For 30 plus years I have researched and written extensively about the global obesity epidemic, often from the point of view that highly palatable foods and specifically sugars, can cause neuroadaptation in much the same way as drugs of abuse in genetically susceptible persons.
The World Health Organization (WHO), which coined the term Globesity, has taken leadership in detailing the global consequences of obesity in terms of rates of metabolic derangement, which includes diabetes, cardiovascular disease, and other morbidities including obstructive sleep apnea, cancers and a high lifetime prevalence of mental illness.
While behavioral and pharmacological treatments have had limited efficacy, surprisingly, bariatric surgery has proven to be a safe and effective tool for Type 2 diabetes reversal and weight loss. Bariatric surgery outcomes, even five year outcomes, show important and sustained improvements in medical co-morbidities and quality of life. There is, however, emerging evidence correlating to a range of mental health complications following bariatric surgery that require the assistance of specifically-trained psychiatrists and other mental health professionals for providing individualized, patient centered care for such individuals.
Long-Term Bariatric Surgery Outcomes
Our group and others have reported on Roux-en-Y gastric bypass surgery outcomes that increase the risk for alcohol abuse and dependence. Others research has shown de novo substance use disorders after bariatric surgery.
Post-surgical changes in alcohol absorption and metabolism can cause impairment in both cognitive functioning and of course reaction time to physical stimuli, e.g., impaired driving, behavioral loss of control, nutritional deficiencies, or increased caloric consumption limiting weight loss. Consequently, a complete psychiatric and addiction evaluation before surgery followed by strict post-surgical follow-up is an essential component in our clinical practice guidelines.
Why Does This Matter?
Bariatric surgery works but complications and emerging problems can compromise success. Early on we hypothesized that the brain’s reward and reinforcement mechanisms produced by food, and the anticipation, preoccupation of eating highly palatable food is ground zero in the battle to reduce mortality, morbidity and to improve one’s quality of life.
Post-surgical depression, thoughts of self-harm and suicide are statistically significant complications following weight loss surgery. The reasons for this are poorly understood. But, the Psychosomatic Council of the American Psychiatric Association (APA) suggests the following might be causal:
- Post-surgical neurohormonal changes
- Behavioral loss of control
- Altered absorption of alcohol and/or psychiatric medication
- Lack of improvement in one’s quality of life
- Weight regain, and continued or recurrent physical limitations
Additionally, excess skin folds after surgery may create co-morbid body image concerns leading to lowered self-image and distressed psychological health.
Many experts think bariatric surgery is far and away the best treatment for morbid obesity and obesity with T2 diabetes. We have come a long way from telling obese persons to simply diet and exercise, but we have miles to go to make a dent in the globesity pandemic.