Against the
background that up to 70% of all obesity patients were affected by a mental
illness at some point in their lives, the guidelines for obesity surgery
recommend a psychosomatic evaluation.
Psychosomatic
evaluation does not have the function of consistently sorting out obesity
patients with mental abnormalities or denying them access to bariatric surgery.
Instead, mental illnesses should be recognised and treated in advance in order
to optimise the outcome of the surgical intervention and to prepare the
patients for the psychosocial changes after the operation. Only in the case of serious
psychopathological conditions such as psychoses, suicidal tendencies, substance
dependencies and untreated bulimia does the bariatric intervention have to be
postponed for the time being.
The
evaluation is carried out through personal interviews and questionnaires. These
include eating disorders, unsuccessful conservative weight loss attempts, but
also substance abuse, depression, suicidal thoughts and attempts. Patients'
expectations of the bariatric operation should also be discussed, as these are
often unrealistic with regard to weight loss and the expected aesthetics of the
physical changes. Sometimes the surgical treatment of obesity is regarded as a
quick and comprehensive solution to problems which, from the point of view of
the person concerned, are attributed exclusively to obesity. Further topics of
the psychosomatic evaluation are the willingness of the patient to sustainably
change previous living and eating habits and to guarantee reliable lifelong
medical aftercare.
Bilbiography sources:
Deutsche Adipositas-Gesellschaft, Deutsche Diabetes
Gesellschaft, Deutsche Gesellschaft für Ernährung, deutsche Gesellschaft für
Ernährungsmedizin (2014) Interdisziplinäre Leitlinie der Qualität S3 zur
„Prävention und Therapie der Adipositas“. AWMF-Register Nr. 050/001. Klasse:
S3. Version 2.0.
Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie,
Chirurgische Arbeitsgemeinschaft für Adipositastherapie (CAADIP), Deutsche
Adipositas-Gesellschaft (DAG), Deutsche Gesellschaft für Psychosomatische
Medizin und Psychotherapie, Deutsche Gesellschaft für Ernährungsmedizin (2010)
S3-Leitlinie: Chirurgie der Adipositas.
Müller A, Herpertz S, de Zwaan M (2012) Psychosomatische
Aspekte der Adipositaschirurgie. Psychother Psychosom Med Psychol 62: 473–479
Wimmelmann
CL, Dela F, Mortensen EL (2014) Psychological predictors of mental health and
health-related quality of life after bariatric surgery: a review of the recent
research. Obes Res Clin Pract 8: e314–324
Wimmelmann
CL, Dela F, Mortensen EL (2014) Psychological predictors of weight loss after
bariatric surgery: a review of the recent research. Obes Res Clin Pract 8:
e299–313
