Psychosocial Concerns Following Bariatric Surgery: Current Status
- 69 Downloads
Purpose of Review
The purpose of this paper is to review the current status of research on psychosocial concerns following bariatric surgery.
Bariatric surgery has a positive overall impact on weight and obesity-related comorbidities, as well as a positive short-term impact on mental health and psychosocial functioning. Nonetheless, research has documented a number of different psychosocial concerns that may emerge following surgery including maladaptive eating, substance use disorders, suicide, lack of social support, and excess skin. Moreover, special populations of patients may have distinctive psychosocial concerns based on sociodemographic factors such as age or severity of obesity. Available studies suggest that psychosocial interventions have a positive impact on post-surgery outcomes, particularly maladaptive eating. However, research is limited, and long-term data are lacking.
Monitoring patients after bariatric surgery for negative psychosocial outcomes is warranted. Research is needed to develop and evaluate personalized approaches to optimize long-term weight loss and psychosocial adjustment.
KeywordsBariatric surgery Psychosocial factors Maladaptive eating Substance use Suicide Social support
Compliance with Ethics Guidelines
Conflict of Interest
Melissa A. Kalarchian declares that she has no conflict of interest.
Marsha D. Marcus has received compensation from Weight Watchers International, Inc., for serving on Scientific Advisory Boards.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American Association of Clinical Endocrinologists and American College of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22:1–203.PubMedGoogle Scholar
- 2.American College of Cardiology. American Heart Association task force on practice guidelines, Obesity Expert Panel, 2013. Expert panel report: guidelines (2013) for the management of overweight and obesity in adults. Obesity (Silver Spring). 2014;22:S41–410.Google Scholar
- 12.Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database of Syst Rev. 2014:CD003641.Google Scholar
- 16.Coulman KD, MacKichan F, Blazeby JM, Owen-Smith A. Patient experiences of outcomes of bariatric surgery: a systematic review and qualitative synthesis. Obes Res. 2017;18:547–59.Google Scholar
- 17.Lindekilde N, Gladstone BP, Lübeck M, Nielsen J, Clausen L, Vach W, et al. The impact of bariatric surgery on quality of life: a systematic review and meta-analysis. Obes Res. 2015;16:639–51.Google Scholar
- 21.• Ivezaj V, Grilo CM. The complexity of body image following bariatric surgery: a systematic review of the literature. Obes Res. 2018;19:1116–40 This comprehensive literature review of body image as a multidimensional construct documented that eating pathology is reated to greater body image dissatisfaction following surgery. Notably, however, most studies do not investigate concerns related to excess skin and body contouring surgery.Google Scholar
- 22.• Kolotkin RL, Kim J, Davidson LE, Crosby RD, Hunt SC, Adams TD. 12-year trajectory of health-related quality of life in gastric bypass patients versus comparison groups. Surg Obes Relat Dis. 2018;14:1359–65 This prospective study evaluated changes in quality of life in bariatric surgery patients and 2 non-surgical comparsion groups. Improvements in weight-related and physical quality of life peaked at 2 years post-surgery, and remained improved relative to pre-surgery through 12 years following gastric bypass. PubMedGoogle Scholar
- 26.• Dawes AJ, Maggard-Gibbons M, Maher AR, Booth MJ, Miake-Lye I, Beroes JM, et al. Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. JAMA. 2016;315:150–63 Mental health conditions are common among bariatric surgery patients, but their relationship to weight loss is inconsistent as reported in the literature. However, moderate quality evidence supports an assocation between bariatric surgery and lower rates of depression post-surgery. PubMedGoogle Scholar
- 36.Delvin MJ, King WC, Kalarchian MA, White GE, Marcus MD, Garcia L, et al. Eating pathology and experience and weight loss in a prospective study of bariatric surgery patients: 3-year follow-up. Int J Eat Disorder. 2016;49:1058–67.Google Scholar
- 39.Conceição EM, Mitchell JE, Engel SG, Machado PPP, Lancaster K, Wonderlich SA. What is “grazing”? Reviewing its definition, frequency, clinical characteristics, and impact on bariatric surgery outcomes, and proposing a standardized definition. Surg Obes Relat Dis. 2014;10:973–82.Google Scholar
