Bariatric Surgery Doesn’t Offer Mental Health Benefit

ORLANDO, Fla — A new analysis of a major study of the long-term effects of bariatric surgery failed to prove a mental health benefit for this procedure, although it affirmed the general positive results for this approach to weight loss.

At the American Diabetes Association (ADA) 84th Scientific Sessions, Donald C. Simonson, MD, MPH, ScD, of Brigham and Women’s Hospital, Boston, presented an update on findings of a major research project that followed what happened to people who had sought weight loss interventions, the ARMMS-T2D. This project tracked some patients for as long as 12 years.

At the 2023 ADA meeting, major initial findings of the ARMMS-T2D were released which showed bariatric surgery produced sustained, long-term glucose control and weight loss in some US patients with type 2 diabetes and a baseline body mass index of at least 27 kg/m². At ADA this year, Simonson reported findings based on results of patients’ responses on a tool used to gauge people’s perceptions of their physical and mental well-being using the short-form health survey (SF-36).

Researchers compared reports for 228 patients, of whom 152 patients were initially randomized to metabolic/bariatric surgery interventions and 76 randomized to medical and lifestyle intervention. Some of these patients later underwent bariatric surgery. Still there were differences in the cumulative scores for these patient groups, Simonson reported.

Both groups initially showed an increase in physical component scores in the first few years after treatment, with greater gains for the surgical group (5.2 ± 0.8 vs 0.0 ± 1.1 units; P

But at the 12-year mark, patients in both groups generally reported less satisfaction with their physical health, as could be expected due to aging, Simonson said.

“There was a downward trend over time, which is not too surprising since patients are getting older and accumulating various concomitant diseases,” he told Medscape Medical News via email. “However, the group randomized to surgery had better physical function overall during the 12-year time period compared to the lifestyle group.”

There was no such clear pattern for the mental component scores, with small variations in scores over the years in both groups. At the 12-year mark, scores for both groups were little changed from the baseline with no significant change in either the surgical-start group (0.0 ± 1.0 units) or the lifestyle intervention group (0.7 ± 1.6 units).

Simonson noted that the SF-36 is a broadly designed and used tool, so it doesn’t have specific measures that might tease out responses to weight loss treatments.

“In retrospect, it would have been nice if we had planned 12 years ago to do some specific measure of mental health assessment, if we knew how the study was going to turn out,” Simonson said. “But we didn’t, so we are basically left with the assessment of mental health as it is done by the SF36.”

In an interview with Medscape Medical News, Richard M. Peterson, MD, MPH, the president-elect, American Society for Metabolic and Bariatric Surgery (ASMBS), agreed with Simonson’s assessment. The SF-36, while useful in research, is not designed to parse out the kind of differences that might have occurred between the groups in the ARMMS-T2D study.

“I would echo his point in that,” Peterson said.

The ARMMS-T2D project has its roots in four trials, each run by a leading institution among its own patients: The Cleveland Clinic, Cleveland; the University of Pittsburgh, Pittsburgh; Joslin Diabetes Center/Brigham and Women’s Hospital, Boston; and the University of Washington/Kaiser Permanente Washington, Seattle.

Researchers then decided to pool analysis of results comparing different forms of bariatric surgery with treatment based on lifestyle changes. These were initiated between 2007 and 2009. Around 2013, the researchers decided to seek National Institutes of Health funding for additional follow-up of the patients in the initial studies.

Screening, Counseling

Concerns about mental health issues are tackled early in discussions between bariatric surgeons and patients, Peterson said.

The ASMBS included a section on addressing psychosocial issues in its 2021 position statement on preoperative patient optimization before metabolic and bariatric surgery.

Prospective patients undergo evaluations by psychiatrist, psychologist, or licensed social workers, seeking to identify issues such as eating disorders or trauma that may need to be addressed, Peterson said.

There’s also an aim to make sure that the patients understand what bariatric surgery is going to do for them and how it can help them, but also to make sure they understand its limits.

“So they have a realistic understanding of what they’re getting into, and the support that they need following surgery,” said Peterson, who is also a professor of surgery at the University of Texas Health Science Center at San Antonio.

Simonson and Peterson did not have related financial disclosures. The National Institute of Diabetes and Digestive and Kidney Diseases provided funding for ARMMS-T2D.

Kerry Dooley Young is a freelance journalist based in Washington, DC.