Discussion
obesity, Depressive, anxiety, pain, anxiety symptoms[In, depressive, depressive symptoms, depression, weight loss
OBESITY, BARIATRIC SURGERY CANDIDATE, TYPE 2 DIABETES, DISORDERS
In patients with obesity and type 2 diabetes, both SR-RYGB and SG were associated with significant improvements to depressive symptoms and quality of life scores from baseline to 5 years. The majority of this overall improvement occurred in the initial post-operative year when the greatest weight loss also occurred. Although improvements to depressive symptoms and quality of life plateaued after the first year, these remained as significant improvements from baseline at 5 years. In contrast, despite a significant improvement in anxiety symptoms from baseline to 1 year, this returned to baseline levels at 5 years. Pre-existing depressive symptoms tended to be associated with lower percent weight loss after SR-RYGB, but this was not significantly different at 5 years. Those with pre-existing depressive symptoms had greater weight loss at 1 year after SG, but then greater weight regain between 2 and 5 years, leading to similar weight loss at 5 years.Previous studies have indicated that both SR-RYGB and SG procedures produce similar improvements to depressive symptoms, anxiety symptoms[In line with previous research, both surgeries facilitated an improvement to the physical functioning, role limitations caused by physical health problems, energy/fatigue, bodily pain, and general health domains from baseline to 5 years, but there was no evidence of improved emotional wellbeing[Anxiety symptoms may be less likely to improve in comparison to depressive symptoms as a result of bariatric surgery, because although often overlapping disorders, they are inherently different with distinct psychological and physical symptoms. Depressive symptoms (in particular anhedonia which the HADS taps into) may be more likely to improve after bariatric surgery due to the well-established bidirectional association between depression and obesity[Literature exploring the impact of depressive symptoms on bariatric surgery outcomes is so far inconclusive[Higher prevalence of pre-existing mental health issues in bariatric surgery candidates, may reflect this being one of the reasons driving people to seek bariatric surgery[One of the most significant contributions of this study is the clinical implications these findings may have on the provision of psychological support throughout bariatric surgery treatment. Most bariatric services require a psychological evaluation prior to weight loss surgery [Although this study has several strengths, there were also some limitations. Firstly, this study did not include those with severe clinical depression so our conclusions are not generalisable to this group. In addition to this, indicators of pre-operative depressive symptoms were dependent on self-reported measures and previous research indicates that bariatric patients may underreport symptoms to avoid exclusion from surgery[