Psychiatric issues in bariatric surgery

WLS is a proven, effective intervention for severely obese patients. There are four broad categories of surgery, but all reduce excess body weight to an extensive extent. Using surgery in the treatment of a disease with a large behavioral component may seem counterintuitive, but numerous studies have shown the ineffectiveness of diet and exercise in the morbidly obese. The ineffectiveness of these methods is the result, in part, of an alteration in hormones and peptides involved with long-term regulation of energy and weight. The WLS procedures have been shown to alter the anatomic and physiologic function of the stomach. In a motivated patient, this change in the gastrointestinal tract results in weight loss and a significant reduction in weight-related health problems. Evaluating a patient for WLS can be challenging, and multiple organizations have suggested that a multidisciplinary approach be used. The mental health professional often is called on to assess many different domains of psychologic function. This evaluation should go beyond the standard interview and should pay attention to the patient's eating behavior, knowledge of surgery, and motivation for surgery. The use of standardized instruments will facilitate accuracy and further research in the field of WLS. Because there are few absolute psychologic contraindications to WLS, the assessment should also focus on risk management, with the goal of improving the patient's postoperative quality of life.