Bariatric Surgery: Some Post-Op Measures Don't Change

The approximately 200,000 patients who undergo bariatric surgery expect significant results. So do their physicians. After all, bariatric surgery promises to deliver when all other attempts at weight reduction have failed. The Roux-en-Y gastric bypass (RYGB) is a popular, effective procedure. Researchers from Vestfold Hospital Trust in Norway recently conducted a randomized lifestyle intervention study in 165 patients who had undergone RYGB surgery to determine the magnitude of health and comorbidity improvements, change in psychopharmacologic drug use and change in employment over 2 years. They included prescription drug use for mental health issues and employment as measures of overall outcome, noting weight loss alone is not sufficient to define success.

The researchers had access to medical records and participant’s journal from before surgery and throughout the 2-year study period.

Weight loss was significant in study participants, with 83% losing more than half of their body weight at 2 years. The researchers found that patients who had preoperative type 2 diabetes mellitus, hypertension or metabolic syndrome were likely to see improvements.

• Among 51 patients diagnosed with T2DM before surgery, the condition went into remission in 40
• Two-thirds of patients who were taking antihypertensive drugs were able to discontinue their medication
• Metabolic syndrome resolved in 84 of 127 patients

The researchers did not see similar improvements in use of psychopharmacologic drugs including antidepressants. Before surgery, 34 patients were taking psychopharmacologic drugs (mostly antidepressants). After surgery, 31 patients continued to take psychopharmacologic drugs. Women were more likely to discontinue antidepressants than men. The researchers suggest that RYGB patients may not have received adequate attention to their psychological issues.

Unemployment was relatively unchanged. Before surgery, 61 patients were unemployed. After surgery, 54 patients remained unemployed. This finding is different than findings from other studies that report RYGB patients are more likely to return to work after successful weight loss. The authors note that more than half of their study participants remained obese despite their significant weight losses. Most of these patients had BMIs greater than 43 kg/m² before surgery.

The researchers recommend considering bariatric surgery before BMI exceeds 43 kg/m², and making greater efforts to treat and resolve mental illness. This article appears electronically ahead of print in the journal Obesity Surgery.