Psychological changes among weight loss injection users compared with bariatric surgery patients in Saudi Arabia

Ahmed B. Alasiri; Faisal S. Alahmari; Sadeem D. Alanazi; Alanoud W. Alhnake; Abdullah H. Alkahtani; Mohammed Abdullah Aljaffer

doi:10.17712/nsj.2024.4.20230112

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Figure 1
- Psychological changes being noticed after performing surgery.

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Table 1

- Patients’ socio-demographic characteristics (N=721).

Study variables	n (%)
Age group
18 – 29 years	163 (22.6)
30 – 39 years	217 (30.1)
40 – 49 years	188 (26.1)
50 – 60 years	122 (16.9)
>60 years	31 (04.3)
Gender
Male	188 (26.1)
Female	533 (73.9)
Nationality
Saudi	700 (97.1)
Non-Saudi	21 (02.9)
Residency region
Central Region	360 (49.9)
Eastern Region	89 (12.3)
Western Region	155 (21.5)
Northern Region	17 (02.4)
Southern Region	100 (13.9)
Educational level
High school or below	146 (20.2)
Bachelor’s degree	475 (65.9)
Master or Higher education	100 (13.9)
Associated chronic disease
Yes	307 (42.6)
No	414 (57.4)
Specific chronic disease ^{^†}
Diabetes	102 (14.1)
Hypertension	84 (11.7)
Dyslipidemia	96 (13.3)
Heart disease	20 (02.8)
Hypothyroidism	95 (13.2)
Polycystic Ovarian Syndrome	56 (07.8)
Others	30 (04.2)

↵† Some patients have more than one chronic disease

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Table 2

- Weight loss-related characteristics (n=721).

Variables	N (%)
Current BMI
Underweight (<18.5 kg/m²)	04 (0.60)
Normal (18.5 – 24.9 kg/m²)	157 (21.8)
Overweight (25 – 29.9 kg/m²)	248 (34.4)
Obese (≥30 kg/m²)	312 (43.3)
When did you start using treatment/When was the surgery?
<1 year	290 (40.2)
1–5 years	289 (40.1)
>5 years	142 (19.7)
Was the treatment prescribed by a doctor?
Yes	546 (75.7)
No	175 (24.3)
Was the treatment one of the following options?
Weight loss surgery	344 (47.7)
Weight loss injection Saxenda	117 (16.2)
Weight loss injection Ozempic	180 (25.0)
Others	80 (11.1)
Was it a doctor’s suggestion or your suggestion?
Doctor’s suggestion	287 (39.8)
My suggestion	420 (58.3)
Others	14 (01.9)
Have you undergone a psychological evaluation prior to the prescription/operation procedures?
Yes	188 (26.1)
No	533 (73.9)
Having symptoms of the psychiatric disorder before performing the surgery
Yes	274 (38.0)
No	447 (62.0)
Specific symptoms of disease before performing surgery
General anxiety disorder	166 (23.0)
Depression	113 (15.7)
Binge eating disorder	112 (15.5)
Obsessive-compulsive disorder	23 (03.2)
Anorexia nervousa	10 (01.4)
Bipolar disorder	06 (0.80)
Others	05 (0.70)

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Table 3

- Prevalence of anxiety using general anxiety disorder (GAD-7) questionnaire and depression using patient health questionnaire (PHQ-9) according to the treatment method (N=721).

Variables	Total n (%) (N=721)	Weight loss treatment method^*
Variables	Total n (%) (N=721)	Surgical n (%) (n=344)	Injection n (%) (n=297)	P-value ^{^§}
Severity of anxiety
Normal (score 0 – 4)	405 (56.2)	189 (54.9)	170 (57.2)	0.539
Mild (score 5 – 9)	174 (24.1)	84 (24.4)	67 (22.6)
Moderate (score 10 – 14)	84 (11.7)	38 (11.0)	39 (13.1)
Severe (score 15 – 21)	58 (08.0)	33 (09.6)	21 (07.1)
Symptoms of anxiety
Positive (score ≥10)	142 (19.7)	71 (20.6)	60 (20.2)	0.891
Negative (score <10)	579 (80.3)	273 (79.4)	237 (79.8)	0.891
Severity of depression
Minimal (score 0 – 4)	333 (46.2)	170 (49.4)	124 (41.8)	0.030 ^**
Mild (score 5 – 9)	215 (29.8)	101 (29.4)	89 (30.0)
Moderate (score 10 – 14)	89 (12.3)	37 (10.8)	43 (14.5)
Moderately severe (score 15 – 19)	49 (06.8)	17 (04.9)	30 (10.1)
Severe (score 20 – 27)	35 (04.9)	19 (05.5)	11 (03.7)
Symptoms of depression
Positive (score ≥10)	173 (24.0)	73 (21.2)	84 (28.3)	0.038 ^**
Negative (score <10)	548 (76.0)	271 (78.8)	213 (71.7)	0.038 ^**

↵* Other treatment methods were excluded from the comparison,
↵^§ p-value has been calculated using Chi-square test,
^‡ p-value has been calculated using Mann Whitney Z-test,
↵** Significant at p<0.05 level

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Table 4

- Relationship between anxiety and depression according to the socio-demographic and weight loss-related characteristics of the patients (n=721).

