Sanita L Hunsaker1, Beth H Garland2, Dana Rofey3, Jennifer Reiter-Purtill1, James Mitchell4, Anita Courcoulas5, Todd M Jenkins6, Meg H Zeller7. 1. Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 2. Department of Pediatrics, Texas Children's Hospital, Houston, Texas. 3. Department of Psychiatry, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. 4. Department of Neuroscience, Neuropsychiatric Research Institute, Fargo, North Dakota. 5. Division of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 6. Division of Bariatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 7. Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: meg.zeller@cchmc.org.
Abstract
PURPOSE: We aimed to characterize prevalence, change, predictors, and correlates of psychopathology and associations with weight loss in adolescents with severe obesity 24 months after weight loss surgery (WLS) utilizing a controlled multisite sample design. METHODS: Adolescents undergoing WLS (n = 139) and nonsurgical comparisons with severe obesity (NSComp; n = 83) completed validated questionnaires assessing psychopathology and potential predictors and correlates at presurgery/baseline and 24 months postoperatively/follow-up. RESULTS: At 24 months, 34.7% of WLS and 37.7% of nonsurgical comparisons were categorized as "symptomatic" (Youth Self-Report ≥ borderline on at least one DSM scale). The majority maintained their symptomatic or nonsymptomatic status from baseline to 24 months postbaseline. Remission of symptoms was more common than the development of new symptomatology at 24 months. Beyond demographics, separate models of baseline predictors and concurrent correlates of 24-month psychopathology identified baseline psychopathology and loss of control (LOC) eating as significant. Alcohol use disorder (AUD) and LOC eating emerged as correlates in the concurrent model. For the WLS group, preoperative, postoperative, and change in symptomatology were not related to 24-month percent weight loss. CONCLUSIONS: At 2 years, approximately one in three adolescents were symptomatic with psychopathology. Maintenance of symptomatic/nonsymptomatic status over time or remission was more common than new incidence. Although symptomatology was not predictive of surgical weight loss outcomes at 2 years, preoperative psychopathology and several other predictors (LOC eating) and correlates (LOC eating, AUD) emerged as signals for persistent mental health risks, underscoring the importance of pre- and postoperative psychosocial monitoring and the availability of adjunctive intervention resources.
PURPOSE: We aimed to characterize prevalence, change, predictors, and correlates of psychopathology and associations with weight loss in adolescents with severe obesity 24 months after weight loss surgery (WLS) utilizing a controlled multisite sample design. METHODS: Adolescents undergoing WLS (n = 139) and nonsurgical comparisons with severe obesity (NSComp; n = 83) completed validated questionnaires assessing psychopathology and potential predictors and correlates at presurgery/baseline and 24 months postoperatively/follow-up. RESULTS: At 24 months, 34.7% of WLS and 37.7% of nonsurgical comparisons were categorized as "symptomatic" (Youth Self-Report ≥ borderline on at least one DSM scale). The majority maintained their symptomatic or nonsymptomatic status from baseline to 24 months postbaseline. Remission of symptoms was more common than the development of new symptomatology at 24 months. Beyond demographics, separate models of baseline predictors and concurrent correlates of 24-month psychopathology identified baseline psychopathology and loss of control (LOC) eating as significant. Alcohol use disorder (AUD) and LOC eating emerged as correlates in the concurrent model. For the WLS group, preoperative, postoperative, and change in symptomatology were not related to 24-month percent weight loss. CONCLUSIONS: At 2 years, approximately one in three adolescents were symptomatic with psychopathology. Maintenance of symptomatic/nonsymptomatic status over time or remission was more common than new incidence. Although symptomatology was not predictive of surgical weight loss outcomes at 2 years, preoperative psychopathology and several other predictors (LOC eating) and correlates (LOC eating, AUD) emerged as signals for persistent mental health risks, underscoring the importance of pre- and postoperative psychosocial monitoring and the availability of adjunctive intervention resources.
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