Prevalence of Behavioral Health Factors in Patients Undergoing Endoscopic Sleeve Gastroplasty and Impact on Weight Loss Outcomes

Introduction: Endoscopic sleeve gastroplasty (ESG) is an effective treatment for type I-II obesity. Previous reports note a higher prevalence of clinically significant psychiatric symptoms among patients undergoing ESG compared to the general population. However, there is limited data on preprocedural behavioral health profiles of patients undergoing ESG, especially as documented in the electronic medical record (EMR) including patient self-reported data. In a retrospective study based on review of the EMR, we evaluated the behavioral health profile of patients undergoing ESG at a tertiary medical center and the impact on procedural outcomes. Methods: Behavioral health data were obtained from a sample of patients (N=43) who underwent ESG at a tertiary medical center from 2019 to 2021. Procedural data and weight outcomes were extracted from a prospective endobariatric database. Behavioral data were abstracted from the EMR and included any mental health diagnosis, self-reported level of stress, alcohol use, and amount of exercise at time of consultation. Demographic frequencies were tabulated, and exploratory correlational and mean-comparison tests investigated the relationship of baseline variables to post-procedure percent total body weight loss (TBWL) at 3 timepoints (+3, +6, +12 months postop). Statistical analyses were performed using SPSS 25. Results: Demographic data are presented in Table 1. Seventeen patients (40%) had at least 1 documented mental health diagnosis in their medical history (Figure 1). At baseline, 18% of the patient sample endorsed consuming alcohol ≥ 2-3x/week, 54% reported exercising ≥ 3 days/week. Patients with documented mental health diagnosis demonstrated lower average TBWL (3%) at 3 months postoperatively (P< .05, d=.783). Although not statistically significant, this trend was also observed at 6 months and 12 months. Number of days of exercise/week was positively correlated with %TBWL at 6 months (P < .05; r=.942). Baseline perceived stress and rate of alcohol use were not significantly associated with weight loss. Conclusion: A substantial proportion of patients undergoing ESG have a mental health diagnosis at some point in their medical record. Presence of psychiatric diagnosis appears to be associated with reduced percent TBWL outcomes at 3 months postoperatively. Future studies should evaluate the efficacy of structured preoperative assessment and treatment of MH conditions in patients undergoing ESG.Figure 1.: Mental health prevalence by diagnosis. Table 1. - Sample characteristics Total sample (N = 43) Sex, female (n, %) 28 (65%) Average BMI at baseline (kg/m2) 37.89 Average weight at baseline (kg) 110.86 Mental health diagnosis (n, %) 17 (40%) Psychiatric medication prescription (n, %) 15 (33%) Exercise ≥ 3 days/week (n, %) 7 (17%) Alcohol use ≥ 2-3x/week (n, %) 8 (18%) BMI = Body mass index.