Prospective Assessment of Medical and Psychiatric Comorbidities in the Massive Weight Loss Population Prior to Body Contouring Surgery

Goals/Purpose: The resolution of comorbidities after bariatric surgery is well documented. However, the medical and psychiatric comorbidities in the massive weight loss (MWL) population presenting for body contouring surgery are unique and have not been well characterized. With increased emphasis placed on comprehensive patient evaluation, knowledge of the composite comorbidities of the MWL population presenting for body contouring surgery is essential.

Methods/Technique: 170 consecutive massive weight loss patients (>50 lb weight loss) presenting for body contouring following bariatric surgery (n=150) or self weight loss from diet and exercise (n=20) were prospectively enrolled in our database. Patient demographics included age, weight loss method, and BMI indices. Patient comorbidities included hypertension, diabetes, GERD, sleep apnea, hypercholesterolemia, arthritis, depression, and anxiety. Multivariate logistic regression analyses were performed in order to determine the association between comorbidity resolution and Delta BMI after controlling for patient demographics and the pre-existing condition.

Results/Complications: 150 (88%) patients underwent bariatric surgery (GBP) and 20 (12%) underwent self weight loss from diet and exercise (DE). GBP patients had a greater Delta BMI (p<0.04) and lower Current BMI (p<0.03) than DE patients. Comorbidities did not improve significantly in the DE group, but there were significant improvements in hypertension, sleep apnea, diabetes, GERD, hypercholesterolemia in the GBP population (p<0.0001). Depression and anxiety did not improve significantly following bariatric surgery. In the multivariate logistic regressions, larger Delta BMI increased odds of resolving hypertension (OR=1.2; p=0.0032), sleep apnea (OR=1.2; p=0.0023), GERD (OR=1.1; p=0.0449), and hypercholesterolemia (OR=1.1; p=0.0674), after adjusting for patients age, gender, Max BMI, and the pre-existing condition.

Conclusion: Massive weight loss patients presenting for body contouring surgery have significantly improved medical comorbidity profiles, with larger improvements appreciated in GBP patients. This improved profile does not appear to extend to mental health issues. Body contouring surgeons should be aware of pre-existing psychiatric conditions in the massive weight loss population.