Bariatric Surgery in Patients With Schizophrenia

THEORETICAL FRAMEWORK. PROBLEM STATEMENT:

Background Obesity affects approximately 45-55% of patients with schizophrenia (1). Weight gain in these patients may be due to different factors such as the use of antipsychotic drugs with an unfavorable metabolic profile, the coexistence of sleep disorders or negative cognitive symptoms that often translate into a more sedentary lifestyle and alterations in eating behavior, among others (2). The coexistence of obesity and its comorbidities in this group of patients significantly worsens both their physical and mental health (3). In fact, cardiovascular disease is one of the main causes of mortality in patients with schizophrenia (4).

Lifestyle interventions, while they may be effective in people with schizophrenia (5), often fall short of achieving weight goals. At present, obesity surgery represents the most effective treatment in terms of weight loss and resolution of comorbidities, being indicated in cases of patients with a body mass index (BMI) > 35 kg/m2 with comorbidities or BMI > 40 Kg/m2 with/without comorbidities. However, the access of patients with schizophrenia to bariatric surgery techniques is usually limited by different factors such as fear of a possible worsening of the underlying disease, or a lower weight loss in this population, among others. In addition, clinical practice guidelines recommend that all patients with psychiatric pathologies be evaluated in a regulated manner prior to surgery (6), although the content of this evaluation and the criteria for declining or accepting surgery are not clear. Although the course of schizophrenia is variable and its symptoms may be stable without being a clear contraindication for bariatric surgery, in actual practice, a considerable number of professionals contraindicate bariatric surgery in the presence of a psychotic disorder (7).

For these reasons, data on the efficacy of bariatric surgery in patients with schizophrenia are scarce and limited to very small case series with short-term follow-up (2,8,9). Our objective is therefore to carry out a multicenter retrospective study that allows us to study the long-term evolution after bariatric surgery in a large series of patients, focusing not only on weight evolution but also on the long-term evolution of psychiatric pathology.

Justification It is necessary to have information about the prognosis of subjects with severe obesity and schizophrenia who undergo bariatric surgery. This knowledge will make it possible to establish clear guidelines for action in these cases.