title: Older bariatric surgery candidates: is there greater psychological risk than for young and midlife candidates?
abstract: BACKGROUND
  Although severe obesity is dramatically increasing in older adults, many bariatric programs use age cutoffs due to concerns about greater perioperative morbidity and mortality risks. More recently, surgical outcomes have been reported in older adults. However, a paucity of data is available on the psychological risks of older bariatric candidates. Our objective is to examine psychiatric risk factors and weight loss outcomes in older (≥65 yr) versus midlife (40-55 yr) versus young adult (18-29 yr) patients.
  
  
  METHODS
  Older, midlife, and young adults (n = 608) who underwent weight loss surgery (74.6% women, 75.6% white, mean body mass index 48.07 ± 9.61 kg/m2) at the Cleveland Clinic Bariatric and Metabolic Institute completed a psychiatric diagnostic interview, and the Minnesota multiphasic personality inventory-2-restructured form, binge eating scale, and Cleveland Clinic behavioral rating scale before surgery. The data gathered from follow-up visits and weight loss outcomes at 1, 3, 6, 9, 12, and 18 months after surgery were measured.
  
  
  RESULTS
  Young adults had a greater reduction in excess body mass index than those at midlife in the first 6 months but no age differences were noted in the following year. Older patients were less likely to have a suicide history but the groups were equivalent on other psychiatric variables and self-report measures. Psychologist evaluators rated older adults less favorably on the capacity to consent and realistic nature of expectations.
  
  
  CONCLUSIONS
  Although medical risks may cause concern, older adults do not demonstrate any increased psychological risk factors compared with midlife or young adult surgical candidates and evidenced equivalent weight loss. However, concerns with lower ratings on consent and expectations warrant additional research.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. heinbel@ccf.org
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Heinberg
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ashton
authors.forename: Amy
authors.initials: A
authors.lastname: Windover
authors.forename: Julie
authors.initials: J
authors.lastname: Merrell
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D050110:Bariatric Surgery / Q000523:psychology*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000523:psychology / Q000601:surgery*; D012307:Risk Factors; D015431:Weight Loss; D055815:Young Adult