Obesity surgery and serious psychiatric conditions, lessons learned from 5 patients: A case report

Obesity and severe psychiatric disorders, including schizophrenia, bipolar disorder, and major depressive disorder, frequently coexist, with obesity prevalence nearly twice that in the general population. This association is driven by antipsychotic-induced metabolic effects, sedentary behavior, and poor dietary habits. Despite the proven efficacy of bariatric surgery for morbid obesity, its application in patients with serious psychiatric illness remains controversial due to concerns regarding treatment adherence, psychiatric relapse, and decision-making capacity.

Five patients with established severe psychiatric disorders (schizophrenia, bipolar disorder, and severe depression) presented with morbid obesity requiring surgical management. Concerns included poor adherence to medical recommendations, vulnerability to psychiatric decompensation, and limited preoperative psychiatric evaluation.

All patients were diagnosed with morbid obesity in the setting of chronic severe psychiatric illness. Postoperatively, several patients developed complications, including psychiatric relapse (psychotic or mood episodes), somatic symptomatology without an identifiable organic cause, and surgical complications.

Patients underwent various bariatric procedures. However, preoperative psychiatric assessment was insufficient, and structured postoperative psychiatric follow-up was lacking across all cases.

Although significant weight loss and metabolic improvement were achieved in all patients, outcomes were overshadowed by major adverse events. These included psychiatric relapses, treatment noncompliance, functional somatic symptoms, surgical complications, and one completed suicide.

Bariatric surgery in patients with severe psychiatric disorders carries substantial risk when not managed within a multidisciplinary framework. Thorough preoperative psychiatric evaluation and continuous postoperative mental health support are essential to optimize outcomes. Surgical candidacy should be based on individualized functional stability rather than diagnosis alone, and such procedures should be limited to specialized centers capable of addressing complex psychiatric and medical needs.