Abstract
Background
Obesity is a significant global health issue, leading to various physical and psychological complications. Bariatric surgery is considered to be an efficient treatment for obesity, contributing to weight loss and metabolic improvements. While the physical benefits of bariatric procedures are well documented, the psychological effects, particularly gender differences in quality of life and depression post-surgery, remain an area of interest in the Indian context.
Purpose
The study aims to examine the gender changes in QoL and depression among individuals experienced the Surgery BS. It focuses on three surgical procedures: Roux-en-Y gastric Bypass (RYGB), One Anastomosis Gastric Bypass (OAGB) and sleeve gastrectomy (SG). The study hypothesised that gender differences exist in post-surgical QoL outcomes and depression levels.
Methods
A quantitative, cross-sectional research design is employed to assess the gender differences among 200 post-bariatric surgery patients (100 males, 100 females) who had undergone surgery between 3 and 6 months. The equipment that is utilised is the WHOQoL-BREF and even the BDI-II. Hence, the ANOVA and t-tests are even conducted to examine the differences in gender and variations across the process of surgeries.
Results
The results outlined that there is no significant difference in depression and Qol among the patients of post-bariatric surgery. The findings even demonstrated that no differences in QoL scores among distinct processes of surgeries among both genders. However, the core trend in depression stages is observed in males based on their surgery type, recommending the possible changes in the outcomes across distinct processes.
Conclusion
The results identified no gender-based disparities in QoL and depression following surgery. While RYGB showed slightly higher QoL scores in males while SG exhibited greater levels of depression, these distinctions were not significant. The findings outline the significance of post-operative support for individuals, regardless of type, to enhance mental well-being and QoL.
Introduction
Obesity is a critical health issue with the occurrence of epidemic proportions over the last decades. 1 The World Heart Federation (2023) 2 examined over 2.3 billion individuals globally are under obesity and rising in further years. It is a serious medical concern that can lead to several issues in health, akin to the BP, stroke and diabetes. 3
This Table Shows BMI Ranges to Help People Understand How Their Weight Relate to Their Height and Possible Health Risks.
Surgery of Bariatric is defined as an extremely efficient action for critical overweightness, resulting in weight loss and enhancements in metabolic health. 10 Gastric bypass surgery is performed on people for weight-loss purposes. The changes are made in the digestive system that can help the affected person lose weight. Bariatric surgery is performed on a person when their weight has exceeded significantly and diet and exercise are not suitable for losing weight. 11 The types of bariatric surgery explored in this study are One Anastomosis Gastric Bypass (OAGB), Roux-en-Y gastric Bypass (RYGB) and sleeve gastrectomy (SG), highlighting their surgical procedures and associated benefits’ contains the formation of a minor stomach bag and a single-loop bypass of the slight intestine, offering a relatively simpler surgical technique with effective outcomes in terms of weight loss and improvement in metabolic process of human body. 12 RYGB, considered a gold standard in bariatric procedures, entails forming a minor pouch from the digestive or gastric and rerouting the small intestine, showing significant benefits in weight mitigation and resolution of comorbidities such as T2D. 13
SG contains the removal of stomach skin by 75%–80% through surgery, resulting in a narrow, sleeve-shaped stomach. This procedure not only limits the food intake but also reduces levels of the hunger hormone-contributing to substantial weight loss. 14 Each of these procedures presents unique mechanisms and advantages, offering tailored procedures grounded on the patient’s requirements in clinics and preferences. However, while the physical benefits of bariatric procedures are well documented, the psychological outcomes remain an area of growing interest, particularly regarding gender differences in the Indian population. Bariatric surgery is basically understood for the efficiency in accomplishing substantial and sustained loss in weight however, for its optimistic influence on the obesity-associated comorbidities and mental well-being.
Recent evidence from an umbrella review suggests that bariatric procedures significantly reduce symptoms of depression, anxiety and disordered eating within the first two years post-surgery. 15 Enhancement in HRQoL has also been reported, with many patients experiencing enhanced self-esteem and social functioning following surgery. 16 However, the extent of psychological benefits varies, and long-term studies show that factors such as gender and preoperative health status (e.g., the presence of diabetes) can influence outcomes. 17 Gender differences in post-operative psychological responses have become an area of interest. Men tend to report advanced stages of psychological satisfaction and mental well-being after surgery, despite often experiencing fewer physical benefits compared to women. 18
In contrast, women may face ongoing challenges related to body image, emotional adjustment, and social expectations, which can contribute to persistent symptoms of depression. 19
These findings underscore the importance of incorporating a gender-sensitive lens when evaluating mental health outcomes in bariatric surgery patients. Further study is required to examine how distinct surgical processes intersect with gender to impact the QoL and depression and offer gender-sensitive support.
