Bariatric Surgery Postoperative Behavioral Change: The Importance of Ongoing Assessment and Teaching

In bariatric surgery we modify, in varying degrees, the gastrointestinal system. We observe the patients clinically over the postoperative period of a few months or more. During this time our main concern is to monitor them physiologically, noting the decline in weight, change in body structure, and vast improvement in their comorbidities. Frequently the reaction of the patient may be somewhat surprising to us. One or 2 years past surgery they have forgotten about having had diabetes and hypertension, diseases for which they had received a barrage of medical treatment. It does not seem to matter anymore that at one time they wore a size 2X and now can wear size 14. Now we are forced to wonder what the expectation of the patient was. Our goal was to improve their physiological and psychological well-being, assuming they would go hand in hand with weight loss. If the patient does not recognize an improvement in their quality of life and continues to question their self-worth, then perhaps we should reassess our goals and our obligations. The principles of surgery and how it is or should be done is fairly clear. If we are to maintain standards of quality in this particular field of medicine, we must recognize our commitment to patients and make these principles just as clear. The commitment involves ongoing postoperative assessment and teaching, assessment of emotional well-being and lessons in dietary and physical activity, including exposure to and involvement in group support.