Bariatric Surgery Patients Often Have Mental Health Problems

When a few of the new members read this in endocrinology advisor, they were concerned about two friends that were setting up for bariatric surgery. Janet was very concerned about her friend and Millie was concerned as were several others that knew their friends. They asked Tim and me to come and talk with them about what they should know.

Both Tim and I were somewhat aware of the problems, but we reread the information. Apparently, depression and binge eating disorder are common among patients seeking and undergoing bariatric surgery. This is according to the data published in JAMA recently. Janet and Millie both said that both of their friends often suffered from depression and Janet said her friend had the habit of binge eating regularly. Millie said her friend seldom binge ate, but has a few times when she in going into depression.

Tim suggested that they should see professionals before the surgery to find out if they would talk about these two mental health problems. Janet asked why we called binge eating a mental health problem. I said because it is something that is a problem that needs to be addressed and it has mental health ramifications. Millie said she could understand this and did see the need for counseling about this. Tim suggested that they have their friends receive counseling before bariatric surgery and not have the surgery until they have the counseling.

Tim asked if they knew the weight of the two individuals. Janet said her friend was about 340 pounds and Millie said her friend was about 300 pounds. Tim said that while both of us did not favor bariatric surgery, it is one method of promoting weight loss and improving weight-related comorbidities in obese patients, but mental health has received less attention. Mental health conditions may be common in this patient population; research on the prevalence and their association with outcomes after bariatric surgery varies.

Random-effects pooled estimates revealed that 23% of patients seeking and undergoing bariatric surgery had a current mood disorder, most commonly depression and 17% were diagnosed with binge eating disorder.

Both estimates are higher than published rates for the general U.S. population, suggesting that special attention should be paid to these conditions among bariatric patients. Other mental health conditions, such as psychosis, PTSD, and personality disorders are less common but may be more prominent in select subgroups such as U.S. veterans.

Data regarding the link between preoperative mental health conditions and postoperative weight loss were conflicting. Neither depression nor binge eating disorder was consistently associated with differences in weight outcomes. However, bariatric surgery was consistently associated with an 8% to 74% decrease in prevalence of depression in 7 studies and a 40% to 70% decrease in the severity of depressive symptoms in 6 studies.

Future studies would benefit from including these characteristics as well as having clear eligibility criteria, standardized instruments, regular measurement intervals, and transparency with respect to time-specific follow-up rates. By addressing these methodological issues, future work can help to identify the optimal strategy for evaluating patients' mental health before bariatric surgery.