Obesity and gastric bypass, impact on quality of life and suicide risk: A review of the literature

In the last few years, the flourishing number of surgery for morbid obesity induces a growing interest in the short, medium and long-term consequences of the operative procedures. Both massive overweight and its surgical treatment such as gastric bypass can influence the mental health of patients and have an impact on their risk of suicide and suicide rates. Indeed, the suicide rate after the surgical treatment of obesity is increased; although medical literature is prolific on the subject of quality of life after gastric bypass surgery, less is known about the causes of postoperative suicide. There are few theories that allow discussion or hypothesis making and among these none can explain alone the excess of preventable deaths. This raises many questions about the management of candidates for gastric bypass: Is it possible to improve preoperative screening of patient's compliance? Should psychiatric follow-up become compulsory after surgery? It appears obvious from the current literature that suicide rates are higher among gastric bypass patients than the general population. It is reasonable to assume that this finding is related to the psychological difficulties experienced by patients, the impact on their quality of life and social functioning, on emotional and on a professional level. The intervention and massive weight loss can often destabilize an already precarious balance. It seems necessary to strengthen the psychiatric treatment of candidates for bariatric surgery and discuss the value of mandatory postoperative follow-up, as well as to promote patient compliance. Bariatric surgery patients with a history of psychiairic comorbidities should benefit from strict preoperative consultations and appropriate medication in order to rigorously balance their condition before surgery. Postoperative measures should include monitoring of high-risk populations such as patients with psychiatric comorbidity, as well as considering couple psychotherapy or support groups for patients and their relatives. (C) 2013 Elsevier Masson SAS. All rights reserved.