Metabolic and bariatric surgery among patients with social anxiety disorder, a matched cohort study

Social anxiety disorder is common among patients considered for metabolic and bariatric surgery (MBS). The combination of social anxiety with obesity may, however, be associated with a higher risk for adverse outcomes after surgery. In this nationwide, registry-based, matched cohort study, all patients who underwent primary MBS in Sweden from 2007 until 2019 and who had a diagnosis of moderate to severe social anxiety disorder (n = 586) were matched using a Propensity score to controls who underwent the same treatment but who did not have social anxiety disorder (n = 5791) with a mean follow-up time of 6.9 years. Patients with social anxiety disorder experienced an increased risk for non-serious postoperative complications (OR 1.59; 95%CI 1.21-2.09), self-harm (HR 2.44 CI 95% 1.84-3.25 p < 0.001) and alcohol or substance abuse (HR 2.41, 95%CI 1.96-2.96, p < 0.001), and reported lower psychosocial health-related quality of life before and after surgery. However, patients with social anxiety disorder significantly improved in health-related quality of life compared to baseline, and experienced similar effects on weight reduction at 2 years after surgery (total weight loss: 32.8 ± 10.3% compared to 32.6 ± 9.7%) and risks for cardiovascular events compared to the matched control group. MBS appears to be a safe and effective treatment for severe obesity in patients with social anxiety disorder, but an individualized and increased peri- and postoperative support should be considered for patients with moderate to severe social anxiety disorder and severe obesity.