Prevalence of mood, panic and eating disorders in obese patients referred to bariatric surgery: patterns of comorbidity and relationship with body mass index

Margherita Barbuti,Paola Fierabracci,Ferruccio Santini,Giulio Perugi,Francesco Weiss,Giulia Carignani,Giulio E Brancati,Guido Salvetti,Alba Calderone

doi:10.1007/s40519-021-01236-y

Margherita Barbuti, Paola Fierabracci + Show 7 more

Open Access

https://doi.org/10.1007/s40519-021-01236-y

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Abstract

PurposeWe aimed at investigating the lifetime prevalence of mood, eating and panic disorders in a large sample of obese patients referred to bariatric surgery. We also explored the patterns of psychiatric comorbidity and their relationship with Body Mass Index (BMI).MethodsThe sample was composed of patients consecutively referred for pre-surgical evaluation to the Obesity Center of Pisa University Hospital between January 2004 and November 2016. Clinical charts were retrieved and examined to obtain sociodemographic information, anthropometric variables and lifetime psychiatric diagnoses according to DSM-IV criteria.ResultsA total of 871 patients were included in the study; 72% were females, and most patients had BMI ≥ 40 kg/m2 (81%). Overall, 55% of the patients were diagnosed with at least one lifetime psychiatric disorder. Binge eating disorder (27.6%), major depressive disorder (16%), bipolar disorder type 2 (15.5%), and panic disorder (16%) were the most common psychiatric diagnoses. Mood disorders showed associations with panic disorder (OR = 2.75, 95% CI = 1.90–3.99, χ2 = 41.85, p = 0.000) and eating disorders (OR = 2.17, 95% CI 1.64–2.88, χ2 = 55.54, p = 0.000). BMI was lower in patients with major depressive disorder (44.9 ± 7.89) than in subjects without mood disorders (46.75 ± 7.99, padj = 0.017).ConclusionBariatric patients show high rates of psychiatric disorders, especially binge eating and mood disorders. Longitudinal studies are needed to explore the possible influence of such comorbidities on the long-term outcome after bariatric surgery.Level of evidenceV, cross sectional descriptive study.

Highlights

Obesity, defined by a body mass index (BMI = kg/m2) of 30 or greater, is a chronic disease with a multifactorial etiopathogenesis, involving genetics, environment, metabolism, lifestyle and behavioral components
The majority of patients was diagnosed with class III obesity (BMI ≥ 40 kg/m2), with more than three fourths of patients affected (N = 707, 81.2%)
A lower number of patients was diagnosed with class II obesity (35 kg/m2 ≤ Body Mass Index (BMI) < 40 kg/m2) (N = 139, 16.0%), while an almost negligible group of subjects was affected by class I obesity (BMI < 35 kg/m2) (N = 25, 2.8%)

Summary

Introduction

Obesity, defined by a body mass index (BMI = kg/m2) of 30 or greater, is a chronic disease with a multifactorial etiopathogenesis, involving genetics, environment, metabolism, lifestyle and behavioral components. Bariatric surgery is the most durable weightloss treatment for severe obesity. It is recommended in patients with a BMI greater than 40 kg/m2, or in those with a lower BMI if obesity-related comorbidities, such as type 2 diabetes and cardiovascular diseases, are present. Surgical treatment for obesity results in greater weight loss than conservative treatments, such as lifestyle interventions and pharmacological therapies, and is associated with significant improvement in obesity-related comorbidities and reduced mortality rate [2]. Psychiatric assessment is widely recommended during the multidisciplinary evaluation performed prior to bariatric surgery. Psychiatric disorders are thought to have an impact on various post-surgical outcomes, both in

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