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Do Adverse Childhood Experiences Affect Surgical Weight Loss Outcomes?
Nayna a. Lodhia*, Ulysses S. Rosas, Michelle Moore, John M. Morton
Surgery, Stanford University, Stanford, CA
Introduction:
Adverse Childhood Experiences (ACEs) are known independent risk factors for chronic diseases. However, little is know about the influence of ACEs on weight loss following bariatric surgery. Understanding the relationship between ACEs and surgical weight loss may optimize perioperative care to ensure long-term success.
Methods:
Demographic, preoperative and postoperative data were prospectively obtained for 148 consecutive patients undergoing weight loss surgery at a single academic institution. Patients enrolled in the study completed the ACE questionnaire, a validated questionnaire in which higher scores indicate greater amounts of childhood maltreatment including verbal, physical or sexual abuse as well as family dysfunction. Patients were compared on the basis of high (≥6) versus low (<6) ACE scores and preoperative comorbidities using Students t-tests, chi-squared tests, and correlation analysis.
Results:
Follow up rates at 3-, 6- and 12-months postoperative were 70%, 64% and 62% respectively. At the time of submission not all patients had reached the 12-month postoperative time point. Patients had an average age of 49 years, 78% were female, 50% were Caucasian, 31% Hispanic and 9.3% African American. 57% of patients had a laparoscopic Roux-en-Y gastric bypass, 36% had a laparoscopic sleeve gastrectomy, and 7% had a laparoscopic gastric band. 12-months postoperatively patients saw a significant reduction from their preoperative BMI of 45 to 31 kg/m2 (p≤0.01). When compared to population norms, surgical weight loss patients were more likely to have an ACE score ≥4 (37.2 vs 12.5%, p<0.001). There was a positive correlation between number of preoperative comorbidities and ACE score (R=0.166, p= 0.04). When compared to patients with low ACE scores (<6), patients with a high ACE score (≥6) had a significantly higher postoperative BMI at 3- (39.2 versus 35.3 kg/m2, p≤0.02) and 6-months (35.7 versus 32.3 kg/m2, p≤0.05) and trended towards a higher BMI at 12-months postoperatively (33.4 versus 30.1 kg/m2, p≤0.16). 6-month percent excess weight loss was significantly lower in patients with a high ACE score vs. those with low ACE score (51.4% vs 63.3%). High scoring patients also had higher total cholesterol (196 vs 171 mg/dL, p=0.06) and LDL cholesterol (119 vs 96 mg/dL, p=0.07) when compared to those with low scores at 12-months postoperative.
Conclusions:
ACE scores correlate with number of comorbidities in this surgical weight loss patient population; however, surgical weight loss patients were found to have significantly greater ACE scores than population norms. Patients with a high ACE score are more likely to have higher postoperative BMIs, total and LDL cholesterol.
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