Nederlandse Obesitas Kliniek, Huis ter Heide, The Netherlands.
Faculty of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands.
Clin Obes. 2020 Aug;10(4):e12373. doi: 10.1111/cob.12373. Epub 2020 May 18.
Patients that have psychiatric comorbidity are thought to lose less weight than the general bariatric population and are therefore sometimes denied surgery. However, there is no scientific evidence for this assumption. The aim of this study is to evaluate the weight loss and health-related quality of life (HRQoL) in patients with psychiatric disorders who undergo bariatric surgery and compare these patients with a general bariatric population.
Patients who underwent bariatric surgery in 2015 were included. Patients who received individual counselling and had a current DSM IV axis 1 or 2 diagnosis were included in the psychiatric group (n = 163), all other patients in the generic group (n = 2362).Weight and HRQoL were assessed before and 12-, 24-, 36- and 48-months after surgery. Data was analysed using regression analyses.
The maximum total weight loss (TWL) was 27.4% in the psychiatric group vs 31.0% in the generic group. Difference in %TWL between the psychiatric and generic group was significant from baseline to all follow-up moments (P < .001). Improvement of PHS was significantly higher in the generic group from baseline to 12-month (P = .002), 24-month (P = .0018), 36-month (P = .025) and 48-monthfollow-up (P = .003). Change in mental HRQoL was only different comparing baseline to 48-monthfollow-up (P = .014).
Although weight loss and change in physical HRQoL was lower in patients with pre-operative psychiatric disorders, results of this group were still excellent. Thus, patients with psychiatric diagnoses benefit greatly from bariatric surgery and these patients should not be denied weight loss surgery.
患有精神共病的患者被认为比一般减重人群减重效果差,因此有时会被拒绝手术。然而,这一假设没有科学依据。本研究旨在评估接受减重手术的精神障碍患者的减重效果和健康相关生活质量(HRQoL),并将这些患者与一般减重人群进行比较。
纳入 2015 年接受减重手术的患者。接受个体咨询且目前有 DSM-IV 轴 I 或 II 诊断的患者被纳入精神科组(n=163),所有其他患者纳入普通组(n=2362)。在手术前和手术后 12、24、36 和 48 个月评估体重和 HRQoL。使用回归分析进行数据分析。
精神科组的最大总减重百分比(TWL)为 27.4%,普通组为 31.0%。精神科组和普通组之间的%TWL 差异从基线到所有随访时间均具有统计学意义(P<.001)。从基线到 12 个月(P=.002)、24 个月(P=.0018)、36 个月(P=.025)和 48 个月随访(P=.003),普通组的 PHS 改善明显更高。心理 HRQoL 的变化仅在与基线相比 48 个月随访时存在差异(P=.014)。
尽管术前有精神障碍的患者体重减轻和身体 HRQoL 变化较小,但该组的结果仍然非常出色。因此,患有精神诊断的患者从减重手术中获益极大,不应拒绝这些患者接受减重手术。