Psychological Effects After Bariatric Surgery

Ashley Rogers

Argosy University Inland Empire

Abstract

In the recent years bariatric surgery has been a proven clinical intervention to help the obese and morbidly obese population effectively lose weight and maintain that weight loss. It has also been proven to help an obese person enhance their overall quality of life. This paper examined the psychological factors of bariatric surgery that a person may experience after having a bariatric surgery procedure, results of the literature review found that both positive psychological as well as negative psychological effects were discovered among the bariatric patients post operation. Future research on ways to deal with the negative effects and ways to prevent the negative effects from escalating were also discussed.

Bariatric surgery is the process of using surgical intervention in order to reduce the size of ones stomach and at the same time limit the amount of food or caloric intake a person can consume at a single time in order to help them lose weight and maintain that weight loss (Sutton. 2008). Bariatric surgery is usually preformed on obese or morbidly obese individuals that have been unable to lose weight or maintain that weight loss in the past. Although weight loss surgery is proven to be the most effective treatment to help an obese person, not only lose the excess body weight, but to also maintain the weight loss, there are many psychological factors that come along with massive weight loss and such a drastic lifestyle change. This presentation and literature review over view examines both the positive and negative psychological effects that bariatric surgery can have on a person.

Hypothesis and Question Asked:

What are the most common psychological issues associated with obesity and being over weight?

Are there psychological effects after bariatric surgery?

What are the psychological effects after bariatric surgery?

How are these psychological effects addressed and/or treated?

Are the psychological effects after bariatric surgery negative or positive? Or even both?

Psychological Issues common with obesity before bariatric surgery:

Between 20% and 60% of patient have been characterized as suffering from a mood or anxiety disorder before having bariatric surgery. (Sarwer, D. 2008)

About 38% of pre operative patients were given a current mood disorder diagnosis. (Sarwer,D. 2008)

About 60% were given a lifetime mood disorder diagnosis. (Sarwer,D. 2008)

Depression and anxiety are the most common mood disorders present prior to bariatric surgery. (Kubik. 2013)

Eating disorders are also common in someone seeking out bariatric surgery. Most common types are binge eating and emotional eating. (Kubik. 2013)

Low self-esteem, body image issues and a low health-related quality of life are also common. (Kubik. 2013)

What are the positive psychological effects after bariatric surgery?

Bariatric surgery is proven to improve the general quality of life. This can be due to the surgery alleviating most, if not all of the patient’s comorbidities within the first year after surgery. (Kubik. 2013)

There have been numerous studies that have reported an overall improvement in depressive symptoms, self-esteem, health-related quality of life and improved body image. These improvements can be contributed to the patient finally taking an active role in changing their lives for the better. (Kubik. 2013)

The patient can also become more active and engage more in social interactions, post-op, which can also help alleviate the symptoms of depression that were related to any physical limitations they may have previously had before surgery. (Kubik. 2013)

Psychosocial functioning and quality of interpersonal relationships also improve. (Grimaldi. 2010)

Positive Effects continued…:

Improvement in body image, improved self-confidence, less social anxiety, and a general improved quality of life. (Grimaldi. 2010)

Decline of binge eating due to the new restrictions due to the surgery. (Grimaldi. 2010)

Improvement in interpersonal relationships due to simple behavioral changes and no longer feeling self-loathing. (Grimaldi. 2010)

Decline of the use of anti-depressants up to 3 years post-op. (Booth. 2014)

What are the negative psychological effects after bariatric surgery?

Depression or anxiety due to the stigma that can often come along with bariatric surgery being seen as taking the easy way out. (Grimaldi. 2010)

Depression or anxiety due to having regrets of having had bariatric surgery due to complications or stigmas. (Grimaldi. 2010)

Patient can also develop or still have body dissatisfaction due to excess skin and it leaving them feeling like they still have not lost enough weight, or that their body will never look they way they want it to. (Grimaldi. 2010)

The constant feeling of not losing enough weight, not losing the weight fast enough can also lead to anxiety or depression. (Grimaldi. 2010)

Negative effects cont…:

Anxiety or depression due to the fear of regaining the weight that they have lost, or even actually regaining some if not most of the weight they have lost. (Grimaldi. 2010)

Stable bipolar disorder is not affected by bariatric surgery. (Karlsson. 2007)

Anxiety due to weight loss and weight regain and weight stability making them feel like they’re on a constant rollercoaster. (Karlsson. 2007)

Anxiety due to the pressure to meet the weight goal the surgeon has set for the patient. (Karlsson. 2007)

Patient can become overly obsessive about they’re weight. (Karlsson. 2007)

Ways to treat or address these psychological issues:

Psychotherapy both before and after surgery. (Yen. 2014)

Antidepressants to help with the anxiety and depression. (Yen. 2014)

Bariatric support groups that are ran by the surgeons office that focus on emotional and cognitive changes that come after surgery and they offer a general support of other people that have had the same surgery as the patient. (Yen. 2014)

Cognitive Behavioral Therapy to help change old behaviors that led to the weight gain in the first place. (Yen. 2014)

Hypothesis revisited:

All the the questions that were presented in my hypothesis were answered in the research. Research showed that yes, there are both positive and negative psychological effects after a person having bariatric surgery. The research supports that there is an overall improvement in depressive symptoms, eating behaviors, body image and a higher overall quality of life after bariatric surgery. In order for these results to be optimal though, the research suggests that the postoperative psychological health needs to be paid attention to and recognized. The research also suggests that the surgical team needs to pay attention to the negative reactions as well as the positive one to help the patient maintain their new higher quality of life.

Summary of findings:

The research supports that bariatric surgery is an effective was to help an obese person lose weight and maintain that weight loss. Bariatric surgery is also proven to help a person maintain a overall higher quality of life, and can help alleviate depression and anxiety that a person had that may have developed due to being overweight or obese. With a new healthier lifestyle change the research also shows that there are negative effects that can come along with a person losing weight so rapidly due to having bariatric surgery. These issues can be anxiety and depression that can be from body dissatisfaction, feeling like they haven’t lost enough weight, or are not losing the weight fast enough, or just from not addressing psychological issues that the patient had prior to surgery. The research supports that although bariatric surgery is an effective tool to improve the overall quality of life a person has, that it is not a magic wand and that follow up psychotherapy and attending weight loss surgery support groups is strongly recommended to maintain the improved quality of life and to try and limit the common psychological issues that a person can experience after bariatric surgery.

Limitations of the research:

The main limitations of the research that was presented is that since bariatric surgery is still a new procedure there is not many longitudinal studies that have been done to determine what the long term psychological effects of bariatric surgery can be. Another limitations of the research was that the researchers had a hard time finding patients willing to do follow up psychological care and so the sample size was not as large as it could have been. The fact that age at the time of surgery was not really mentioned that often in the research was also a limitation to the research. The fact that some of the research was ambivalent on the effects of bariatric surgery and depression is also a limitation of the research. Since some psychological issues develop on so early in life they can be resistant to change. This can be a limitation to the research because in most of the research it was not mentioned when the patient first started experiencing their symptoms of depression or anxiety, so it is unfair to say if bariatric surgery is the reason to why these symptoms got better or worse.

References

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References continued….

Haskins, O. (2015). Surgical patients may have different psychological profiles. Retrieved from http://www.bariatricnews.net/?q=news/111860/surgical-patients-may-have-different- psychological-profiles

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References continued

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