Bariatric Surgery and Mental Health

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A number of surgical weight-loss procedures are available for the treatment of certain patients with obesity. While some of these procedures have been in practice for decades, how they may interact with and affect the mental health of patients with obesity has not been studied in-depth. A new analysis of the available literature is trying to change that, however.

What Is Bariatric Surgery?

The term “bariatric surgery” applies to a number of surgical procedures that have been developed to treat obesity and surgically induce weight loss.

These include gastric bypass, gastric banding, and gastric sleeve (sleeve gastrectomy) procedures, among others, which have been developed for the surgical treatment of obesity.

Who Is a Candidate for Bariatric Surgery?

According to the latest obesity guidelines released by the American Heart Association (AHA), the American College of Cardiology (ACC), and The Obesity Society (TOS), bariatric surgery may be an option for adult patients who meet certain criteria.

These criteria include a body mass index (BMI) of 40 or greater, or a BMI of 35 or greater in a patient who has other medical conditions (known as “comorbid conditions”) caused by obesity.

The obesity guideline writing committee did not find sufficient evidence to recommend bariatric surgery for patients who have BMIs that fall below these cutpoints.

The guideline further advises primary care doctors and others caring for patients with obesity with high BMI to try “behavioral treatment with or without pharmacotherapy” first, and then if this has not worked along with other diet and lifestyle measures to achieve sufficient weight loss, bariatric surgery may be considered.

How Does Bariatric Surgery Impact Mental Health?

A meta-analysis that reviewed the available bariatric surgery literature found 68 publications that reported on mental health conditions in the context of bariatric surgery.

According to the study authors, “Among patients seeking and undergoing bariatric surgery, the most common mental health conditions … were depression and binge eating disorder.”

Specifically, 19% of patients were found to have depression and 17% were found to have binge eating disorder.

While neither depression nor binge eating disorder were found to be consistently associated with differences in weight outcomes following surgery, it appears that bariatric surgery itself had favorable effects on patients with depression.

The researchers found that bariatric surgery was consistently associated with lower rates of depression after the operation. Bariatric surgery was also associated with a decrease in the severity of the symptoms of depression.

The study authors concluded that “mental health conditions are common among bariatric surgery patients—in particular, depression and binge eating disorder.” They also noted the support for “an association between bariatric surgery and lower rates of depression postoperatively [after surgery].”

Sources:

Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society [published online November 27, 2013]. J Am Coll Cardiol.

Jensen MD, Ryan DH. New obesity guidelines: promise and potential. JAMA 2014; 311:23-24.

Dawes AJ, Maggard-Gibbons M, Maher AR, et al. Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. JAMA 2016;315:150-163.