Background

Over 90% of bariatric surgery in Australia is privately funded. Most publicly funded metabolic and bariatric programs use physical comorbidities as entry criteria in addition to high BMI, with mental health and eating disorders often barriers to accessing these services. We sought to determine factors associated with psychological distress, eating disorder risk and quality of life.

Methods

All new patients attending a publicly funded metabolic service in South Western Sydney over 12 months from March 2018, were asked to complete questionnaires including SF-36, K10 and Eating Disorder Examination Questionnaire Short (EDE-QS). Their comorbidities, medications, demographic and anthropometric data were also recorded.

Results

Among 161 patients, 71% were female, mean(SD) age 49(14) years, BMI 51(9.2) kg/m2, 34% in paid employment. 54% had Type 2 Diabetes (T2D): 35% insulin treated, 65% hypertension, 63% dyslipidemia, 15% coronary artery disease (CAD), 48% sleep apnea, and 44% reflux disease. K10 scores showed moderate to severe distress in 50%, with over half having a moderate to high risk of an eating disorder on EDE-QS. All 8 domains of SF-36 scored significantly lower than the Australian norms. Negative correlations were found for BMI with K10, EDE-QS and 5/8 SF-36 domains, and for age with K10 and 4/8 SF-36 domains. On multivariate analysis, only a CAD history was significantly associated with K10 and 3/8 SF-36 domains, and employment status with K10 and 5/8 SF-36 domains.

Conclusions

Patients with severe obesity in this publicly funded metabolic program had high levels of unemployment, very high levels of psychological distress and risk of eating disorders, and a poor quality of life. Apart from degree of obesity, only age, employment status and history of CAD were associated with these impairments. Given the extremely high prevalence, there is a need for better identification and management of mental health and eating disorders in severe obesity, particularly in metabolic/bariatric programs.