Psychosocial function before and after gastric banding surgery for morbid obesity. A prospective psychiatric study.

Abstract

Unlabelled: The objective of this study was to measure psychosocial functioning in morbid obese patients before and after horizontal gastric banding surgery, and to analyse the relations between the changes in psychosocial functioning and preoperative variables and degree of weight loss.

Methods: One hundred and three patients undergoing horizontal gastric banding surgery from 1982-85 were personally interviewed and rated by the author on DSM-III axis 1, 2 and 5, the CPRS, demographic data and precoded clinical scales. The interviews and ratings were completed in the last week before the operation. In addition the patients completed questionnaires concerning psychic symptoms (SCL-90) and quality of life. Twenty-five patients also completed the questionnaires six months before the operation. The patients were followed up after one and three years.

Results: There were 66 women and 24 men with a mean age of 35.4 years. Their mean preoperative weight was 121.8 kg corresponding to a Broca Index of 1.72 and a Body Mass Index of 41.5. They had a mean SCL-90/GSI score of 0.99. Fourty-one percent got a diagnosis on DSM-III axis 1 and 22% a diagnosis on axis 2. Thirty-seven percent had made at least one contact with health services before the operation due to psychiatric problems. There were no strong relations between the relative preoperative weight and any other preoperative variable. The follow-up rate was 93%. The patients had a mean weight loss of 34.9 kg after one year and 31.5 kg three years after the operation. On group level the course and outcome of psychosocial functioning was a beneficial one. These changes were highly statistically significant and evident after one year, with only slight differences to the three years follow-up. The degree of weight loss explained a modest but statistically significant part of the variance in most of the psychosocial outcome variables when the preoperative level of the variable and the preoperative weight were controlled for. The degree of psychiatric contact in the follow-up period seemed to reflect another dimension. It was not related to the changes in the other psychosocial outcome variables, nor to the degree of weight loss, but was highly correlated to the degree of preoperative psychiatric contact. A group of patients with negative psychosocial outcome was identified. This group was characterized by a higher frequency of preoperative psychiatric help-seeking, than the rest of the patients. This pattern was most evident in a subgroup of 19% of the patients, who had a negative psychosocial reaction in spite of a sufficient weight loss.(ABSTRACT TRUNCATED AT 400 WORDS)