ADHD, self-reported mental health and weight loss 10 years after metabolic-bariatric surgery during adolescence

Abstract

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is overrepresented among children and adults with obesity, but knowledge about how ADHD may affect outcomes following metabolic and bariatric surgery (MBS) is limited. The aim of this study was to examine mental health and weight outcomes after undergoing MBS during adolescence in individuals with and without ADHD. Methods: In a multicenter prospective study, 81 adolescents (13-18 years; mean BMI 45.5 kg/m²) underwent Roux-en-Y gastric bypass between 2006 and 2009. ADHD and Autism Spectrum Disorder (ASD) were assessed using the Adult ADHD Self-Report Scale and Autism Quotient 10 respectively, or clinical diagnosis. BMI, anxiety, depression, and binge eating were measured before MBS and at 1-, 2-, 5-, and 10-year follow-ups. Results: ADHD was present in 33 of 81 participants (41%). At 10-year follow-up, 91% of individuals with ADHD reported anxiety or depression, compared to 21% in the group without ADHD (p=0.002), despite no reported difference at baseline. A significant time-by-group interaction (p=0.018) indicated increasing differences between groups over time. Binge eating returned to preoperative levels in the ADHD group (p<0.001) after 10 years following initial improvement. No significant difference in BMI was observed at 10 years, but weight loss was significantly lower in the ADHD-group at 2 and 5-year follow-ups. At the 10-year follow-up, significantly more participants with clinical diagnosis of ADHD had dropped out (56% vs 25%, p=0.013). ASD was present in 14 out of 81 participants (17%) and showed a high degree of overlap with ADHD (79%). Conclusions: ADHD was associated with higher levels of anxiety, depression, and binge eating 10 years after MBS during adolescence. Weight loss was lower in the ADHD group at 2 and 5 years but not at 10 years, potentially due to a high dropout in the ADHD group at 10 years. Preoperative screening for ADHD in adolescents with early initiation of treatment and tailored postoperative follow-up may improve long-term outcomes.