported that 71 percent of adolescents qualified for a psychiatric disorder but found no differences in rates of specific disorders or numbers of diagnoses between those receiving surgery and those not receiving surgery. The presence or absence or number of diagnoses before surgery was not associated with weight loss outcomes after surgery. Even after controlling for demographic factors in study participants, there was no difference in outcome between those with diagnosed psychiatric disorders and those without at three and 12 months post-surgery.

“The presurgical psychological evaluation serves as an opportunity to identify adolescents experiencing psychiatric problems and provide them with care but should not necessarily be considered a contraindication to surgery,” the authors concluded.

Little prior research exists looking specifically at the characteristics of adolescents with obesity who respond favourably to surgery. Recent guidelines echo these findings, but often different programmes or insurers have different criteria, they noted.

Future research will follow participants long term to continue building understanding of the relationship between post-surgical weight loss and these pre-existing psychiatric disorders.

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