Magazine article Clinical Psychiatry News

Psychiatrists' Role in Bariatric Surgery Critical

Magazine article Clinical Psychiatry News

Psychiatrists' Role in Bariatric Surgery Critical

Article excerpt

Obesity has been officially declared a global epidemic by the World Health Organization. In virtually every region of the world, obesity's adverse health effects are a well-documented public health crisis that affects people of all ages. In light of poor long-term weight management reported in most traditional diet strategies, attention has shifted to gastric bypass surgery as an effective treatment option for obesity.

Bariatric weight loss procedures are associated with numerous health benefits in patients: dramatic weight loss, rapid improvement in blood glucose levels, blood pressure stabilization, and resolution of obesity-related orthopedic problems. It's not surprising, then, that gastric bypass surgery is a life-changing event for many patients.

Recently however, it has become clear that "life-changing" interventions do not always mean happy endings. Alongside these encouraging postsurgical outcomes are alarming counterintuitive reports of increased self-harm events. A recent study published in JAMA Surgery by Junaid A. Bhatti, Ph.D., of the department of evaluative clinical sciences, Sunnybrook Research Institute, Toronto, and the department of surgery, University of Toronto, and colleagues reported an increase in suicide attempts among postoperative gastric bypass patients (JAMA Surg. 2015 Oct 7. doi: 10.1001/jamasurg.2015.3414). The study conducted at Sunnybrook found that the rate of self-harm emergencies from attempted suicide was four times higher in these patients, compared with the general population.

Most gastric bypass surgery programs require a pre-op mental health evaluation. This is not enough, according to Dr. Peter F. Crookes, associate professor of Bariatric Surgery at Keck Hospital of the University of Southern California, Los Angeles. Dr. Crookes's clinical experiences and my (Dr. Baron's) 20-plus years of conducting psychiatric evaluations on bypass patients have revealed more vexing issues regarding psychiatric illnesses occurring in morbidly obese patients. The requirement has been established for presurgical psychiatric assessment, but long-term postsurgical emotional and behavioral challenges need to be evaluated as well. In addition to primary mental illness, obese patients are at risk for stress-related exacerbations of preexisting psychopathology. After a body-altering surgical procedure like gastric bypass, maladaptive coping strategies are likely to complicate a patient's physical AND emotional long-term recovery. …

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