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Undergone Bariatric Surgery? Doctor Explains The Importance of Psychological Support That You May Need
Obesity is defined as an accumulation of fat to the extent that it starts affecting health. In the Asian context, a person is considered obese if the body mass index (BMI) 27.5 Kg/m2. Patients with obesity are at risk of multiple health issues that include type 2 diabetes, high blood pressure, dyslipidemia, higher risk of heart disease, lung and liver disease, joint-related issues, PCOD and infertility, and association with some cancers. Obesity also has a significant psycho-social impact and individuals with obesity report a higher incidence of mood disorders, low self-esteem, and anxiety. They are more likely to be subjected to bias, stigma, and discrimination because of their weight. It has been seen that individuals with obesity are five times more prone to a depressive episode than a normal-weight individual. Body image issues are commonly associated with a higher incidence of depression and this is seen more in women with obesity.
Bariatric surgery is an effective option for the treatment of severe obesity. Commonly performed bariatric procedures are sleeve gastrectomy and gastric bypass operations. Bariatric surgery leads to weight loss by a host of mechanisms like a restriction of food intake, neurohormonal mechanisms, mal-absorption in bypass operations, bile acid interactions, change in gut flora, etc. It leads to significant and sustained weight loss along with reversal/improvement in associated health problems.
Studies have reported an "overall positive impact" of bariatric surgery and resultant weight loss on a person's mental health. Post-surgery, improvement is seen in self-esteem, body image, depression, and health-related quality of life. The majority of people after surgery and resultant weight loss may feel more positively about themselves and their future prospects. They may feel closer to their partners, have more energy to give to their children, and feel more motivated in the workplace. Decrease in depression and mental health gains after bariatric surgery are seen quite early after surgery even before significant weight loss and have been seen to continue for 2 to 4 years. This early improvement can be attributed to the feeling of empowerment as they have taken a big step to change their life.
However, a small subset of patients may need continued psychological support after bariatric surgery. These are patients with:
Although bariatric surgery leads to an overall improvement in physical and mental health, it is important to identify patients who may have persistent psychological issues after the surgery. It is also important to counsel patients about what to expect after the surgery and to advise them repeatedly about setting the right expectations about weight loss and improvement in associated co-morbid conditions. It is recommended to have a psychologist on board to help these patients. Positive effects on mental health are much more likely to occur if the patient has a stable physical and psychological support system after the surgery, made up of both loved ones and a team of efficient doctors and psychologists. So, if you are planning to have bariatric surgery, understand the pros and cons of your doctor, have a good support system, take it easy, stay calm and composed and start investing some time in yourself.
(The above article is written by Dr. Aparna Govil Bhasker, Laparoscopic and bariatric surgeon, Saifee Hospital, Apollo Spectra, Namaha and Currae Hospitals, Mumbai)