THE PSYCHOLOGY OF BARIATRIC SURGERY PATIENTS - A CLINICAL REPORT

Our discussion focuses on theoretical and applied considerations for psychological care of the morbidly obese patient presenting for surgical correction of this refractory condition. Observations are gleaned from a biomedical literature review and our clinical experiences in the design and implementation of the psychological component in our extant multidisciplinary bariatric surgery program at Universal Medical Center, Plantation, Florida. The clinical sample includes 401 patients receiving vertical banded gastroplasty, Roux-en-Y gastric bypass and silastic ring gastroplasty from September of 1986 to May of 1994. Beyond a consideration of the psychological sequelae of depression, anxiety and addictions, we discuss the specific impact of psychosocial stress and implications of the morbid obesity archetype, with particular emphasis on iratrogenic medical stereotype. Owing to the nature of this report, and the literature review, our impressions are anecdotal and clinical. However, when considered against the underserved and misconceived needs of the morbidly obese patient, we propose that a comprehensive multidisciplinary program incorporating psychological service is not only of critical benefit in enhancing patient co-operation, but also in securing patients' dramatic quality of life change. Recommendations for future research and the development of standardized psychological care models for the morbidly obese patient conclude the discussion.