How Bariatric Surgery Affects Mental Health

A number of surgical weight-loss procedures are available for the treatment of obesity. Some of these procedures have been in practice for decades, and the well-established health benefits can include a lower risk of diabetes, heart disease, and stroke. Bariatric surgery can also have effects on mental health.

What Bariatric Surgery Is

The term “bariatric surgery” applies to a number of surgical procedures that have been developed to surgically induce weight loss. These include gastric bypass, gastric banding, and gastric sleeve (sleeve gastrectomy) procedures, among others.

Candidates for Bariatric Surgery

According to the obesity guidelines released by the American Heart Association (AHA), the American College of Cardiology (ACC), and The Obesity Society (TOS), bariatric surgery may be an option for adult patients who meet certain criteria.

These criteria include a body mass index (BMI) of 40 or greater, or a BMI of 35 or greater for a patient who has other medical conditions (known as “comorbid conditions”) caused by obesity.

The obesity guideline writing committee did not find sufficient evidence to recommend bariatric surgery for patients with a BMI below these cutpoints.

The guideline further advises primary care doctors and others caring for patients with obesity with high BMI to try behavioral treatment with or without pharmacotherapy first. Then if this has not worked along with other diet and lifestyle measures to achieve sufficient weight loss, bariatric surgery may be considered.

How Bariatric Surgery Impacts Mental Health

Bariatric surgery may have a beneficial effect on mental health, but the mental health benefits are not guaranteed. Research is shedding a light on the mental health effects and providing some direction about how to approach mental health before and after weight loss procedures.

Depression and Binge Eating Disorder

A 2016 meta-analysis included 68 publications that reported on mental health conditions in the context of bariatric surgery. According to the study authors, the most common mental health conditions among people seeking bariatric surgery were depression and binge eating disorder. Specifically, 19% of patients were found to have depression and 17% were found to have binge eating disorder.

The researchers found that bariatric surgery was consistently associated with lower rates of depression and a decrease in the severity of symptoms of depression after the operation. Neither depression nor binge eating disorder was found to be consistently associated with differences in weight outcomes following surgery,

Inconsistent results

The mental benefits are not found across the board after surgery, and treating mental health problems isn't always effective. A research study that included 130 patients who had bariatric surgery found that 37% had mental health symptoms when they were evaluated three and five years after the surgery.

The patients who had mental health symptoms were also less likely to have lost sufficient weight after surgery. Furthermore, the researchers found that cognitive behavioral therapy did not help prevent mental health symptoms.

Weight Bias Internalization

Specific approaches to therapy could potentially benefit mental health after bariatric surgery. Another research study found that weight bias internalization was common among patients undergoing bariatric surgery. This bias led to low self-esteem, depression, and anxiety.

The researchers suggested that therapy specifically targeting weight bias internalization could be beneficial for patients' mental health.

A Word From Verywell

Obesity can have a substantial effect on mental health. If you are planning on having bariatric surgery, you should know that getting to a healthy weight can potentially improve your mental health. But weight loss alone might not be sufficient to alleviate issues of depression, anxiety, or low self-esteem. Keep in mind that obesity is a health condition, and you owe it to yourself to get comprehensive treatment for all of your symptoms—including your mental health symptoms. Seek out a referral to a mental health professional so you can get the treatment you need for any mental health issues that you are dealing with.