Psychosocial Assessment and Treatment of Bariatric Patients

Psychosocial Assessment and Treatment of Bariatric Patients draws together the entire spectrum of the relevant psychosocial dimensions and data necessary to adequately assist in the evaluation and treatment of patients who may be candidates for bariatric surgery. In this respect, the text accomplishes its mission quite well.

The book begins with a thorough outline of the currently used major bariatric surgical techniques. Short- and long-term success of these various modalities of surgery, emergence of depression or addictions, and relapse rates are discussed, and there is some mention of more recent data regarding how surgery affects gut peptide chemistries known to effect anorexigenic and orexigenic responses. However, it might have been helpful to have more extensive data on the disparity between the number of people who have morbid obesity or qualify for bariatric surgery on body mass index criteria and the number of those who are not referred by their physicians.

Chapter 2, “Assessment of Bariatric Surgery Candidates: The Clinical Interview,” covers essential elements necessary for evaluating candidates psychosocially for surgery. On page 16, the authors note, “The goal of a good pre-WLS [weight loss surgery] evaluation is not to uncover factors that contraindicate surgery.” An evaluation ensures that any potential neuropsychiatric complications of surgery are integrated within the entire framework and rationale for treatment. The reader who is inexperienced with prebariatric data collection should find this section illuminating.

The section on bariatric questionnaires is well researched and is a valuable resource. The chapter “Psychosocial Problems and Psychiatric Disorders Pre- and Postbariatric Surgery” does an excellent job of outlining health-related, quality-of-life issues of the obese patient. Of relevance to payment are the data cited on page 69 that show that WLS is a long-term investment in ultimate medical savings, even though it may be a short-term drain on employee benefit costs. A pithy and succinct discussion of eating disorders and their impact on bariatric patients follows. The addition of a brief update on food addictions and their impact on bariatric surgery candidate selection and outcomes would have been worthwhile here.^1,2

Included is an intriguing review of the pharmacokinetic and pharmacodynamic challenges of postbariatric pharmacology. At this point, a description of the cost of pharmaceutical intervention for untreated patients (ie, patients denied WLS) versus the savings for treated patients would have been very helpful. The section “Nutritional Care of the Bariatric Surgery Patient,” although commendable, is for the most part out of date. Updates on recent discoveries in the field of metabolic endocrinology and in low-carbo­hydrate and higher-protein diets should have been included.^3,4

The book ends with a 6-section overview of a presurgical and postsurgical intervention program. All patients selected for surgery should have continued therapy and diet-exercise-behavioral interventions. But, we would suggest personalizing interventions via an up-front cognitive style identifier to remove “one size fits all” limitations of such a program. In “Section 3: Next Step-A Bariatric Psychological Aftercare Program,” authors LaHaise and Mitchell make a critical point. On page 232, they discuss the “teachable moment,” when postsurgical patients may be more willing to participate in group and other therapeutic processes than presurgical patients. Dr Mitchell continues to pioneer such programs.

References:

References

1. Avena NM, Gold MS. Sensitivity to alcohol in obese patients: a possible role for food addiction. J Am Coll Surg. 2011;213:451-452.

2. Avena NM, Gold JA, Kroll C, Gold MS. Further developments in the neurobiology of food and addiction: update on the state of the science. Nutrition. 2012;28:341-343.

3. Lustig RH. Fructose: metabolic, hedonic, and societal parallels with ethanol. J Am Diet Assoc. 2010;110:1307-1321.

4. Keller U. Dietary proteins in obesity and in diabetes. Int J Vitam Nutr Res. 2011;81:125-133.