Psychosocial Effects of Intestinal Bypass Surgery for Severe Obesity

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Abstract
The psychosocial consequences of intestinal bypass surgery and weight loss were observed in 29 massively obese patients. The response to weight loss, as assessed by both semistructured psychiatric interviews and a series of self-administered questionnaires, was an improvement in mood, self-esteem, interpersonal and vocational effectiveness, body image and activity levels, as well as a notable decrease in the use of denial. The decrease in depression and improvements in ego strength, body image and global clinical rating of psychologic status were directly proportional to the magnitude of weight loss. The most important psychologic change responsible for improved functioning was the loss of a pervasive sense of entrapment, helplessness and failure associated with massive obesity. There is evidence that the relative unresponsiveness of obese patients to the internal cues associated with satiety is reversible with weight loss. Symptom substitution did not occur. The reversibility of many of the psychosocial disturbances associated with severe obesity supports the view that they are as much the consequences as the causes of excessive adiposity. (N Engl J Med 290:300–304, 1974)