title: Health-related quality of life and psychological functioning 9 years after restrictive surgical treatment for obesity.
abstract: BACKGROUND
  Bariatric surgery leads to initial weight loss that is associated with improvement in mental health; however, long-term effects are uncertain.
  
  
  OBJECTIVE
  To investigate the impact of restrictive surgical treatment for obesity on weight loss, psychological functioning, and quality of life 9 years after surgery.
  
  
  METHODS
  University hospitals and obesity centers, Germany.
  
  
  METHODS
  152 patients undergoing restrictive surgical treatment (SURG), 249 individuals participating in a conventional weight loss treatment (CONV), and 128 obese control participants without weight loss treatment (OC) were studied using a prospective longitudinal cohort design. After 9 years, 55% of SURG patients, 51% of CONV patients, and 65% of OC participants were reassessed. Body mass index, anxiety, depression, self-esteem, and health-related quality of life (HRQOL) were explored.
  
  
  RESULTS
  The SURG group had significantly greater weight loss and improvements in physical HRQOL at all postbaseline assessments. Although SURG patients experienced initial improvements in depression, anxiety, self-esteem, and mental aspects of HRQOL, these improvements deteriorated at the 9-year assessment and were comparable to or worse than presurgical levels.
  
  
  CONCLUSIONS
  Bariatric surgery is an effective treatment for obesity and is linked to maintained improvement of physical aspects of HRQOL. Weight reduction after surgery is also associated with significant initial improvement in mental health that may erode over time. Therefore, psychosocial screening should be included at follow-ups, with referral to mental health professionals as appropriate.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital of the Ruhr University Bochum, Bochum, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Herpertz
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany. Electronic address: mueller.astrid@mh-hannover.de.
authors.forename: Astrid
authors.initials: A
authors.lastname: Müller
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital of the Ruhr University Bochum, Bochum, Germany.
authors.forename: Ramona
authors.initials: R
authors.lastname: Burgmer
authors.affiliation: Neuropsychiatric Research Institute and University of North Dakota, School of Medicine and Health Sciences, Fargo, North Dakota.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: de Zwaan
authors.affiliation: Department of Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr University Bochum, Hamm, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Legenbauer
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D008603:Mental Health; D009765:Obesity / Q000523:psychology / Q000601:surgery*; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology*; D012649:Self Concept; D013997:Time Factors; D016896:Treatment Outcome
keywords: Anxiety; Bariatric surgery; Conventional weight loss treatment; Depression; Health-related quality of life; Obesity; Self-esteem