What is the effect of weight-loss surgery on psychological health in patients with type 2 diabetes and obesity?

This study investigated the psychological impact of Roux-en-Y gastric bypass with silastic ring (SR-RYGB) or sleeve gastrectomy (SG) in patients with type 2 diabetes (T2D) and obesity and associations with improved symptoms of depression and quality of life (QoL). The study showed that both types of bariatric (weight-loss) surgery were associated with significant improvements in depressive symptoms and QoL from baseline to 5 years.

Bariatric surgery includes gastric bypass and other types of weight-loss surgeries. These surgeries can aid in reducing excess weight and in lowering health risks that are associated with overweight such as improving or even reversing T2D. SR-RYGB and SG are two types of bariatric surgery. SR-RYGB involves the creation of a small stomach pouch that is then connected to the small intestine. SG is a procedure that involves the removal of a sizable portion of the stomach, resulting in a cylindrical, sleeve-shaped organ.

Most patients who have undertaken bariatric surgery have shown improvements in depression symptoms, anxiety and QoL. A minority of patients, however, do not experience improvements in psychological health. Sometimes, there is even deterioration in psychological health. Moreover, it is unknown whether this also extends to QoL. Since weight regain in patients after surgery depends on several factors, there is a need for psychological evaluations before surgery. However, there are currently no specific guidelines for psychological support of patients. The long-term psychological effect of bariatric surgery in patients with T2D and obesity remains unclear.

This study included 114 patients with obesity and T2D. Patients randomly received either SR-RYGB or SG and were evaluated for diabetes remission over 5 years. Patient data from the Hospital Anxiety and Depression Scale (HADS), RAND 36-item Health Survey, and weight were collected before and after surgery.

98 patients completed psychological follow-up assessments over 5 years. In both groups, symptoms of depression and most RAND-36 measures had significantly improved from baseline to 5 years.

6 patients that had SR-RYGB reported mild to depressive symptoms. 7 patients that had SG experienced mild to depressive symptoms. At 5 years, weight loss with SR-RYGB was 10.6% greater than with SG.

The study concluded that SR-RYGB and SG were associated with improved depression symptoms and QoL. However, weight loss was greater with SR-RYGB in patients with depressive symptoms before surgery.

This study did not include patients with severe clinical depression. Depressive symptoms were self-reported and may have been under-reported.