For bariatric surgery to be truly successful, experts suggest that the individual commit to a sustained lifestyle change. That usually includes a host of habit changes, including adopting a healthy diet with a limit of calories, eating much smaller portions of food, and maintaining a daily exercise schedule. Patients typically fare better when they continue to receive support from a team of experts, which necessitates ongoing visits after surgery, sometimes with multiple individuals. One could assume that in the presence of mental health challenges, bariatric surgery success might be significantly limited. A study published in Obesity, the scientific journal of The Obesity Society, suggests that pre-existing mental health conditions do not seem to impact success rates of bariatric surgery.
The guidelines that have been set for patients to qualify for bariatric surgery include having a certain body mass index, or being significantly overweight with a comorbid condition, such as diabetes. When patients undergo screening, they’re assessed to see whether they will be able to sustain diet and exercise changes, and keep a long-term follow up schedule with the bariatric team specialists. Right after surgery, there are post wound care visits and learning how to eat very small portions of food. There isn’t a good reason to “invest” in the surgery if you think the person will have a strong likelihood of complications — or “failure” — because of lack of adherence, inability to manage the post-surgery lifestyle commitment, or failure to commit to a long-term relationship with the team for support and checkups.
The bariatric surgeon and team might feel that in the presence of mental illness, bariatric surgery will be problematic because of anticipated poor adherence post-surgery. Before this study, no effort had been made scientifically, on a large scale, to see if pre-existing mental illness would change outcomes of bariatric surgery. The researchers reviewed the electronic health medical records of more than 8,000 adults from several healthcare centers across the United States. The pool was a mixture of individuals with and without diagnosed mental health disorders prior to bariatric surgery. The participants who had mental illness prior to surgery were also divided into three groups: Mild to moderate depression, severe depression and anxiety, and psychosis/schizophrenia spectrum disorder. The researchers specifically focused on weight-loss patterns and healthcare use patterns after the surgery. The researchers also focused on post-surgery emergency room visits and hospitalizations.
The researchers found that “mental illness was not a predictor of weight loss after two years, meaning that negligible if any differences were seen in weight loss patterns between participants who did or did not have a mental illness diagnosis before surgery. It should be highlighted that the participants largely came from healthcare centers where specific mental health screenings identified “clinically stable patients” before they were approved for the bariatric surgery.
If you look at the large pool of patients who are diagnosed with obesity or morbid obesity, mental health in general is often an aspect of the disease. Though many individuals who are seriously overweight or have obesity may not have a clear mental health diagnosis, many of them do turn to food to manage emotions including depression, anxiety, and acute and chronic stress. Others may have learned lifelong unhealthy feeding patterns from their parents and other family members, perpetuating dangerous diet habits that resulted in excessive weight gain. In reality, there is a mental health component contributing to obesity in many individuals who struggle with the disease. That’s precisely why screening before surgery is so important. It would seem intuitive that a determination of stability of mental health issues, whether clearly diagnosed or identified during the screening process, needs to be dealt with before and after surgery. That’s why simply having a diagnosis of some form of mental illness should not negate being a good candidate for successful bariatric surgery.
The findings of this study do speak largely to the fact that mental illness should not be considered a deal breaker when treating individuals who would otherwise qualify for bariatric surgery. What is clear is that individuals with mental illness — depending on the stability of their disease and meeting the other criteria for bariatric surgery — can benefit from this treatment for obesity.
All patients having any type of bariatric surgery need ongoing post-surgery support. The support team should be multi-disciplinary and include a surgeon, primary care physician and/or obesity specialist, dietician, and an exercise expert. Care should include dietary counseling, exercise education, and group meetings with similar patients. If the patient has a mental health diagnosis, their psychologist or psychiatrist should also be part of the pre- and post-surgery health team.