A long-term follow up of people who had successful bariatric surgery – weight loss surgery – has found that their mental health is in a worse state 10 years later.

Bariatric surgery is used to treat morbid obesity. Surgery can involve different techniques including placing a restrictive band around the top of the stomach, removing part of the stomach or a gastric bypass where the small intestine is attached to a different part of the stomach.

Depending on the surgical technique used, weight loss results with bariatric surgery can be impressive with reports of up to 35 percent loss of body weight. With this weight loss comes dramatic improvements in a range of chronic health conditions especially type 2 diabetes, high blood pressure and heart disease risk.

Bariatric surgery is not a first line treatment for obesity nor should it be considered lightly. One question that’s yet to be resolved is the long-term mental outlook for people who undergo this surgery.

One to two years after surgery improvements in mental health indicators are seen but little long-term data has been collected.

Research into long-term mental health in bariatric surgery looks at the mental health of 36 people before undergoing bariatric surgery and then at one year and 10 years after.

A comparison group of 34 people who were participants in a more traditional weight-loss dietary program was also studied over the same time frame as a control group.

Ten years after the surgery, the bariatric group had lost 27 percent of their pre-operative weight and their health-related quality of life was better.  What was worse though was their general mental health, neuroticism, sense of control and fear of intimacy.

The dietary control group exhibited minimal changes in these measures over the 10 years.

Even compared to the general population, the overall mental health of the surgery group was worse off than expected states.

The researchers proposed that insufficient development of social skills to fit within their new ‘weight acceptance’ place in society could be one explanation for these results.

Alternatively, long-standing mental health problems that were buried by excessive eating were now unmasked. It could even be possible that the dietary changes needed to manage the surgical changes could be changing the gut microbiome matrix, which is linked to mental health.

Implications

Bariatric surgery is not a panacea for making life better for a person in all ways. This small study highlights the importance of identifying at risk groups among people undergoing bariatric surgery for whom additional psychological follow-up and support may be needed.

Last Reviewed: 10/09/2019

© Norman Swan Medical Communications.



References

Canetti L et al. Deterioration of mental health in bariatric surgery after 10 years despite successful weight loss. European Journal of Clinical Nutrition 2016;70:17-22.