Experiences of Weight-Loss Surgery in People With Serious Mental Illness: A Qualitative Study

Abstract

Background: Bariatric surgery is seldom accessed by people with serious mental illness, despite high rates of obesity in this population. It is sometimes assumed that patients with complex psychiatric histories will have poor post-surgical weight loss or exacerbation of psychiatric symptoms, although this is unsubstantiated.Objectives: A qualitative descriptive study to explore personal experiences and the impact of bariatric surgery on physical and mental well-being and life-quality in individuals with serious mental illness.Methods: Nine adults with a history of bariatric surgery and concurrent severe depressive disorder, bipolar disorder, or schizoaffective disorder were interviewed about their experiences of bariatric surgery and its outcomes using semi-structured interview schedules. Data were transcribed and inductive thematic analysis undertaken.Results: Five broad themes emerged: (1) surgery was highly effective for weight loss, and resulted in subjective improvements in physical health, quality of life, and mental health described as being able to live a life; (2) recovering from surgery was a tough road, notably in the post-operative period where negative sequelae often anteceded benefits; (3) postoperative support was important, but sometimes insufficient, including from families, mental health services, and surgical teams; (4) most considered surgery life-changing, recommending it to others with mental illness and obesity, two had different experiences;(5) participants considered it discriminatory that people with mental illness were not referred or declined weight loss surgery.Conclusions: Participants benefited from bariatric surgery and felt it should be offered to others with mental illness, but with additional care and support.

Safety and Effect of Bariatric Metabolic Surgeries for Psychiatric Patients with Obesity: A Retrospective Matched Case–control Trial

“…A qualitative study found that patients with severe psychiatric issues benefited from BMS, which improved their quality of life and physical and mental health. The study tested a broad spectrum of PI diagnoses, including severe depressive disorder, bipolar disorder, and schizoaffective disorder, and found that patients self-requested extra care and support for obesity treatment and aftercare [ 11 ]. Therefore, allowing extra time, attention, and listening to the patient can help improve mental health outcomes in the postoperative period.…”

“…The focus has been mainly on antipsychotic drug-induced weight gain and schizophrenia [ 9 , 10 ]. Another study found that BMS effectively reduced psychiatric patients’ body weight and improved their quality of life, especially in those with severe depressive, bipolar, and schizoaffective disorders [ 11 ]. In addition, patients with bipolar disorders who underwent Roux-en-Y gastric bypass (RYGB) had successful weight loss outcomes at 12 months, which did not significantly differ from those of patients without PIs [ 12 ].…”

Examining the effects of national initiatives to improve the physical health of people with psychosis in England: secondary analysis of data from the National Clinical Audit of Psychosis

“…Weight gain is a well-recognised and particular troubling side-effect of many antipsychotic medications. 17 Given the implications of obesity for subjective well-being, medication adherence and therapeutic outcomes in the context of treatment for psychosis, and associated diabetes and cardiovascular risk and likelihood of premature mortality, [44][45][46] improving interventions in this area needs to remain a focus for researchers. To date, studies of current weight management programmes for people with psychosis have produced mixed results.…”

It’s not in my head: a qualitative analysis of experiences of discrimination in people with mental health and substance use conditions seeking physical healthcare

“…Previous research in Aotearoa New Zealand (NZ) reported that 23% of people with MHSUC experienced discrimination from health services ( 20 ). Examples of discrimination include acting on stereotypes and prejudice, such as clinicians avoiding patients with MHSUC due to unwarranted fear of violence or discomfort with mental illness ( 21 ) and patients with MHSUC being denied weight loss surgery due to unsubstantiated assumptions they will have poorer outcomes ( 22 ). Discrimination from clinicians can also deter people from seeking treatment ( 23 ), creating further barriers to appropriate diagnosis and treatment of physical conditions.…”