title: Post-traumatic stress disorder (PTSD) is not a contraindication to gastric bypass in veterans with morbid obesity.
abstract: BACKGROUND
  The veteran population is routinely screened for post-traumatic stress disorder (PTSD). The prevalence of obesity in this population continues to increase. We examined whether weight loss outcomes in veterans with PTSD is comparable to results in veterans who do not suffer from PTSD, after gastric bypass. We also examined the effect of bariatric surgery on PTSD symptoms.
  
  
  METHODS
  This retrospective review of prospective data compares veterans with and without PTSD who underwent laparoscopic gastric bypass. Differences between the means of age, initial BMI, and percent excess weight loss were compared between the groups using a Student's t test. Pearson's chi(2) was used to evaluate the relationship between a diagnosis of PTSD, major depressive disorder (MDD), and other Axis I psychiatric disorders. A similar analysis was done to assess for a relationship between PTSD and obesity-related comorbidities, including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, and GERD.
  
  
  RESULTS
  We identified 24 patients who had gastric bypass and a diagnosis of PTSD before surgery and compared them to those without PTSD. Both groups had a similar mean age and initial BMI. There was no significant difference between the percent excess weight lost after 1 year follow-up between the PTSD group (66%) and the non-PTSD group (72%) (p = 0.102). In assessing comorbid conditions, we found a significant association between the diagnosis of PTSD and MDD (p = 0.002), PTSD and other Axis I disorders (p = 0.004), and PTSD and GERD (p = 0.002). However, we saw no significant association between PTSD and DM (p = 0.977), HTN (p = 0.332), and obstructive sleep apnea (OSA) (p = 0.676). The severity of PTSD symptoms fluctuated in the postoperative period.
  
  
  CONCLUSIONS
  Veterans with PTSD have comparable weight loss to those without PTSD after gastric bypass. In addition, surgery does not seem to have an adverse effect on PTSD symptoms, although PTSD symptomatology tends to fluctuate over time. Further study in this patient population is warranted.
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, CA 94304, USA.
authors.forename: Danagra G
authors.initials: DG
authors.lastname: Ikossi
authors.forename: Jose R
authors.initials: JR
authors.lastname: Maldonado
authors.forename: Tina
authors.initials: T
authors.lastname: Hernandez-Boussard
authors.forename: Dan
authors.initials: D
authors.lastname: Eisenberg
mesh_terms: D000328:Adult; D000368:Aged; D000075202:Contraindications; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*; D014728:Veterans