medwireNews: Obese people with bipolar disorder should not be denied bariatric surgery because of their psychiatric condition, say US researchers.
They found that such surgery did not increase the risk for hospitalization or the use of outpatient psychiatric services among stable patients with bipolar disorder.
Given that patients with bipolar disorder have a higher prevalence of obesity and obesity-related comorbidities, this suggests that “people with stable [bipolar disorder] can be evaluated for bariatric surgery using the same criteria as other patients,” say the study authors, led by Ameena Ahmed (The Permanente Medical Group, San Francisco, California).
Among 144 severely obese individuals (average body mass index [BMI], 42 kg/m2) with bipolar disorder who underwent bariatric surgery, just 13 (9.0%) were admitted to a psychiatric hospital during more than 2 years of follow-up. This was not significantly different to the 10.6% of 1440 patients with bipolar disorder who did not undergo such surgery.
After taking into consideration factors such as age, ethnicity, psychiatric medication use, baseline BMI, and comorbidities, the hazard ratio for psychiatric hospitalization following bariatric surgery was nonsignificant at 1.03, the team reports in Bipolar Disorders.
There was also no significant increase in the use of psychiatric outpatient services following surgery, with only a 0.5 visit per year difference in outpatient utilization from baseline to year 2 when compared with controls.
Reports of an increased risk for suicide following bariatric surgery were not supported by the study; in fact, all-cause mortality was lower in bariatric patients than controls, at 2.88 versus 8.96 deaths per 1000 person–years of follow-up.
The researchers point out that the study participants all had stable bipolar disorder, having not been admitted to hospital in the year prior to surgery and with no current substance abuse or dependence. They therefore cannot surmise how bariatric surgery affects disease course in patients with unstable bipolar disorder.
They conclude that, with the increasing use of bariatric surgery to treat severe obesity, “a complete knowledge of how this procedure affects psychiatric and metabolic course for patients with psychiatric diagnoses is needed,” including its effects on structural, functional, and neurochemical measures.
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