The Impact of Bariatric Surgery on Psychological Health

Abstract

Obesity is associated with a relatively high prevalence of psychopathological conditions, which may have a significant negative impact on the quality of life. Bariatric surgery is an effective intervention in the morbidly obese to achieve marked weight loss and improve physical comorbidities, yet its impact on psychological health has yet to be determined. A review of the literature identified a trend suggesting improvements in psychological health after bariatric surgery. Majority of mental health gain is likely attributed to weight loss and resultant gains in body image, self-esteem, and self-concept; however, other important factors contributing to postoperative mental health include a patient's sense of taking control of his/her life and support from health care staff. Preoperative psychological health also plays an important role. In addition, the literature suggests similar benefit in the obese pediatric population. However, not all patients report psychological benefits after bariatric surgery. Some patients continue to struggle with weight loss, maintenance and regain, and resulting body image dissatisfaction. Severe preoperative psychopathology and patient expectation that life will dramatically change after surgery can also negatively impact psychological health after surgery. The health care team must address these issues in the perioperative period to maximize mental health gains after surgery.

The effectiveness of bariatric surgery on long term psychosocial quality of life – A systematic review

“…A number of reasons have been attributed to persistent psychological issues post-surgery including unrealistic patient expectations [72]. These findings point to a need for greater modelling of the psychological pathway to obesity in order to potentially improve treatment outcomes.…”

A psychiatric perspective view of bariatric surgery patients

“…Some studies have stated significantly reduced levels of depression symptoms 1, 2, and 10 years after bariatric surgery in comparison with the preoperative period 5,58 . Other findings indicate an initial improvement in the first years postoperatively followed by the reappearance or worsening of depressive symptoms which seem to be associated with weight regain or weight stabilization 18 . Studies have reported increased levels of depression after 5 years when compared to the first year following bariatric surgery 59 .…”

“…Assessing postsurgical data regarding eating behavior is considered difficult and one of the pointed drawbacks is the difference in definitions of binge eating employed by different studies 18 . Binge eating disorder (BED) is characterized by recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances, with episodes marked by feelings of lack of control.…”

“…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 . Regarding psychiatric medication, some studies showed a decrease in their overall usage following bariatric surgery 27 .…”

“…High incidences of somatization, hypochondria and obsessive compulsive disorder were also found in bariatric patients 14 . Moreover, the prevalence of binge eating behaviors and binge eating disorder (BED) is variable with a range from 4%-40% 11,[15][16][17][18] .…”