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Activity lowers depression risk post-bariatric surgery

Sunday February 17, 2013
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Adults undergoing bariatric surgery who are more physically active are less likely to have depressive symptoms and to have recently received medication or counseling for depression or anxiety than their less active counterparts, according to a study.

"Typically, clinical professionals manage their patientsí depression and anxiety with counseling and/or antidepressant or anti-anxiety medication," Wendy C. King, PhD, the studyís lead author and an epidemiologist at the University of Pittsburgh Graduate School of Public Health, said in a news release. "Recent research has focused on physical activity as an alternative or adjunct treatment."

Adults with severe obesity are nearly twice as likely to have a major depressive disorder (13.3%) or anxiety disorder (19.6%) when compared with the general population (7.2% and 10.2%, respectively). King noted the importance of treating these conditions before surgery, given that preoperative depression and anxiety increase the risk of occurrence of these conditions after surgery, and have been shown to have a negative impact on long-term, surgically-induced weight loss.

As part of the Longitudinal Assessment of Bariatric Surgery-2, an observational study designed to assess the risks and benefits of bariatric surgery, King and her colleagues used a small electronic device worn above the ankle to assess participantsí physical activity for a week before bariatric surgery. Participants also completed surveys to assess mental health functioning, depressive symptoms and treatment for psychiatric and emotional problems, including depression and anxiety. The study included 850 adults seeking bariatric surgery between 2006 and 2009 at 10 hospitals throughout the United States.

About a third of participants reported depressive symptoms, while two in five reported taking medication or receiving counseling for depression or anxiety. "Those who reported treatment were more likely to report impaired mental health functioning and depressive symptoms, highlighting the need for better treatment modalities," King said.

The association between physical activity and these outcomes was strongest when only moderate intensity physical activity was considered. However, the number of steps a person walked each day, no matter the pace, also was related.

"Another goal of the study was to determine physical activity thresholds that best differentiated mental health status," King said. "We were surprised that the thresholds were really low." One hour of moderate-intensity physical activity a week, or about 8.5 minutes a day, was associated with 92% lower odds of treatment for depression or anxiety among adults with severe obesity. Similarly, 4,750 steps a day — fewer than half the 10,000 steps recommended for a healthy adult — reduced odds of depression or anxiety treatment by 81%.

"It could be that, in this population, important mental health benefits can be gained by simply not being sedentary," King said.

Because this was an observational, cross-sectional study — meaning patientsí regular physical activity behavior and depressive symptoms were measured at the same time — the findings do not prove a cause-and-effect relationship between a patientís physical activity and mental health status.

"Results of the study are provocative, but we would need further research to verify that physical activity was responsible for lower levels of depressive symptoms in this patient population," said Melissa A. Kalarchian, PhD, a study co-author and associate professor at Western Psychiatric Institute and Clinic, part of the University of Pittsburgh Medical Center.

"Nonetheless, physical activity is a key component of behavioral weight management, and it is encouraging to consider that it may have a favorable impact on mental health as well."

The study appears in the February issue of the Journal of Psychosomatic Research. The study abstract is available at www.jpsychores.com/article/S0022-3999%2812%2900319-4/abstract.


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