Mental Health in Bariatric Surgery: Selection, Access, and Outcomes

Abstract

Severe obesity has many psychiatric consequences that can be influenced by bariatric surgery. The goal of this article is to review these challenges, including the mental health status of patients with severe obesity, the evaluation of surgical candidates, and the early and late effects of the operations, and to offer some recommendations to manage these challenges. The failure of the insurance‐mandated preoperative psychosocial evaluation is also discussed.

Assessing psychopathology in bariatric surgery candidates: discriminant validity of the SCL-90-R and SCL-K-9 in a large sample of patients

“…Indeed, 45.4% of patients were found to suffer from a psychiatric disorder. Furthermore, in accordance with previous studies [ 4 , 27 ], we found that MDD and BED were the most prevalent disorders in this population.…”

On the Randomness of Suicide

“…However, bariatric surgery was consistently associated with post-operative decreases in the prevalence of depression (seven studies; 8-74% decrease) and the severity of depressive symptoms (six studies; 40-70% decrease) (50). The increase in physical activity observed in post-bariatric surgery patients may contribute to these positive changes (46).…”

“…In addition, only nine of the studies included a suitable control group. Overall, however, the larger body of evidence would suggest that, in general, weight loss is associated with improvements in psychosocial status, including health-and weight-related quality of life, self-esteem and sexual functioning (14,46). The improvements are more marked in people who undergo bariatric surgery, suggesting that the response is linked to the magnitude of weight loss (14).…”

“…It is also important to be aware that approximately one in three female patients undergoing bariatric surgery have experienced childhood sexual abuse (48). This appears to be a risk factor for psychiatric hospitalisation after bariatric surgery and may impact poorly on post-surgical weight loss (46). It has been hypothesised that in cases where the individual has suffered sexual assault in childhood, or indeed adulthood, weight gain may have served a function in avoiding unwanted sexual attention, and that the removal of this defence leaves the individual feeling suddenly unprotected and vulnerable (49).…”

Bariatric surgery and cognitive impairment

“…Severe obesity and obesity‐related comorbid conditions have many neuropsychiatric consequences that can be influenced by bariatric surgery. Severe obesity results in increased risk of psychopathology, and the weight loss outcome of bariatric surgery results in significant reduction in psychopathology (1). Severe obesity also has negative effects on cognition (2).…”