Abstract
Conservative interventions for weight reduction are not very effective in many cases of morbid obesity. For this reason, bariatric surgery plays an increasing role in the treatment of these patients. Bariatric surgery, however, is not the solution but an important precondition for successful management of morbid obesity. Psychological evaluation of the weight loss surgery patients is recommended because of the prevalence of psychiatric comorbidities and of eating disorders in individuals with morbid obesity. Morbid obese eatingdisordered patients with co-morbid psychiatric disorders, especially with personality disorders, show greater difficulties in adapting to the new demands, including the need to cope with stress and other problems in a new way, to relearn how to eat, distress over weight loss plateaus, failure to achieve a normal-looking body etc. Therefore, psychological and/or psychiatric treatment seem to be needed in some obese patients to gain an early postoperative understanding of possible psychological or eating problems. Various kinds of psychological support are available at Innsbruck Medical University Hospital before and after bariatric surgery, such as pharmacotherapy, individual psychotherapy, small-group psychotherapy, and the “Obesity Club”. The reasons for the relatively low degree of willingness to take part in psychological treatment programs are demonstrated.
References
Bray GA. Obesity: a time bomb to be defused. Lancet 1998; 352: 160–1.
Bray GA. The missing link — lose weight, live longer. N Engl J Med 2007; 357: 818–20.
Sjostrom L, Narbro K, Sjostrom CD. Swedish Obese Subjects Study: Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357: 741–52.
Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007; 357: 753–61.
Van Hout GC, Leibbrandt AJ, Jakimowicz JJ, et al. Bariatric surgery and bariatric psychology general overview and the Dutch approach. Obes Surg 2003; 13: 926–31.
Van Hout GC, Boekestein P, Fortuin FA, et al. Psychosocial functioning following bariatric surgery. Obes Surg 2006; 16: 787–94.
Saunders R. Post-surgery group therapy for gastric bypass patients. Obes Surg 2004; 14: 1128–31.
Rusch MD, Andris D. Maladaptive eating patterns after weight-loss surgery. Nutr Clin Pract 2007; 22: 41–9.
Fox KM, Taylor SL, Jones JU. Understanding the bariatric surgical patient: A demographic, lifestyle and psychological profile. Obes Surg 2000; 10: 477–81.
Grothe KB, Dubbert PM, O’Jile JR. Psychological assessment and management of the weight loss surgery patient. Am J Med Sci 2006; 331: 201–6.
Vallis TM, Ross MA. The role of psychological factors in bariatric surgery for morbid obesity: identification of psychological predictors of success. Obes Surg 1993; 3: 346–59.
Powers PS, Rosemurgy A, Boyd F, et al. Outcome of gastric restriction procedures: weight, psychiatric diagnoses, and satisfaction. Obes Surg 1997; 7: 471–7.
Maddi SR, Khoshaba DM, Persico M, et al. Psychosocial correlates of psychopathology in a national sample of the morbidly obese. Obes Surg 1997; 7: 397–404.
Sarwer DB, Cohn MI, Gibbons LM, et al. Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates. Obes Surg 2004; 14: 1148–56.
Guisado JA, Vaz FJ, Lopez-Ibor JJ, et al. Eating behavior in morbidly obese patients undergoing gastric surgery: differences between obese people with and without psychiatric disorder. Obes Surg 2001; 11: 576–80.
Pawlow LA, O’Neil PM, White MA, et al. Findings and outcomes of psychological evaluations of gastric bypass applicants. Surg Obes Relat Dis 2005; 1: 523–7.
Glinski J, Wetzler S, Goodman E. The psychology of gastric bypass surgery. Obes Surg 2001; 11: 581–8.
Kinzl JF, Schrattenecker M, Traweger C, et al. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg 2006; 16: 1609–14.
Kinzl JF. Bedeutung der psychologischen Betreuung morbid Adipöser nach bariatrischer Operation. Aktuel Ernaehr Med 2007; 32: 1–4.
Van Gemert WG, Severeigns RM, Greve JW, et al. Psychological functioning of morbidly obese patients after surgical treatment. Int J Obes 1998; 22: 393–8.
Terra JL. The psychiatrist’s point of view on the treatment of morbid obesity by gastroplasty. Ann Chir 1997; 51: 177–82.
Kinzl JF, Schrattenecker M, Traweger C, et al. Quality of life in morbidly obese patients after surgical weight loss. Obes Surg 2007; 17: 229–37.
