Psychology in Bariatric surgery
Contraindications for bariatric surgery
– Uncontrolled psychiatric disorder
– Suicide attempt within last 18 months
– Active substance abuse
– Active smoking (stopped for at least 6 months)
– Mental or intellectual limitations that would limit adherence to dietary and lifestyle modifications
– Active bulimia nervosa
Binge eating disorder is present in 25% of patients undergoing surgery and is the most likely disorder to re-emerge post operatively and is predictive of poorer weight loss at 12 and 24 months
There is increased alcohol intake in a subgroup of patients who have gastric bypasses
There is increased suicide rates amongst those having surgery with 70% occurring in the first 3 years.
Most psychological difficulties are not diagnosable but instead due to undergoing major life/body changes. Coping with excess skin and body image uses are the biggest problems. Others are difficulties in maintaining eating behaviours, emotional eating and unmet weight loss expectations.
Most services (90%) in UK assess all patients undergoing surgery pre-operatively with individual interventions. The interventions tend to focus on eating difficulties (eg. binge eating, emotional eating, night eating) to prepare them for surgery.
Only 41% of services provide pre-operative group support.
NB. Pre-operative behavioural lifestyle intervention results in significantly greater weight loss before surgery [Obesity 2013, Kalarchian RCT]. Those who lost weight pre-surgery had greater weight loss 1 year after surgery [Obes R Dis 2009, Livhits Systematic review]
68% of services have capacity to provide post-surgery assessment but none routinely.