Swirling Void

The Void: Understanding Mental Health and Bariatric Surgery

Above the NeckOver and over we hear it. The physical changes that come with bariatric surgery are obvious. But the biggest challenges are inside our own heads. And it shows up in research. Rarely, but significantly, substance abuse, alcohol use, depression, or even suicide can follow in the years after surgery. Though we know much about this surgery, we still don’t know enough about the mental health aspects.

Substance Abuse

Data from the LABS-2 study earlier this year provides a clear picture. An increased risk of alcohol and substance abuse follows for years after gastric bypass. One in five patients reported symptoms of alcohol abuse in the five years after surgery.

Caroline Apovian is president-elect of the Obesity Society and director of nutrition and weight management at Boston Medical Center. Caring for many patients over many years, she sees this problem clearly and shares perspective from a recent case:

A very dear patient of mine lost a great deal of weight and resolved many issues. But now she faces issues with alcohol and substance abuse. She has been in rehab twice already. Currently we have very little knowledge to guide us in counseling patients.

Knowing more about potential risk factors could help us identify patients at risk. These are outcomes we desperately need to study.

Depression and Suicide

Observational studies, such as this one, make it clear that a small but important risk of suicide can follow after bariatric surgery. Likewise, depression is an important consideration. In a recent review,  Noah Switzer and colleagues noted:

While generally, bariatric surgery is beneficial for depression, there exists a cohort of patients who might actually worsen following surgery. A likely multifactorial consequence of weight regain, unrealistic expectations or other life stresses, this group needs to be monitored closely, as postoperative bariatric surgery patients appear to be at an increased risk of suicide. Overall, a multidisciplinary team including psychiatrists, psychologists and other mental health professionals are vital to optimize patient care.

We have abundant evidence for the immediate benefits of bariatric surgery. But we’re only scratching the surface of the evidence needed to support long-term mental health outcomes.

Click here for the LABS-2 study on substance abuse, here for the study of suicide, and here and here for the further perspective on mental health and bariatric surgery.

Swirling Void, photograph © Fan.D / flickr

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September 11, 2017