The Impact of Psychiatric History and Peri-operative Psychological Distress on Weight Loss Outcomes 1 Year After Bariatric Surgery.

Abstract

To determine if self-reported baseline psychological distress moderates the association between lifetime psychiatric diagnosis and weight loss 1year after bariatric surgery. An exploratory analysis assessed change in psychological distress from baseline on weight loss at 1year. A retrospective cohort study using data from the Ontario Bariatric Registry for all individuals undergoing surgery between January 1, 2012, and December 31, 2018, with a complete baseline psychological assessment and 1-year post-operative weight recorded (N = 11,159). Multiple linear regressions assessed the relationship between psychiatric diagnosis and percentage of excess body mass index loss (%EBMIL) at 1-year post-surgery, controlling for baseline body mass index, socio-demographics, medical co-morbidities, and surgical complications. Baseline psychological distress, measured with the EQ-5D-5L anxiety/depression rating, was examined as a moderator of this relationship. %EBMIL was separately regressed on change in psychological distress from baseline to 1year, controlling for psychiatric diagnosis. In the adjusted model, psychiatric diagnosis was associated with lower %EBMIL at 1year (B = - 1.00, P = .008). Baseline psychological distress was not a moderator, but had a significant main effect on %EBMIL (B = - .84, P = .001). Those who experienced a decrease in psychological distress at 1year, or remained low throughout, fared better than those who increased or had persistently high symptoms. These findings support use of a self-report assessment for psychological distress prior to bariatric surgery. Addressing active psychological distress prior to and/or following surgery may increase the likelihood of successful outcomes.