Wadden Thomas A, Butryn Meghan L, Sarwer David B, Fabricatore Anthony N, Crerand Canice E, Lipschutz Patti E, Faulconbridge Lucy, Raper Steven E, Williams Noel N
Department of Psychiatry, Weight and Eating Disorders Program, University of Pennsylvania School of Medicine, 3535 Market Street, Suite 3029, Philadelphia, PA 19104, USA.
Obesity (Silver Spring). 2006 Mar;14 Suppl 2:90S-98S. doi: 10.1038/oby.2006.288.
This study compared the psychosocial status and weight loss expectations of women with extreme (class III) obesity who sought bariatric surgery with those of women with class I-II obesity who enrolled in a research study on behavioral weight control.
Before treatment, all participants completed the Beck Depression Inventory-II and the Weight and Lifestyle Inventory. This latter questionnaire assesses several domains including symptoms of depression and low self-esteem, history of psychiatric complications, current stressors, and weight loss expectations.
Women with class III obesity, as compared with class I-II, reported significantly more symptoms of depression. Fully 25% of women in the former group appeared to have a significant mood disorder that would benefit from treatment. As compared with women with class I-II obesity, significantly more women with class III obesity also reported a history of psychiatric complications, which included physical and sexual abuse and greater stress related to their physical health and financial/legal matters. Both groups of women had unrealistic weight loss expectations. Those who sought surgery expected to lose 47.6 +/- 9.3% of initial weight, compared with 24.8 +/- 8.7% for those who enrolled in behavioral weight control.
These findings suggest that women with extreme obesity who seek bariatric surgery should be screened for psychosocial complications. Those determined to have significant psychiatric distress should be referred for behavioral or pharmacological treatment to alleviate their suffering. Long-term studies are needed to provide definitive guidance concerning the relationship between preoperative psychopathology and the outcome of bariatric surgery.
本研究比较了寻求减肥手术的极端肥胖（III 级）女性与参加行为体重控制研究的 I-II 级肥胖女性的心理社会状况和减肥期望。
在治疗前，所有参与者均完成了贝克抑郁量表第二版和体重与生活方式量表。后一份问卷评估了多个领域，包括抑郁症状和低自尊、精神并发症史、当前压力源以及减肥期望。
与 I-II 级肥胖女性相比，III 级肥胖女性报告的抑郁症状明显更多。前一组中整整 25%的女性似乎患有严重的情绪障碍，需要治疗。与 I-II 级肥胖女性相比，III 级肥胖女性中报告有精神并发症史的人数也明显更多，这些并发症包括身体和性虐待以及与身体健康和财务/法律事务相关的更大压力。两组女性的减肥期望都不切实际。寻求手术的女性预计体重减轻初始体重的 47.6±9.3%，而参加行为体重控制的女性为 24.8±8.7%。
这些发现表明，寻求减肥手术的极端肥胖女性应接受心理社会并发症筛查。那些被确定有严重精神痛苦的人应转介接受行为或药物治疗以减轻痛苦。需要进行长期研究，以提供关于术前精神病理学与减肥手术结果之间关系的明确指导。
