|
|
Quality of Life and Mental Health in Adolescents Seeking Bariatric Surgery« Back to Volume 22, Issue 3, September 2006 - Table of Contents Zeller and colleagues conducted a medical chart review of standardized health-related quality of life (HRQoL) and depressive symptoms questionnaires administered to parents and extremely obese adolescents seeking bariatric surgery. A total of 33 consecutively referred youths, 13 to18 years of age, presenting for bariatric surgical evaluation and met eligibility criteria: demonstrated failure of 6 months of organized, medically-supervised weight loss attempts; a BMI ≥40 kg/m² in the presence of a severe obesity-related comorbidity, or a BMI ≥50 kg/m² in the presence of less severe comorbidities (Table). Data were collected as part of the family’s comprehensive clinic visit that included physiological, anthropometric, and psychological assessment. Adolescents completed the PedsQL, a generic HRQoL measure and the Beck Depression Inventory, while mothers completed the parent-proxy PedsQL and the Child Behavior Checklist. Self- and parent-proxy HRQoL scores were markedly impaired and significantly lower for the overweight adolescents compared to published norms for healthy adolescents. Gender differences were not generally apparent, although females exhibited poorer social functioning than males. The presence or absence of a medical comorbidity was unrelated to HRQoL scores. By self-report, 52% of the sample would be classified as experiencing a minimal level of depressive symptoms, 21% mild, 12% moderate, and 15% had severe levels of depressive symptoms (ie, approximately 30% of the sample reported clinically significant depressive symptoms). There were no significant gender differences. An even higher proportion (45%) fell in the clinical range for depressive symptoms by maternal report. However, only 21% of patients were currently engaged in some form of mental health treatment (eg, psychotropic medication or psychosocial treatment). Editor’s CommentThis report highlights the negative HRQoL and depressed mood associated with extreme obesity among youths seeking bariatric surgery. It would be premature, however, to conclude that it is the overweight and comorbid health states that are the sole or primary precipitants of the negative psychosocial and mental health status. Persons seeking gastric bypass experience poorer HRQoL than non-treatment-seeking individuals after controlling for BMI, age, and gender.1 Might it be that factors other than obesity (or in addition to) are contributing to the depressed mood in thosen seeking bariatric surgery?2,3 Opting for surgery without concomitantly addressing these factors would conceivably result in suboptimal outcomes. Other studies have reported that the presence of comorbid conditions contributes to some aspects of HRQoL impairment.1 As pointed out by this study’s authors, future research should include a comparison group of similarly obese adolescents not undergoing weight loss surgery to ascertain the influence of selection factors. Depressive symptoms (as well as being black, older, and experiencing lower self-concept) are associated with attrition from a pediatric weight-management program.2 In a recent review of the increasing prevalence of adolescent obesity, a major concern noted was that successful outcomes for effective bariatric surgery require lifelong adherence to prescribed dietary restrictions and medical follow-up.4 Adolescence is typically a period in which adherence to medical regimens is quite poor.5 For this reason, it is critically important to develop and implement alternative interventions before opting for what should be a last line of defense. In the study, inclusion criteria mandated that the patient demonstrate failure of other medically-supervised weight-loss intervention over the course of a 6-month trial. One might justifiably ask about the likelihood of lifelong regimen adherence post-surgery among adolescents who were unsuccessful in adhering to 6 months of lifestyle adjustment. Some bariatric surgical procedures result in malabsorption and lead to serious nutritional deficiencies if proper adherence to vitamin and mineral supplementation is not maintained. Rand conducted a 6-year follow-up study for adolescent bariatric surgery patients the results of which demonstrated very poor adherence.6 A recent commentary states that depression is typically the most common psychiatric disorder among adult bariatric surgery candidates, and these patients run the risk of becoming more depressed postoperatively due to lower brain serotonin levels from decreased intake, increased pain levels, and fear of complications.7 It is recommended that psychopathology be effectively treated prior to surgery. It has also been noted that bariatric surgery has a track record of therapeutic superiority compared with many other therapies for obesity. As rates of severe obesity increase over time, bariatric surgery may be an increasingly attractive option for insurers and employers facing rapidly increasing health care costs attributed to obesity and related comorbidities.8 The trends show a dramatic increase in adolescents exhibiting extreme obesity, doctors qualified to perform bariatric surgery, institutions providing bariatric surgery, as well as high rates of insurance coverage for bariatric surgery. All of these factors play a role in advocating surgery as an acceptable and effective treatment for obese adolescents, and may not take into consideration the many risks of physical complications, as well as the importance of psychosocial status prior to surgery in order to have a successful outcome, if surgery is deemed absolutely necessary. David E. Sandberg, PhD References - (linked to
|
Volume 24 Number 1
May 2008
www.GGHjournal.com
ISSN 1932-9032
)