The study aims to examine the gender disparities in psychological findings, with respect to depression and QoL among people who have undergone surgeries with a focus on the OAGB, RYGB and SG. By analysing post-surgical variations among men and women, the study looks to contribute to further better understanding of the psychological impact of the process of bariatric surgery. It is hypothesised that gender differences exist in the QoL and Depression following surgery, and these findings even assist in relying on the segment of procedure performed.
Method
Research Design
To determine the disparities in the QoL and Depression among bariatric surgery patients, cross-sectional study design is integrated. This includes the utilisation of validated psychological equipment to measure the level of depression and QoL among females and males.
Sampling
The chosen sampling technique, which is purposive, is chosen grounded on the specific criteria and qualities that better link with the objectives. The sample of the present study consisted of 200 participants (100 males and 100 females) who had undergone bariatric surgery between 3 and 6 months. The participants were recruited from the Surgical Centre located in Moga, Punjab.
The participants were from various regions, including India, specifically Punjab, Haryana, Rajasthan and Himachal Pradesh.
Inclusion criteria
Patients who have completed surgery at least 3 months but not more than 6 months ago.
Patients who were attending regular follow-up visits at the Surgical Centre in Punjab.
Adults aged between 20 and 65 years, because it is a rare population.
Exclusion criteria
The participants from centres other than the chosen healthcare centre.
Patients with severe medical health conditions or cognitive impairments.
Patients who underwent bariatric surgery combined with other major procedures (e.g., cholecystectomy).
Data Collection
The data of the study were collected using standardised tools over a period of one year. During the follow-up visits, patients were invited to participate, and the questionnaires were administered. The average time taken to complete the questionnaires was 10–15 minutes per patient.
Tools Used
World Health Organisation Quality of Life Questionnaire (BREF)
It consists of 26 items, which consider different aspects of social relationships, psychological health, physical health, and environment for determining health. It is a shortened form of the WHOQOL-100. Each item on this scale is scored from 1 to 5 for each response, and then they are displayed linearly on a 1–100 scale. The internal consistency with the coefficients of Cronbach’s coefficients ranges 0.7–0.9 for the distinct domains in several studies, and the t-test accuracy is quite good with the intraclass correlation coefficients from 0.7 to 0.85. 20 It correlated well with WHOQOL 100, indicating that it measures similar constructs.
Beck Depression Inventory II
The BDI-II consists of 21 questions, which are a self-reported questionnaire that helps in assessing the severity of depression among the participants. The list of BDI is helpful in determining depression symptoms of the participants, which would provide due results for the research. 21 In this questionnaire, the score of 0–3 represents the intensity of the depression level. It evaluates the emotional, behavioural, psychological, and cognitive health of the participants.
The BDI scale differentiates the patients for the statistical analysis into 4 groups: Depression 14–19, Minimal or no depression 0–13, mild moderate depression 20–28, and severe depression 29–63. The test has demonstrated strong internet consistency with Cronbach’s alpha coefficients typically ranging from 0.76 to 0.95, 22 and test-retest reliability is also good with correlations ranging from 0.60 to 0.83 over varying time intervals. 23
Data Analysis
T-test analysis for gender differences and ANOVA to assess the influence of different operation types on QoL and depression.
Results
T-test Analysis for Quality of Life & Depression.
A t-test analysis is conducted to examine the gender differences in quality of life and depression levels among post-bariatric surgery patients. The results in Table 2 indicated no statistically significant differences between males and females across these psychological variables, and thus the hypothesis is null.
Quality of Life
Males reported an average score of 95.93 (SD = 19.04), while females had an average score of 95.25 (SD = 17.90).
The obtained t-value (0.26) is minimal, indicating no significant gender differences in overall quality of life.
Depression
Males had an average score of 9.67 (SD = 9.47), whereas females scored slightly lower, with a. mean of 8.50 (SD = 7.68)
The t-value (0.96) did not reach statistical significance, suggesting no meaningful gender-based differences in depression levels.
The descriptive statistics for Depression and QoL scores are displayed for three different surgical procedures. Among males, the RYGB group reported the highest mean total quality of life score (M = 98.88, SD = 19.84), followed closely by SG (M = 97.11, SD = 21.09) and the OAGB (M = 94.80, SD = 18.40). This suggests that RYGB may have the most positive impact on QoL among bariatric surgery patients.
