Bariatric Psychology, Psychological Aspects of Weight Loss Surgery

The prevalence of obesity has reached epidemic proportions; obesity is one of the largest public health concerns and is called the ‘disease of the 21st century’ [1, 2]. Obesity is an international disease that is spreading worldwide, in the Western world as well as in the Third World [3]. The epidemic is rampant in the USA; however, Europe is not far behind, especially in Southern and Eastern European countries [4]. In Europe, obesity affects 10–25% of the male population and 10– 30% of the female population [5]. In the Netherlands, about 12% of adults are obese, this number has doubled in the last decades [6]. As obesity increases, so does the advancement to the severe form, morbid obesity; in fact, one of the most rapidly growing segments of the obese population is that of the morbidly obese [7]. Obesity results in physical and psychosocial co-morbidities, as well as poor quality of life (QoL) [8]. It is associated with an increased risk of morbidity and premature mortality from numerous related medical conditions [9]. Because of these co-morbid conditions, obesity is responsible for more than 2.5 million deaths per year worldwide [10]. The loss of life expectancy due to obesity is marked, and can be up to 20 years shorter in severe obesity [11]. The most serious adverse health conditions are associated with morbid obesity; the more severe the obesity, the more serious the medical complications and mortality risk, hence the term ‘morbid’. In addition to an increased risk of physical morbidity and mortality, obesity is associated with debilitating psychological and social consequences as well as impaired QoL, especially in morbidly obese patients seeking surgical treatment [12, 13]. Their QoL in general is worse compared to patients with other chronic diseases [14]. Obesity is nowadays associated with greater morbidity and poorer health-related QoL (HRQoL) than smoking, problem drinking, or poverty [15].