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Differences in physical and mental health-related quality of life outcomes 3 years after bariatric surgery: a group-based trajectory analysis

  • Alaa Youssef
    Correspondence
    Correspondence: Alaa Youssef, B.Sc., Ph.D. Candidate, Research Fellow, Bariatric Surgery Program, Centre for Mental Health |University Health Network (UHN), Toronto Western Hospital, 399 Bathurst Street, Toronto, M5 T 2 S8, ON, Canada.
    Affiliations
    Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Bariatric Surgery Program, Toronto Western Hospital—University Health Network, Toronto, Ontario, Canada

    The Wilson Centre, University Health Network, Toronto, Ontario, Canada
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  • Charles Keown-Stoneman
    Affiliations
    Dalla Lana School of Public Health, Department of Biostatistics, University of Toronto, Toronto, Ontario, Canada

    Applied Health Research Centre (AHRC), St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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  • Robert Maunder
    Affiliations
    Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Susan Wnuk
    Affiliations
    Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Bariatric Surgery Program, Toronto Western Hospital—University Health Network, Toronto, Ontario, Canada
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  • David Wiljer
    Affiliations
    Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    The Wilson Centre, University Health Network, Toronto, Ontario, Canada

    Education, Technology & Innovation, UHN Digital, University Health Network, Toronto, Ontario, Canada
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  • Maria Mylopoulos
    Affiliations
    The Wilson Centre, University Health Network, Toronto, Ontario, Canada
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  • Sanjeev Sockalingam
    Affiliations
    Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Bariatric Surgery Program, Toronto Western Hospital—University Health Network, Toronto, Ontario, Canada

    The Wilson Centre, University Health Network, Toronto, Ontario, Canada

    Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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      Abstract

      Background

      While bariatric surgery has proven to be effective to achieve significant weight loss and short-term improvements in both physical and mental (HRQoL), little is known about the factors associated with long-term decline in mental HRQoL after bariatric surgery.

      Objective

      To examine differences in physical and mental HRQoL trajectories in a bariatric patient population 3 years after bariatric surgery and examine associated sociodemographic, weight, and mental health factors.

      Setting

      A Canadian academic bariatric care center.

      Methods

      A group-based trajectory model was used to examine physical and mental HRQoL trajectories 3 years after bariatric surgery. In a prospective cohort bariatric sample (n = 2270), demographic factors, body mass index, binge eating symptoms, anxiety symptoms (Generalized Anxiety Disorder-7), depressive symptoms (Patient Health Questionnaire-9), and physical and mental HRQoL (Short-form health survey-36 (SF-36)), were measured at baseline, 6 months, 1, 2, and 3 years respectively. The effect of time-varying covariates (body mass index, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7) were investigated to examine effects on physical and mental HRQoL trajectories.

      Results

      Five distinct trajectories described changes in (n = 1939 of 2270) individuals’ physical HRQoL outcomes (SF-36–physical health component summary score) and five other trajectories described changes in mental HRQoL (SF-36–mental health component summary score) outcomes from baseline to 3 years postsurgery. The group-based distribution for the 5 physical HRQoL trajectories were as follows: (1) low baseline-stable low (5.8%); (2) low baseline-moderate rise (12%); (3) low baseline-stable high (41.1%); (4) high baseline-stable high (33.2%); and (5) moderate baseline-decline (7.9%). The 5 mental HRQoL trajectories were as follows: (1) low baseline-slow decline (10%); (2) low baseline-stable high (25%); (3) high baseline-unstable rise (12%); (4) high baseline-stable high (48.9%); and (5) high baseline-transient decline (4.1%). Compared with physical HRQoL, mental HRQoL trajectories were not associated with changes in body mass index, yet strongly correlated with changes in binge eating symptoms, Generalized Anxiety Disorder-7, and Patient Health Questionnaire measures at all time points.

      Conclusion

      This study demonstrates distinct patterns in physical and mental HRQoL trajectories after bariatric surgery. The decline in mental HRQoL trajectories was more heterogeneous and associated with several psychosocial predictors that may be useful to guide risk prediction of long-term physical and mental HRQoL outcomes postbariatric surgery.

      Key words

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