Academic journal article International Journal of Psychology and Psychological Therapy

Psychosocial Profile of Bariatric Surgery Candidates and the Correlation between Obesity Level and Psychological Variables

Academic journal article International Journal of Psychology and Psychological Therapy

Psychosocial Profile of Bariatric Surgery Candidates and the Correlation between Obesity Level and Psychological Variables

Article excerpt

World Health Organization (WHO, 2006) declared obesity as "a global epidemic". Obesity is defined as an abnormal or excessive fat accumulation that represents a plethora of health risks. Obesity is mainly the result of consuming more energy than body requires. There are other factors involved in its etiology like genetics, environment, socioeconomics, psychological, sedentarism, hormonals, and so (Feldman & Christensen, 2008).

It is identified by Body Mass Index (BMI) (kg/m2) parameter; overweight is defined as BMI .25 kg/m2 and obesity as .30 kg/m2. According to WHO statistics, in 2005 at least 400 million people in the world were obese, and projections for 2015 are that, 2300 million people will be overweight and more than 700 million people will be obese.

Overweight and obesity are risk factors for diabetes, coronary diseases, high blood cholesterol levels, stroke, arterial hypertension, gallbladder diseases, osteoarthritis, obstructive sleep apnea, respiratory problems, and some types of cancer. Bariatric Surgery is one of the most effective treatments for patients with morbid obesity; it is indicated for patients with BMI .40 kg/m2 or .35 kg/m2 in case of associated comorbidities. Recently, the FDA has cut down the BMI requirement for lap-band procedures to 30 kg/m2. Presurgical psychological evaluation and intervention are proposed for a better post surgical prognosis, better patient's satisfaction about treatment, and also to identify specific cases in need of psychological intervention to improve surgical outcomes (Greenberg, Sogg, & Perna, 2009). It has been reported that negative anymic states, emotional eating, unrealistic expectations about surgery and poor or inadequate knowledge about surgery procedures, its risks, and the need for a lifestyle change, are related to poor adherence to nutritional and physical activity indications. The latter is related to less weight loss, lower patient's satisfaction and less post surgical success (Bauchowitz, Gonder-Frederick, Olbrisch et al., 2005; Kinzl, Schrattenecker, Traweger et al., 2006; Marcus, Kalarchian, & Courcoulas, 2009; Pull, 2010).

Obesity is a health problem not only related to physical risks (Kral, 2001), but also to a great variety of psychological symptoms such as body concerns, depressed mood, low self esteem (Kalarchian, Marcus, & Levine, 2007; Petri, Barry, Pietrzak, & Wagner, 2008; Werrij, Jansen, Mulkens, Elgersma, Ament, & Hospers, 2009) and discrimination (Magallares, Morales, & Rubio, 2011). It has been reported that patients seeking for bariatric surgery have higher prevalence of psychiatric disorders like depression and eating behavior disorders than those who are not and that these psychiatric disorders as well, are related to higher levels of obesity (Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005). Obesity has also been found to increase the risk of depression (Hayden, Dixon, Dixon, Shea, & O'Brien, 2010; Luppino, de Wit, Bouvy et al., 2010).

Not all patients undergoing bariatric surgery get benefits from it; there have been significant variations in weight loss at short and long term after surgery (Kinzl et al., 2006); an example is that 20% of patients undergoing weight loss surgery don'tlose significant weight or regain it at a short time period (Greenberg et al., 2009).

There is not enough evidence to support psychopathology as a contraindication for bariatric surgery, however, as psychopathology as well as other psychological factors can impact surgery's outcome, presurgical psychological evaluation can identify behavioral and psychological factors that could affect patient's safety and efficacy of surgery (Dwyer, 1998; Greenberg et al., 2009; Hsu, Benotti, & Dwyer, 1998).

A Psychologist's role in a bariatric surgery multidisciplinary team should consist on initial evaluation of bariatric surgery candidates in order to determine patient's ability to make required lifestyle changes before and after surgery, to offer psychoeducation to patients in order to prepare them for these changes and to help them make an informed decision about undergoing or not surgery. …

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