Impact of psychosocial stress and symptoms on indication for bariatric surgery and outcome in morbidly obese patients

Background: Obese patients often suffer from physical and psychiatric co-morbidity. Bariatric surgery has been widely used to treat morbid obesity. The present study addresses the issues of the impact of psychosocial stress and symptoms on indication for and outcome of bariatric surgery. Methods: A sample of 131 morbidly obese patients applying for bariatric surgery underwent assessment via the Psychosocial Stress and Symptom Questionnaire (PSSQ). Patients were categorized as under little/no (below cut-off) or great (above cut-off) psychosocial stress. 2 years after their first assessment and 1 year after potential bariatric surgery, 119 patients (90.8% participation rate), 69 of whom were treated surgically, were followed up by a telephone interview asking for outcome variables such as BMI, employability, medication, doctor consultations, and physical/psychological well-being. Results: 86 patients (72.3%) scored above the cutoff in the PSSQ. There was no correlation between the result of the PSSQ and the surgeons' indication for bariatric surgery. 69 patients (58.0%) underwent bariatric surgery, of whom 48 had PSSQ scores above the cut-off. Individuals under great psychosocial stress experienced the same positive physical and psychological well-being after surgery as subjects under little or no stress. Psychosocially stressed patients (n = 38) who did not undergo surgery showed the worst outcome. Conclusion: Great psychosocial stress in morbidly obese subjects should not be a contraindication for bariatric surgery. However, those patients should receive pre- and post-surgical counseling, to reduce anxiety before surgery and increase compliance after surgery.