Mean weight losses were less than have been previously reported with gastric restriction procedures but the follow-up was longer than usually reported and many patients had 'super obesity' prior to surgery. The implications of 'super obesity' for weight loss are discussed.
In this study, 100 patients were evaluated prior to surgery to assess psychiatric status. The demographic anthropometric and psychological characteristics are described. Seventeen patients developed severe psychiatric complications and required hospitalization; the diagnoses which precipitated hospital admission were most commonly affective disorders (especially major depression with suicidal ideation). The only deaths in the sample of 100 occurred among the patients who required post-surgical psychiatric hospitalization. The hospitalized group was compared to a matched group drawn from the original 100 patients. Factors associated with post-surgical psychiatric hospitalization were: presurgical psychiatric hospitalization, presence of multiple pre-surgical Axis I psychiatric diagnoses, and untreated Axis I diagnosis at the time of pre-surgical assessment. Psychiatric screening criteria were revised and 31 subsequent patients were evaluated; less than half of this group were found suitable for surgery at the time of preliminary assessment.
Fifteen anorexia nervosa patients were evaluated on hospitalization at their lowest weights; 10 were restudied after 25% of their weight deficit had been restored and five at 75% weight restoration. Cardiac function improved with weight gain, but different aspects of cardiac performance varied in their course of recovery. Restoration of normal cardiac rhythm occurred early in weight gain. Left ventricular mass index assessed by echocardiogram increased significantly by 25% weight restoration, while other echocardiographic abnormalities, including mitral valve prolapse, did not change markedly during weight recovery. Overall functional exercise capacity improved, but not until 75% of weight restoration. Consistent with the concept that systolic function lags in recovery, resting left ventricular ejection fraction (LVEF) actually demonstrated a trend to decline by the time 25% of the weight deficit was restored.
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