In terms of depression, the SG group exhibited the lowest mean depression scores (M = 14.00, SD = 11.43), followed by RYGB (M = 10.06, SD = 8.81), and OAGB (M = 8.28, SD = 8.72). While the average depression score for the SG is advanced, the spread of scores (standard deviation) indicates variability in individual experiences of depression across groups.
The ANOVA for quality of life yielded a non-significant result, F(2, 97) = 0.349, p = .706. This indicates no statistically important modification in the quality of life scores across the three surgery types. This suggests that the type of surgery may not have a substantial impact on the QoL of male patients.
The ANOVA for depression scores showed a near-significant effect, F(2, 97) = 2.788, p < .066. Although the result did not reach the conventional import level of p < .05, the p value is close to the threshold, suggesting a possible difference in depression levels among the surgery types.
The descriptive table provides an overview of the mean, standard deviation and confidence intervals for total quality of life and depression scores among different surgery types. In terms of quality of life, Surgery Type 2 has the highest mean score of 100.57, followed by Surgery Type 3 at 94.65 and Surgery Type 1 at 93.61. Surgery 2 appears to have the greatest impact on a better quality of life.
For depression scores, Surgery Type 3 appears to be most effective in reducing depression levels among females, as it has the lowest mean depression score of 7.29. In contrast, Surgery Type 1 and Surgery Type 2 show slightly higher depression scores of 8.77 and 8.67, respectively. In conclusion, Surgery Type 3 may be the most effective in reducing depression levels among females.
For the total quality of life, the ANOVA revealed no statistical differences between the groups, F(2, 97) = 1.202, p = .305 and similarly for the depression; the ANOVA showed no statistically significant differences between the surgical groups, F(2, 97) = 0.250, p = .779. These results indicate that the type of weight loss surgery did not significantly impact either the total quality of life or depression levels.
Discussion
Obesity remains a significant global health issue, contributing to various physical and psychological complications. Given its status as a leading public health concern, BG is often suggested for people with a BMI index exceeding 40. This surgical intervention aims to support substantial weight loss, promote healthier lifestyles, and mitigate the threats of severe diseases and psychological well-being issues, ultimately enhancing the life expectancy of patients. Despite its benefits, individuals who undergo this surgery often face considerable challenges. The procedure involves significant anatomical changes that restrict food intake, resulting in altered eating patterns and lifestyle adjustments. Such changes can impact both the physical and psychological well-being of patients. Recognising these challenges, the current research sought to examine the post-surgical experiences of bariatric patients.
When examining depression scores by gender, male participants reported a somewhat advanced average score (M = 9.67, SD = 9.47) associated to female participants (M = 8.50, SD = 7.68). However, the difference between these groups was not statistically significant, as evidenced by a low t-test value (t = 0.96). These findings suggest that, in this sample, gender was not a significant factor influencing depressive symptom levels. One possible explanation for the lack of Significant gender differences in this study could be related to shared experiences among participants, such as coping with obesity or the decision to undergo surgery, which may act as equalising factors in terms of psychological distress.
From a clinical perspective, the findings reinforce the importance of screening for depressive symptoms in all individuals, regardless of gender. Given the known impact of depression on post-operative outcomes, such as adherence to lifestyle changes, weight loss maintenance and overall well-being, routine psychological assessments remain crucial.
The study examined the potential gender differences in total quality of life following surgery. The results revealed that males reported a mean QOL score of 95.93 (SD = 19.04), while females reported a comparable mean score of 95.25 (SD = 17.90). These findings suggest that gender did not play a role in determining post-operative quality of life outcomes. Both males and females experienced high levels of quality of life following surgery. A plausible explanation for the lack of significant gender differences could be that both females and males equally benefited from the surgery. It is important to note that while no significant differences were observed, this does not mean that male and female patients experience identical recovery processes. There may have been gender specific factors that influence individual experiences in different life domains, such as social relationships or psychological well-being. These findings highlight the importance of providing equitable support and resources to all patients, regardless of gender, to optimise post-operative outcomes.
For male participants, as shown in Table 3, the SG group reported the highest mean depression score (M = 14.00, SD = 11.43), followed by RYGB (M = 10.06, SD = 8.81) and the OAGB group (M = 8.28, SD = 8.72). The ANOVA results in Table 4 revealed a near-significant difference in depression scores among the three surgical groups in males. While this result did not meet the threshold for statistical significance (p < .05), the p value suggests a possible trend toward differing depression outcomes based on the type of surgery performed in males. Specifically, this may indicate that males who underwent SG experienced greater stages of depressive symptoms as contrasted to those who underwent RYGB or OAGB. It is possible that the different physiological and psychological impacts of each surgical procedure contribute to variations in depressive symptoms. For example, differences in post-operative complications, changes in eating behaviour, or expectations of weight loss outcome might affect emotional well-being differently across different surgeries.
