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Mind Over Matter: Mental Health Conditions in Bariatric Surgery Patients


Many would argue that more attention needs to be paid mental health issues in the United States.

In recent months, this topic has been picking up steam with attention from the Chicago Tribune in an article that stresses the need to end mental health stigma. More pop culture-focused outlets are also addressing this issue, as in an article from Refinery29 suggesting that everyone should be screened for depression. This recent spike in media coverage certainly shows promise for raising awareness of these once swept-under-the-rug issues.

According to a Center for Disease Control and Prevention’s (CDC) report, approximately 25 percent of American adults have a mental illness, and nearly 50 percent will develop at least one mental health condition during their lifetime. What’s even more interesting is that in a smaller subset of the general population – candidates for bariatric surgery – mental health issues, specifically depression and binge eating disorders, were more than twice as common, as reported study published in the Journal of the American Medical Association.

Researchers found that the prevalence of mental health conditions in candidates for bariatric surgery is startlingly high – 19 percent experience depression, 17 percent suffer from binge eating disorder, and 12 percent battle anxiety.

“I would estimate that 5 to 10 percent of the patients we see for preoperative psychological evaluations are candidates for additional therapy or treatment for a mental health condition,” said Kelly Allison, PhD, an associate professor of Psychology in Psychiatry and director of Clinical Services at the Center for Weight and Eating Disorders.

While it may seem like these numbers are high, Allison noted, “there is an association between mental health and obesity.” She goes on to say that in many people, women specifically, there is a correlation between an increase in weight and depressed mood.

With that in mind, patients beginning the bariatric surgery process are required to participate in a psychological evaluation to identify any underlying mental health issues and barriers to behavioral changes to one’s eating patterns and choices. Allison added, “It’s important to begin addressing these behaviors before the surgery occurs, because following the procedure, there are a great many lifestyle modifications that are asked of the patient.”

After surgery, patients are required to follow a regular meal schedule, take vitamins regularly, and engage in physical activity most days of the week. Allison notes that asking for any patient to implement these changes is significant, but asking this of someone with an existing mental health issue or mood disorder can make the transition that much more challenging.

“All of our patients go through the medical weight management program before surgery and work with our clinicians to make changes in preparation for surgery,” said Colleen Tewksbury, MPH, RD, LDN, bariatric surgery program manager. “However, some patients need additional therapy or support before surgery. We always emphasize to our patients that weight loss surgery is a major life change and can be a stressful time.  It is important to be prepared for those changes, and for many people that includes addressing mental health concerns.”

The average bariatric surgery patient, though each person is different, will experience a 30 percent weight loss in the first 12 to 15 months following surgery. This is a considerable amount when the patient is upwards of 100 pounds overweight at the start of the process.

Tewksbury continues, “the numerous behavior changes for both before and after surgery can be overwhelming, so assessing whether someone is ready for those changes is vital.  If someone is not prepared to follow post-operative recommendations, taking more time beforehand may be beneficial in the long run.”

This study reported that there was little evidence to support a correlation between preoperative mental health issues and postoperative weight loss, but the results showed that certain mental health issues – depression, binge eating and anxiety – did in fact decrease following surgery. 

“We do see that mood tends to get better following bariatric surgery, but there is very limited long term data on whether or not these issues return,” Allison added. “Most of us in the field suspect that mood is improved when people get back to living their lives without the excess weight, but when the newness wears off, some mental health issues can return.”

During most pre-operative evaluations, patients are educated on what behavioral changes are needed to ensure positive post-operative results, in addition to any psychological changes they may experience following surgery. Patients are also offered support services to help guide them through the process, which experts feel makes the transition a bit more manageable.

Allison noted, this study, and others evaluating similar data points, can only help to eliminate the stigma associated with mental health issues. In fact, she said, mental health conditions, like depression and anxiety, should be included alongside other obesity comorbidities such as diabetes and cardiovascular disease.

“What’s important to note is that a mental health diagnosis does not automatically disqualify a patient from being a candidate for bariatric surgery,” Allison said. “Most often a mild degree of depression or anxiety can be controlled with medications or therapies, and patients can still proceed as planned.”

So while this study and others published in recent years seem to cover what Allison called a “hot” topic in the field, these researchers, and experts like Allison, stress the importance of continuing to explore the impact of mental health on bariatric surgery patients, and the impact on the greater population.

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