Vallis MT, Butler GS, Perey B, et al. The role of psychological functioning in morbid obesity and its treatment with gastroplasty. Obes Surg 2001; 11: 716–25.
Kinzl JF, Traweger C, Guenther V, et al. Family background and sexual abuse associated with eating disorders. Am J Psychiatry 1992; 151: 1127–31.
Guisado JA, Vaz FJ. Personality profiles of the morbidly obese patients after vertical banded gastroplasty. Obes Surg 2003; 13: 394–8.
Stunkard A, Grace WJ, Wolff HG. The night-eating syndrome. A pattern of food intake among certain obese patients. Am J Med 1955; 19: 78–86.
Saunders R. “Grazing”: a high-risk behavior. Obes Surg 2004; 14: 98–102.
Fairburn CG, Walsh BT. Atypical eating disorders. In: Brownell KD, Fairburn CG (Eds) Eating Disorders and Obesity. A comprehensive handbook. New York-London, The Guilford Press, 1995, pp 135–40.
Spitzer RR, Devlin M, Walsh BT. Binge eating disorders: a multiple field trial of the diagnostic criteria. Int J Eat Disord 1992; 11: 191–203.
Hsu LKG, Bentacourt S, Sullivan SP. Eating disturbances before and after vertical banded gastroplasty: a pilot study. Int J Eat Disord 1996; 19: 23–34.
Saunders R. Binge eating in gastric bypass patients before surgery. Obes Surg 1999; 9: 72–6.
Kielmann R, Herpertz S. Möglichkeiten und Grenzen der Adipositas-Chirurgie aus psychotherapeutischer Sicht. Verhaltenstherapie 2002; 12: 319–26.
Dubovsky SL, Haddenhuorst A, Murphy J, et al. A preliminary study of the relationship between preoperative depression and weight loss following surgery for morbid obesity. Int J Psychiatr Med 1985; 15: 185–96.
Elkins G, Whitfield P, Macus J, et al. Noncompliance with behavioral recommendations following bariatric surgery. Obes Surg 15, 546–551, 2005.
Burgmer R, Grigutsch K, Zipfel S, et al. The influence of eating behavior and eating pathology on weight loss after gastric restriction operations. Obes Surg 2005; 15: 684–91.
DeZwaan M, Muhlhans B. Essverhalten vor und nach adipositaschirurgischer Behandlung. Aktuel Ernaehr Med 2009; 34: 83–7.
Castelnuovo-Tedesco P, Weinberg J, Buchanan DC, et al. Long-term outcome of jejuno-ileal bypass surgery for super obesity: a psychiatric assessment. Am J Psychiatry 1982; 139: 1248–52.
American Society of Plastic Surgeons: Psychological considerations of the massive weight loss patient. Plast Reconstr Surg 2006; 117 (Suppl. 1): 17S–21S.
White MA, Masheb RM, Rothschild BS, et al. Do patients’ unrealistic weight goals have prognostic significance for bariatric surgery. Obes Surg 2007; 17: 74–81.
Smiertika JK, MacPherson BH. Beyond bariatric surgery: Complications we fail to address. Obes Surg 1995; 6: 277–381.
Delin CR, Watts JM, Bassett DL. An exploration of the outcomes of gastric bypass surgery for morbid obesity: Patient characteristics and indices of success. Obes Surg 1995; 5: 159–60.
Hawke A, O’Brien P, Watts J, et al. Psychosocial and physical activity changes after gastric restrictive procedures for morbid obesity. Aust NZ J Surg 1990; 60: 755–80.
Kinzl JF, Traweger C, Trefalt E, et al. Psychosocial consequences of weight loss following gastric banding for morbid obesity. Obes Surg 2003; 13: 105–10.
Kinzl JF, Trefalt E, Fiala M, et al. Psychotherapeutic treatment of morbidly obese patients after gastric banding. Obes Surg 2002; 12: 292–4.
Elekkary E, Elhorr A, Aziz F, et al. Do support groups play a role in weight loss after laparoscopic adjustable gastric banding. Obes Surg 2006; 16: 331–4.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kinzl, J.F. Morbid obesity: Significance of psychological treatment after bariatric surgery. Eat Weight Disord 15, e275–e280 (2010). https://doi.org/10.3275/7080
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.3275/7080