Why is a psychological assessment required?

Post-Surgery Weight Regain: Mental Health

Regular readers will appreciated the importance of mental health factors both as a promoter of weight gain as well as an important barrier to weight management.

It is therefore no surprise that in our systematic review of weight regain after bariatric surgery, published in Obesity Surgery, we found substantial evidence for the role of mental health factors both in failure to lose adequate amounts of weight or to regain any weight lost.

Out of the sixteen studies included in the review, all studies that examined this factor, implicated uncontrolled mental health issues as an important cause of weight regain.

These included, binge eating disorder, depression and addictive behaviours (alcohol and drug use).

In fact, there was a linear relationship between the number of reported psychiatric diagnoses and the magnitude of weight regain. Overall, patients with two or more psychiatric conditions were approximately six times more likely to either lose no further weight or regain weight than patients without psychiatric problems.

At least one study reported that 80 % of patients identified pre-operatively with an eating disorder, and who did not receive any treatment pre-operatively, had recurrent feelings of binge eating at 6 months post-operation. In addition to binge eating, some researchers describe a new sub-clinical disorder described as “grazing” (consuming multiple small meals with feelings of loss of control with eating), the incidence of which appeared to increase after surgery and was associated with an increased tendency for weight regain.

Interestingly, one study found that completion rates of behavioural modification therapy increased to 91% when performed post-operatively, compared to 14 % when done pre-operatively.

Nevertheless, it probably makes more sense, when possible, to address mental health issues prior to undergoing surgery.

In summary, our review finds ample evidence that a wide range of mental health problems can lead to maladaptive eating, which if unregocgnised and untreated will prove a persistent impediment to surgical weight loss.

This is why extensive mental health assessments and interventions both prior to as well as following surgery should be a routine part of bariatric care.

If you have experienced specific mental health issues to be an important factor in weight gain after surgery, I’d like to hear about it.

@DrSharma

Edmonton, AB

Karmali S, Brar B, Shi X, Sharma AM, de Gara C, & Birch DW (2013). Weight Recidivism Post-Bariatric Surgery: A Systematic Review. Obesity surgery PMID: 23996349