Mental health quality of life after bariatric surgery: A systematic review and meta‐analysis of randomized clinical trials

Abstract

Recent literature has raised concerns regarding the risk of adverse psychiatric events among bariatric surgery patients. However, the relationship between weight loss therapy and psychiatric outcomes is confounded by baseline psychosocial characteristics in observational studies. To understand the impact of bariatric surgery on the risk of adverse mental health outcomes, we conducted a systematic review and meta‐analysis of randomized controlled trials that compared surgical and non‐surgical treatments and assessed mental health quality of life (QoL). We evaluated the PubMed, EMBASE, Web of Science PsycINFO, http://clinicaltrials.gov and Cochrane databases through 7 March 2018. Pooled standardized mean differences (SMDs) for mental health QoL scores were estimated using random effects models. Eleven randomized trials with 731 participants were included in the final analyses. Surgery was not associated with an improvement in mental health QoL from baseline as compared to non‐surgical intervention (SMD: 0.02, 95% confidence interval [CI] −0.22 to 0.25). Final mental health QoL scores were similar for surgically and non‐surgically treated patients (SMD: 0.37, 95% CI −0.07 to 0.81). Subgroup analyses assessing the effect of specific surgical interventions, and varying lengths of follow‐up did not identify a beneficial effect of bariatric surgery on mental health QoL outcomes. These results, in conjunction with the fact that individuals who choose bariatric surgery tend to have high‐risk baseline characteristics, suggest that intensive mental health follow‐up following surgery should be routinely considered.

Physical and Mental Health–Related Quality of Life Changes Among Insurer Subgroups Following Bariatric Surgery

“…Notably, prior to undergoing bariatric surgery, the MCS scores among both the patient group with Medicaid and the patient group with commercial insurance were at or near the US population norm. These findings generally align with those of other research on mental HRQOL among patients undergoing bariatric surgery: obesity has little impact on mental HRQOL .…”

“…Findings among the general patient population align with the current study’s findings; a recent meta‐analysis reported that bariatric surgery had a greater positive influence on physical HRQOL compared with mental HRQOL across 72 studies . Similarly, a second meta‐analysis found no effect of surgery on mental HRQOL following bariatric surgery among 11 randomized clinical trials, findings which also align with the current study’s report . Our findings support reporting group‐specific changes following bariatric surgery, as reporting overall findings may mask important policy‐relevant and clinically relevant differences.…”

“…In both postoperative time periods, the MCS scores did not undergo a meaningful clinical change among the insurer‐ and surgery‐type groups. Some evidence suggests there may be an inverse association between bariatric surgery and mental HRQOL, in which the psychological impacts of the surgery may actually worsen mental HRQOL over time or the incidence of postoperative mental health conditions increases . Our findings do not support this hypothesis and suggest that bariatric surgery has little impact on mental HRQOL postoperatively, regardless of the insurer group or surgery type.…”

Preoperative and post‐operative psychosocial interventions for bariatric surgery patients: A systematic review

“…Quality of life is a multidimensional construct composed of physical and mental components, yet bariatric surgery has a much greater impact on physical than mental quality of life . In fact, a recent meta‐analysis concluded that bariatric surgery does not improve short‐ or long‐term mental quality of life compared with nonsurgical interventions for obesity . Psychosocial factors, such as psychological comorbidities and various forms of disordered eating, impact mental quality of life .…”

“…4 In fact, a recent meta-analysis concluded that bariatric surgery does not improve short-or long-term mental quality of life compared with nonsurgical interventions for obesity. 18 Psychosocial factors, such as psychological comorbidities and various forms of disordered eating, impact mental quality of life. 7 Thus, improving psychosocial functioning is important in its own right because it reduces psychological distress and enhances well-being.…”