Depression is associated with increased severity of co-morbidities in bariatric surgical candidates.

BACKGROUND: Depression is prevalent among bariatric surgical patients, and previous studies have suggested a link between depression and quality of life. Our objective was to examine the relationship between depression and other co-morbidities of obesity at a university hospital in the United States. METHODS: Data were collected from 1368 consecutive patients evaluated for bariatric surgery. The demographic and co-morbidity profiles of these patients were compared between the depressed and nondepressed individuals. Depression was defined as an Assessment of Obesity-Related Co-morbidities score of > or = 3, signifying that the patient required medical treatment for (score of 3) or had complications of (score of 4-5) depression. RESULTS: The prevalence of depression among these patients was 36%. The mean age of the patients with depression was older (44.3 + or - 9.4 versus 42.2 + or - 9.6, P <.05), but the mean body mass index was similar. Depression was more prevalent among the female patients (37.4% versus 29.6%, P <.05). Diabetes mellitus, hypertension, polycystic ovarian syndrome, idiopathic intracranial hypertension, and obesity hypoventilation syndrome occurred with similar frequency and severity in persons with and without depression. The analysis revealed a significantly greater prevalence and severity of dyslipidemia (P <.05), gastroesophageal reflux disease (P <.05), back pain (P <.0001), joint pain (P <.05), sleep apnea (P <.01), stress incontinence (P <.01), and hernia (P <.05) among patients with depression. Overall, patients with depression had more co-morbidities per patient (5.46 versus 4.55) and a greater likelihood of severe or complicated co-morbidities (2.67 versus 1.89 per patient). CONCLUSION: This report has characterized a link between depression and other co-morbidities in bariatric surgical patients. This association was independent of the body mass index. Although a causal relationship could not yet be identified, our findings indicate that depression, in this patient population, is associated with a greater prevalence and increased severity of medical co-morbidities that express distinct physical symptoms.

Weight loss before gastric bypass: feasibility and effect on postoperative weight loss and weight loss maintenance.

BACKGROUND: This study was performed at a tertiary care university hospital. We hypothesized that weight loss before laparoscopic Roux-en-Y gastric bypass (LRYGB) is feasible, does not diminish the expected postoperative weight loss, and might enhance overall weight loss and maintenance. METHODS: A population of 351 consecutive patients, who had undergone LRYGB, was divided into 4 groups depending on the percentage of body weight loss achieved before surgery (group 1, none or gain; group 2, <5%; group 3, 5-10%; and group 4, >10%). Data were collected regarding the demographics, body mass index (BMI) change, and excess weight loss and analyzed by analysis of variance and Fisher's exact test at the alpha = 0.05 level. RESULTS: All groups were demographically similar in age and were predominantly women. The maximal follow-up was 36 months. Groups 3 and 4 had significantly greater initial excess weight and BMI (P <.05) but these became similar after the preoperative weight loss. Most patients (74%) were able to lose weight before surgery, with 36% losing >5% body weight. Preoperative weight loss did not decrease the magnitude of the expected postoperative weight loss. Patients who lost weight preoperatively demonstrated more excess weight loss and BMI change (from their initial weight) that was sustained far into the postoperative period and reached statistical significance at several points (P <.05). CONCLUSION: The results of this study have demonstrated that obese patients are capable of losing weight before LRYGB and that this weight loss does not negatively affect their expected postoperative weight loss. Furthermore, preoperative weight loss combined with LRYGB might result in better long-term excess weight loss and BMI change than surgery alone.