Behavioral and psychological factors in the assessment and treatment of obesity surgery patients.
OBJECTIVE
To provide evidence-based guidelines on the psychological and behavioral screening of weight loss surgery (WLS) candidates and the impact of psychosocial factors on behavior change after gastric bypass surgery.


METHODS
The members of the Behavioral and Psychological subgroup of the Multidisciplinary Care Task Group conducted searches of MEDLINE and PubMed for articles related to WLS, behavior changes, and mental health, including quality of life (QOL) and behavior modification. Pertinent abstracts and literature were reviewed for references. A total of 198 abstracts were identified; 17 papers were reviewed in detail. Search periods were from 1980 to 2004.


RESULTS
We found a high incidence of depression, negative body image, eating disorders, and low QOL in severely obese patients. Our task subgroup recommended that all WLS candidates be evaluated by a licensed mental health care provider (i.e., psychiatrist, psychologist, or social worker), experienced in the treatment of severely obese patients and working within the context of a multidisciplinary care team. We also recommended development of pre- and postsurgical treatment plans that address psychosocial contraindications for WLS and potential barriers to postoperative success.


CONCLUSIONS
The psychological consequences of obesity can range from lowered self-esteem to clinical depression. Rates of anxiety and depression are three to four times higher among obese individuals than among their leaner peers. A comprehensive multidisciplinary program that incorporates psychological and behavior change services can be of critical benefit in enhancing compliance, outcome, and QOL in WLS patients.
Greenberg
Isaac
I
Obesity Consult Center, Tufts-New England Medical Center, 750 Washington Street, Tufts-NEMC 900, Boston, MA 02111, USA. Igreenberg@tufts-nemc.org
Perna
Frank
F
Kaplan
Marjory
M
Sullivan
Mary Anna
MA
D001519:Behavior; D001828:Body Image; D002032:Bulimia; D000075202:Contraindications; D003863:Depression; D013505:Digestive System Surgical Procedures / Q000523:psychology*; D019317:Evidence-Based Medicine; D015390:Gastric Bypass / Q000523:psychology; D006801:Humans; D016239:MEDLINE; D009765:Obesity / Q000523:psychology* / Q000601:surgery*; D011788:Quality of Life