Psychological morbidity among those seeking bariatric surgery

Obesity is a serious public health problem and a particular challenge in people with mental health disorders (Devlin 2000). Bariatrics is the branch of medicine that offers treatment of obesity, and bariatric surgery is an increasingly common intervention for morbid obesity. It is typically requested by the primary care team. Before an individual is considered for surgery, the National Institute for Health and Clinical Excellence (NICE) expects the patient to have engaged with a multi component programme of lifestyle change that has been individually tailored by a competent healthcare professional (National Collaborating Centre for Primary Care 2006). This should have incorporated a behavioural intervention to increase levels of physical activity and improve eating behaviour and quality of diet. In many cases, drug treatment with the lipase inhibitor orlistat will have been tried, although failure to respond to drug treatment is not a requirement for surgery. NICE has recommended that surgery be considered for all those with a body mass index (BMI) greater than 40 kg/m2 who have failed to respond to other interventions and for those with a BMI greater than 35 kg/m2 with obesity-related comorbid illnesses. Clinical studies have reported rates of obesity in patients with schizophrenia and bipolar affective disorder of up to 60% (McElroy 2009). Those with severe mental illness have increased rates of medical conditions connected with obesity, including diabetes, cardiovascular disease and metabolic syndrome (Sims 1987). Weight loss surgery has been shown in the USA to reduce overall mortality by 40% over a mean 7 years. The same study showed that there was a 56% reduction in death from coronary artery disease, a 92% reduction for those with diabetes and a 60% reduction in death from cancer after gastric bypass surgery (Adams 2007). Patients can access information on surgery through a range of online resources, such as the British Obesity Surgery Patient Association (www. bospa.org).