Bariatric Psychology, Psychological Aspects of Weight Loss Surgery

Abstract

Obesity is the ‘disease of the 21st century’ and results in physical and psychosocial co-morbidities as well as poor quality of life (QoL). In contrast to the nonsurgical treatment of obesity, bariatric surgery is treatment of choice for morbid obesity. Since improved QoL and enhanced psychosocial functioning are important goals of bariatric surgery, success following bariatric surgery should not only include weight loss and improvement or cure of co-morbid conditions, but also improvements in eating behavior, psychosocial variables, and QoL. Unfortunately, bariatric surgery does not lead to identical results in every patient. Patients who fail to adjust their eating behavior and lifestyle after bariatric surgery may experience adverse reactions. Compliance and adjustment may be attributed largely to psychological factors, implying that the operation on its own represents only one element in bariatric surgery. Considering the role of psychosocial factors in the outcomes of bariatric surgery and the impact of the operation on the psychological and social situation, mental health professionals should be a part of the process of evaluation and treatment of bariatric surgery patients. In the Netherlands, between 2000 and 2005, bariatric surgery has increased tremendously, and most Dutch hospitals have a multidisciplinary selection process.

A psychiatric perspective view of bariatric surgery patients

“…Thus, traumatic histories might mediate the relationship between poorer postoperative weight loss and the maintenance of psychiatric symptoms 14 . Another implicated factor was the patient´s expectations after surgery that may have a negative impact if the expected results are not obtained 3 . Furthermore, it may be difficult to cope with the persistence of pre-surgical problems or new negative life events which were attributed to obesity in the past 18 .…”

“…Pharmacological treatment, diet regimens and lifestyle alterations do not seem to be effective in morbidly obese patients 3 . Therefore, bariatric surgery is considered the most effective treatment in severe obesity, yielding more enduring weight loss 1 .…”

“…Therefore, bariatric surgery is considered the most effective treatment in severe obesity, yielding more enduring weight loss 1 . Several surgical procedures are performed: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, laparoscopic adjustable gastric banding (LAGB), vertical banded gastroplasty and biliopancreatic diversion 1,3,4 .…”

“…However, up to 20% appeared to be dissatisfied and the reasons pointed were psychosocial problems, surgical complications and not fulfilling their weight expectations 3,7 .…”

“…Therefore, weight loss and improvement in medical comorbidities should be seen as successful factors after bariatric surgery, but the amelioration of psychiatric symptoms, eating behavior, psychosocial variables and quality of life are important outcomes to consider 3 . Thus, the aim of this review is to evaluate specific areas of psychopathology in individuals with morbid obesity underwent to bariatric surgery, such as, eating behaviors, mood disorders, body image, suicide and substances of abuse.…”