CME/CE: Bariatric Surgery & Mental Health

CME/CE: Bariatric Surgery & Mental Health
Author Information (click to view)

Aaron J. Dawes, MD

Fellow, VA/RWJF Clinical Scholars Program
PhD Candidate, UCLA Fielding School of Public Health
Resident, Department of Surgery
David Geffen School of Medicine at UCLA David Geffen School of Medicine
Ronald Reagan UCLA Medical Center

Aaron J. Dawes, MD, has indicated to Physician’s Weekly that he has received grants/research aid from the Department of Veterans Affairs, the VA/Robert Wood Johnson Foundation Clinical Scholars Program, and the UCLA Fielding School of Public Health.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians and nurses.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Discuss the results of a systematic review that was conducted to examine the prevalence of mental health conditions in patients seeking and undergoing bariatric surgery as well as to evaluate two important connections between surgery and mental health.

Method of Participation(click to view)

Release Date: 12/21/2016

Expiration Date: 12/21/2017

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwDec05.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Physician Assistants
NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.

 

Nursing

AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is awarded 0.5 contact hours.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Aaron J. Dawes, MD
Discloses no financial relationships with pharmaceutical or medical product manufacturers:
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Aaron J. Dawes, MD (click to view)

Aaron J. Dawes, MD

Fellow, VA/RWJF Clinical Scholars Program
PhD Candidate, UCLA Fielding School of Public Health
Resident, Department of Surgery
David Geffen School of Medicine at UCLA David Geffen School of Medicine
Ronald Reagan UCLA Medical Center

Aaron J. Dawes, MD, has indicated to Physician’s Weekly that he has received grants/research aid from the Department of Veterans Affairs, the VA/Robert Wood Johnson Foundation Clinical Scholars Program, and the UCLA Fielding School of Public Health.

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Mental health conditions appear to be common among patients seeking and undergoing bariatric surgery, particularly depression and binge eating disorder. These conditions may represent mental health comorbidities of obesity and warrant the same attention, both pre- and postoperatively, as more commonly discussed physical health comorbidities like diabetes and hypertension.
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Bariatric surgery is recognized as a viable option to promote weight loss and to treat obesity-related comorbidities among the severely obese. “While bariatric surgery is increasingly being used with some success, less attention has been paid to the mental health of patients with obesity and how this may influence the outcomes of patients who undergo these types of procedures,” explains Aaron J. Dawes, MD. Studies estimate that about one in five Americans has a mental health condition, including about 8% who are depressed, and another 1% to 5% who have a binge eating disorder. Previous research has suggested that these conditions may be more common among bariatric surgery patients, but no good estimates exist to suggest how common.

To address this research gap, Dr. Dawes and colleagues performed a systematic review, which was published in JAMA, to examine the prevalence of mental health conditions in patients seeking and undergoing bariatric surgery. The analysis also evaluated two important connections between surgery and mental health. First, the researchers explored if preoperative mental health conditions were associated with differences in weight loss after surgery. Second, they examined if surgery was associated with changes in the clinical course of mental health conditions.

 

Taking a Closer Look

For the study, investigators searched trusted resources for studies published between January 1988 and November 2015 using terms like bariatric and obesity as well as the names of obesity surgery procedures, psychiatric disorders, and eating disorders. After screening nearly 2,300 articles, the authors identified 68 publications that met their inclusion criteria: 59 reported on the prevalence of preoperative mental health conditions (involving 65,363 patients) and 27 reported associations between preoperative mental health conditions and postoperative outcomes (involving 50,182 patients).

According to the results, 23% of patients seeking and undergoing bariatric surgery had been diagnosed with a mood disorder. “Most clinicians might not be surprised that mood disorders were more common among this population, but it was surprising to find that nearly one in four patients carried a diagnosis at the time of evaluation for surgery,” Dr. Dawes says. The three most common individual mental health conditions in the study were depression, binge eating disorder, and anxiety (Table). The authors also found that 9% of patients seeking and undergoing bariatric surgery had previous thoughts of suicide whereas 3% had previous substance abuse disorders and 1% had PTSD.

“Our estimates for depression and eating disorders were significantly higher than established rates for the general United States population,” says Dr. Dawes. “This suggests that special attention should be paid to these conditions when managing bariatric surgery patients.” In addition, clinicians should be vigilant about identifying other mental health conditions, such as psychosis, PTSD, and personality disorders. Although they appear to be less common, they may be more prominent in select subgroups, such as U.S. veterans.

Dr. Dawes noted that there was conflicting evidence regarding the association between preoperative mental health conditions and postoperative weight loss. “Depression and binge eating disorder were not consistently associated with differences in weight outcomes,” he says. “However, bariatric surgery was consistently linked to decreases in the prevalence of depression and the severity of depressive symptoms after the procedure. While surgery shouldn’t be viewed as a treatment for depression, it’s possible that severely obese patients with depression may gain psychological benefits from surgery in addition to the myriad of physical benefits that are already associated with the procedure.”

 

Considering Safety

According to the study, the safety of patients with mental health conditions who undergo surgery appears to be complex. Higher rates of alcohol abuse were seen in patients who underwent some bariatric procedures—particularly among Roux-en-Y gastric bypass (RYGB) recipients—when compared with similar groups that were treated without surgery. This increase in alcohol consumption after RYGB may be due to physiological changes following intestinal bypass that are not present after other procedures, such as laparoscopic adjustable gastric banding. More research is needed to assess whether bariatric patients are at higher risk for suicide and alcohol abuse and to establish the most appropriate methods for postoperative monitoring in patients with a history of depression or substance abuse.

National guidelines recommend routine preoperative health assessments, including a review of patients’ mental health conditions, but a more comprehensive, preoperative mental health exam may be necessary for those undergoing bariatric surgery. There are a variety of scales that focus on mental health diagnoses rather than psychosocial factors, and more studies are needed to further establish the roles of self-esteem, mental image, cognitive function, temperament, support networks, and socioeconomic stability.

“As we continue to gain a better understanding of these issues, physicians should make efforts to address mental health conditions in bariatric surgery patients and direct them to the appropriate resources,” says Dr. Dawes. “Our evidence suggests that, in this patient population, mental health conditions should be seen as comorbidities that require directed care, just like physical health conditions.”

Readings & Resources (click to view)

Dawes AJ, Maggard-Gibbons M, Maher AR, et al. Mental health conditions among patients seeking and undergoing bariatric surgery. JAMA. 2016;315:150-163. Available at: http://jama.jamanetwork.com/article.aspx?articleid=2481004.

Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA. 2015;313:62-70.

van Hout GC, Verschure SK, van Heck GL. Psychosocial predictors of success following bariatric surgery. Obes Surg. 2005;15:552-560.

Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22:70-89.

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