- 41.• Li L, Wu L-T. Substance use after bariatric surgery: a review. J Psychiatr Res. 2016;76:16–29 This review of substance use following surgery (alcohol, tobacco, and illicit or non-medical drugs) doucumented that a considerable proportion of patients use substances post-surgery. Although results from prospective studies are limited, individuals with a history of substance use may be at risk for post-surgery use, which has been assocaited with medical complications and psychological problems. PubMedPubMedCentralGoogle Scholar
- 46.• Castaneda D, Popov VB, Wander P, Thompson CC. Risk of suicide and self-harm is increased after bariatric surgery—a systematic review and meta-analysis. Obes Surg. 2019;29(1):322–33 This review found that risk for self-harm/suicide attempt is higher among bariatric surgery patients compared to age-, sex-, and BMI-matched controls. The authors highlight the pre- and post-surgery psychosocial, pharmacokinetic, physiologic, and medical factors that may be involved. Google Scholar
- 49.Mitchell JE, Crosby R, de Zwaan M, Engel S, Roerig J, Steffen K, et al. Possible risk factors for increased suicide following bariatric surgery. Obesity (Silver Spring, MD). 2013;21:665–72.Google Scholar
- 50.Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, et al. Is social support associated with greater weight loss after bariatric surgery?: a systematic review. Obes Res. 2011;12:142–8.Google Scholar
- 55.• Bruze G, Holmin TE, Peltonen M, Ottosson J, Sjöholm K, Näslund I, et al. Associations of bariatric surgery with changes in interpersonal relationship status: results from 2 Swedish cohort studies. JAMA Surg. 2018;153:654–61 In two large Swedish cohorts with long-term follow-up, baritric surgery was associated with changes in relationship status. Specifically, surgery was associed with increased incidence of divorce/separation for those who were married, as well as increased incidence of marriage and new relationships for those who were single. PubMedGoogle Scholar
- 58.• Baillot A, Brais-Dussault E, Bastin A, Cyr C, Brunet J, Aimé A, et al. What is known about the correlates and impact of excess skin after bariatric surgery: a scoping review. Obes Surg. 2017;27:2488–98 Women report more excess skin and greater inconveniences related to excess skin than men following surgery. Although excess skin may adversely impact physical and psychosocial functionig, as well as activites of daily living, it has not been possible to determine which individuals are at risk. PubMedGoogle Scholar
- 68.Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, et al. The enduring effects of abuse and related adverse experiences in childhood: a convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2006;256:174–86.Google Scholar
- 72.Hulme PA, McBride CL, Kupzyk KA, French JA. Pilot study on childhood sexual abuse, diurnal cortisol secretion, and weight loss in bariatric surgery patients. J Child Sex Abuse. 2015;24:385–400.Google Scholar
- 77.• Takemoto E, Andrea SB, Wolfe BM, Nagel CL, Boone-Heinonen J. Weighing in on bariatric surgery: effectiveness among Medicaid beneficiaries—limited evidence and future research needs. Obesity. 2018;26:463–73 This systematic review documented that patients with Medicaid experience weight loss similar to patients with commercial insurance through 2-years post-surgery. However, future research is needed to understand baseline differences in health between the groups, as well as how they contribute to higher short-term health care utilization and mortaility among Medicaid beneficiaries. PubMedGoogle Scholar
- 85.Strong J, Ray K, Findley PA, Torres R, Pickett L, Byrne RJ. Psychosocial concerns of veterans of Operation Enduring Freedom/Operation Iraqi Freedom. Health Soc Work. 2014;39:17–24.Google Scholar
- 86.Gibbons MM, Maher AR, Dawes AJ, Booth MS, Miake-Lye IM, Beroes JM, et al. Mental health assessment and psychosocial interventions for bariatric surgery [Internet]. Washington (DC): Department of Veterans Affairs (US); 2014. VA Evidence-based Synthesis Program ReportsGoogle Scholar
- 88.• Funk LM, Gunnar W, Dominitz JA, Eisenberg D, Frayne S, Maggard-Gibbons M, et al. A health services research agenda for bariatric surgery within the Veterans Health Administration. J Gen Intern Med. 2017;32:65–9 The Veterans Health Adminstration held a conference to develop a research agenda for population-based weight management for veterans. Priority evidence gaps identified by the bariatric surgery work group included (but were not limited to) long-term impact on mental health and substance abuse, as well as health services interventions to optimize outcomes. PubMedPubMedCentralGoogle Scholar
- 89.Leahey TM, Crowther JH, Irwin SR. A cognitive-behavioral mindfulness group therapy intervention for the treatment of binge eating in bariatric surgery patients. Cogn Behav Pract. 2008;15:364–75.Google Scholar
- 90.Weineland S, Arvidsson D, Kakoulidis TP, Dahl J. Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT. Obes Res Clin Pract. 2012;6:e21–30.Google Scholar