Despite small improvements in self-esteem and moderate improvements in binge eating, adolescents did not see improvements in their overall mental health after surgery. Photo by Mimimi9977 /Pixabay

Jan. 21 (UPI) -- Bariatric surgery can help teens struggling with their weight get healthier -- physically.

However, the mental and emotional problems many experience, due at least in part to being overweight, may persist long after successful surgery, says a study published Tuesday in the journal The Lancet Child & Adolescent Health.


"The transition from adolescence to young adulthood is a vulnerable time, not least in adolescents with severe obesity," study co-author Kajsa Järvholm, of Skåne University Hospital in Sweden, said in a statement. "We suggest that adolescents and their caregivers should be given realistic expectations in advance of embarking on a surgical pathway, and that as adolescents begin treatment, long-term mental health follow-up and support should be a requirement."

Specifically, Järvholm and her colleagues found that, five years after weight-loss surgery, despite small improvements in self-esteem and moderate improvements in binge eating, adolescents did not see improvements in their overall mental health, compared to peers who received conventional obesity treatment. The study included 161 adolescents and teens from the Scandinavian country.

In general, the number of young people undergoing bariatric procedures is rapidly increasing globally, although estimates suggest that fewer than 1,000 are performed annually in this age group in the United States.

Previous research has shown that bariatric surgery is safe and effective in adolescents, and the 2018 guidelines from the American Society for Metabolic and Bariatric Surgery state that this type of surgery should be considered the standard of care in adolescents with severe obesity.

A significant percentage of adolescents with severe obesity have coexisting mental health problems, however, and little is known about the long-term mental health consequences of bariatric surgery. For example, a 2018 study found no relief from mental health disorders when adolescents were questioned two years following surgery.

The Swedish study takes a longer-term view, using records of psychiatric drug prescriptions and specialist care for mental health disorders, in combination with self-reported data.

For the analysis, the authors recruited 81 Swedish adolescents with severe obesity -- average BMI before treatment was 45 -- who underwent Roux-en-Y gastric bypass surgery between 2006 and 2009, with 80 others -- who had an average BMI of 42 -- enrolled as controls, who received "conventional lifestyle obesity management," including cognitive behavioral therapy and family therapy.

The researchers compared data from a national registry on medication and specialist treatment for mental and behavioral disorders before treatment and five years after treatment with individual study participant data. In addition, participants in the surgical group reported their mental health problems -- including self-esteem, mood, binge eating and other eating behaviors -- using a series of questionnaires before surgery, and one, two and five years afterwards.

Before treatment, the proportion of adolescents prescribed psychiatric drugs was similar in both groups and substantially higher than the proportion in the general population -- 20 percent in the surgical group and 15 percent in the control group versus 2 percent in the general population.

Five years after surgery, the adolescents prescribed psychiatric drugs increased in both groups, and both groups also saw an increase in those who received specialist mental health care.

In addition, five years after treatment, self-reported measures of mental health -- including those covering binge eating, emotional eating and uncontrolled eating -- improved slightly in the surgical group, as did self-reported assessments of self-esteem. However, overall mood didn't improve among most of the participants in the surgical group.

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And, 36 percent of adolescents who had surgery went on to have hospital-based inpatient and outpatient care for mental health problems, compared to just 21 percent of those who didn't have surgery.

According to the authors, this doesn't necessarily mean that surgery exacerbates mental health problems. Rather, it could be that adolescents who undergo surgery are monitored more closely, and therefore get better access to mental health care.

"Our results provide a complex picture, but what's safe to say is that weight-loss surgery does not seem to improve general mental health," Järvholm said.