Descriptive Statistics for Depression and QoL Across Different Surgical Procedures Among Males (1. OAGB*, 2. RYGB*, 3. SG*).
ANOVA for Total Quality of Life and Depression Scores by Surgery Types Among Males.
For female participants, Table 5 presents the descriptive statistics for depression scores across different surgery types in females. The lowest mean depression score is observed in the group labelled as Surgery Type 3 (M = 7.29), suggesting that this procedure perhaps be the core effective in mitigating depressive symptoms among females. In comparison, Surgery Type 1 and Surgery Type 2 showed slightly higher mean depression scores of 8.77 and 8.67, respectively. While the differences in the mean scores appear small, they might point toward subtle variations in post-surgical psychological outcomes in females. However, the ANOVA results presented in Table 6 showed no statistically significant difference in depression scores between the surgery types for females, F (2, 97) = 0.250, p = .779. Clinically, these findings suggest that the type of bariatric surgery alone should not be considered a determining factor for the likelihood of experiencing depressive symptoms postoperatively. Psychological screening and support should be consistently provided across all bariatric surgery types to address the needs of the patients who may be at risk for depression, regardless of the specific procedure they undergo.
Descriptive Statistics for Depression and QoL Across Different Surgical Procedures Among Females.
ANOVA for Total Quality of Life and Depression Scores by Surgery Types Among Females.
The findings of this study indicate that quality of life does not significantly differ among males and females who have undergone different bariatric surgeries. The descriptive statistic suggests that among males, the RYGB group reported the highest mean scores, followed closely by the SG and OAGB groups. However, the differences were minimal, suggesting that while there may be slight variations in patients’ reported QOL outcomes, no particular surgical procedures lead to a substantially higher QOL post-surgery. The results of ANOVA confirmed no statistical differences. This suggests that other factors beyond the type of bariatric procedure, such as post-surgical lifestyle interventions, patients’ expectorations and social support, may play a prominent role in determining a patient’s overall quality of life.
Limitations of the Study
The study has key limitations: The research was confined to participants from the Surgical Centre in Moga, Punjab. This localised sample may not represent broader populations, limiting the applicability of the results to different cultural, geographic or demographic settings. Furthermore, the study did not account for the potential influence of pre-existing psychological conditions or the presence of support systems prior to surgery, which could have influenced post-operative outcomes.
Conclusion
The present study explored gender differences in quality of life and depression among post-bariatric surgery patients. Contrary to the initial hypothesis, the findings revealed no statistically significant gender differences in these psychological variables. Both male and female participants reported similar levels of quality of life and depression, suggesting that gender may not be a primary determinant of psychological outcomes following bariatric surgery. While descriptive analyses indicated minor variations—such as males reporting slightly higher depression scores and differences in depressive symptoms across surgical types—these differences did not reach statistical significance. The results highlight that factors beyond gender, such as shared experiences of undergoing surgery and adjusting to post-operative changes, may have a more substantial impact on psychological well-being.
Further, the study identified no core differences in QoL grounded on the undergone bariatric surgery. While some basic changes were examined across surgical groups, they did not indicate a lucid benefit of one process over another in terms of post-operative QoL.
This recommends that factors akin to the social support, and expectations of the patient, perhaps play a further influential role in designing inclusive psychological support for every bariatric individual instead of surgical type. Routine mental health screenings and tailored interventions should be integrated into post-operative care to ensure optimal outcomes. Future studies could further explore the role of additional factors, akin to socioeconomic status, preoperative psychological health, and support systems, in influencing long-term quality of life and mental health outcomes post-surgery.
Footnotes
Acknowledgements
I would like to express my gratitude to the Chandigarh University in Punjab for the tremendous support and even guidelines at the time of the case report. The tutor’s knowledge and direction during these clinical observations are really appreciated.
Authors’ Contribution
Original writing, editing and reviewing, supervision as well as corresponding author.
Statement of Ethics
The ethical approval was taken from the authorities of the institution for this study. No harm was caused to the participants during the study. The authors take full responsibility for the ethics to be maintained.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The authors received no financial support for the research, authorship and/or publication of this article.
Data Availability Statement
The data have been collected primary and shared on the university as per guidelines.
Patient Consent
Informed consent has been gathered from each participant, outlining their involvement, which is voluntary, confidentiality, as well as privacy prevention.
