Background

The detrimental effects of obesity and its associated diseases on health-related quality of life (HRQoL) are well-established. While bariatric surgery has proven to be effective to achieve significant weight loss and short-term improvements in both physical and mental (HRQoL), little is known about the factors associated with long-term decline in mental HRQoL(mHRQoL) after bariatric surgery.

Methods

A group-based trajectory model was used to examine HRQoL trajectories 3 years after bariatric surgery. In a prospective cohort population(n=2260), demographic factors, Body Mass Index (BMI), binge eating symptoms (BES), anxiety symptoms (GAD-7), depressive symptoms (PHQ-9), and HRQoL (SF-36) were measured at baseline, 6 months, 1, 2, and 3 years respectively. Multivariable linear regression was used to determine trajectories and psychosocial predictors associated with physical and mental (HRQoL) outcomes.

Results

Five HRQoL trajectories described changes in (n=1939 of 2260) individuals physical and mental (HRQoL) outcomes from baseline to 3 years post-surgery. The group-based distribution for physical HRQoL (pHRQoL) trajectories were: (1)low baseline-stable low (5.8%); (2) low baseline-moderate rise (12%); (3) low baseline-stable high (41.1%); (4) high baseline-stable high (33.2%); and (5) moderate baseline- decline (7.9%). While for mHRQoL were : (1) low baseline-low decline (10%); (2) low baseline-stable high (25%); (3) high baseline-steep decline (12%); (4) high baseline-stable high (48.9%); and (5) low baseline- late rise (4.1%). Compared to pHRQoL, mHRQoL trajectories were not associated with changes in BMI yet strongly correlated with changes in BES, GAD-7, and PHQ-9 measures at all time points.

Conclusions

This study demonstrates distinct patterns in pHRQoL and mHRQoL trajectories after bariatric surgery. The decline in mHRQoL trajectories was more heterogeneous and associated with several psychosocial predictors that may be useful to guide risk prediction of long-term HRQoL.