Factors	Anxiety symptoms		Depressive symptoms
Factors	Positive n (%) (n=142)	Negative n (%) (n=579)	Positive n (%) (n=173)	Negative n (%) (n=548)
Age group
<40 years	89 (62.7)	291 (50.3)	103 (59.5)	277 (50.5)
≥40 years	53 (37.3)	288 (49.7)	70 (40.5)	271 (49.5)
P-value	0.008 ^**		0.039 ^**
Gender
Male	31 (21.8)	157 (27.1)	37 (21.4)	151 (27.6)
Female	111 (78.2)	422 (72.9)	136 (78.6)	397 (72.4)
P-value	0.199		0.107
Residency region
Inside Central Region	71 (50.0)	289 (49.9)	88 (50.9)	272 (49.6)
Outside Central Region	71 (50.0)	290 (50.1)	85 (49.1)	276 (50.4)
P-value	0.985		0.778
Educational level
Highschool or below	33 (23.2)	113 (19.5)	38 (22.0)	108 (19.7)
Bachelor or higher	109 (76.8)	466 (80.5)	135 (78.0)	440 (80.3)
P-value	0.323		0.520
Current BMI
Normal or underweight	30 (21.1)	131 (22.6)	30 (17.3)	131 (23.9)
Overweight or obese	112 (78.9)	448 (77.4)	143 (82.7)	417 (76.1)
P-value	0.701		0.071
When did you start using treatment/when was the surgery?
<1 year	55 (38.7)	235 (40.6)	72 (41.6)	218 (39.8)
1 – 5 years	59 (41.5)	230 (39.7)	68 (39.3)	221 (40.3)
>5 years	28 (19.7)	114 (19.7)	33 (19.1)	109 (19.9)
P-value	0.908		0.910
Was the treatment prescribed by a doctor?
Yes	104 (73.2)	442 (76.3)	129 (74.6)	417 (76.1)
No	38 (26.8)	137 (23.7)	44 (25.4)	131 (23.9)
P-value	0.440		0.683
Was the treatment one of the following options? ^{^{^†}}
Weight loss surgery	71 (54.2)	273 (53.5)	73 (46.5)	271 (56.0)
Weight loss injection	60 (45.8)	237 (46.5)	84 (53.5)	213 (44.0)
P-value	0.891		0.038 ^**
Was it a doctor’s suggestion or your suggestion? ^{^{^†}}
Doctor’s suggestion	48 (34.3)	239 (42.2)	64 (37.2)	223 (41.7)
My suggestion	92 (65.7)	328 (57.8)	108 (62.8)	312 (58.3)
P-value	0.090		0.299
Have you undergone a psychological evaluation prior to the prescription/operation procedures?
Yes	28 (19.7)	160 (27.6)	34 (19.7)	154 (28.1)
No	114 (80.3)	419 (72.4)	139 (80.3)	394 (71.9)
P-value	0.054		0.027^**
Associated chronic disease
Yes	62 (43.7)	245 (42.3)	77 (44.5%)	230 (42.0)
No	80 (56.3)	334 (57.7)	96 (55.5%)	318 (58.0)
P-value	0.771		0.556
Having symptoms of the psychiatric disorder before performing the surgery
Yes	90 (63.4)	184 (31.8)	104 (60.1)	170 (31.0)
No	52 (36.6)	395 (68.2)	69 (39.9)	378 (69.0)
P-value	<0.001^**		<0.001^**

↵^† Other category was included in the analysis. P-value has been calculated using Chi-square test.
↵** Significant at p<0.05 level

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Table 5

- Multivariate regression analysis to establish the independent significant factor associated with anxiety and depression (n=721).

Anxiety	AOR	95% CI	P-value
Age group
<40 years	Ref
≥40 years	0.564	0.381 – 0.834	0.004^**
Symptoms of psychiatric disorder before surgery
Yes	3.822	2.595 – 5.629	<0.001^**
No	Ref
depression’s factors
Age group
<40 years	Ref
≥40 years	0.598	0.406 – 0.882	0.009^**
Weight loss treatment method
Weight loss surgery	Ref
Weight loss injection	1.487	1.016 – 2.177	0.041^**
Undergone psychological evaluation before surgery
Yes	0.573	0.364 – 0.903	0.016^**
No	Ref
Symptoms of psychiatric disorder before surgery
Yes	3.724	2.536 – 5.467	<0.001^**
No	Ref