[The psychiatrist's point of view on the treatment of morbid obesity by gastroplasty]

Abstract

The surgical treatment of pathological obesity has been rapidly developing in France over recent years. The growing demand for operation raises a number of questions concerning the indications and the factors predictive of success. Patients are increasingly referred for a psychiatrist's or psychologist's opinion in order to detect psychiatric contraindications and to select patients who are able to comply with their weight reduction programme with the help of the operation and who are able to obtain a lasting improvement in their quality of life. The author starts by describing the explicit demand formulated by candidates for gastroplasty, characterized by a high degree of information and motivation. In view of the uncertainties concerning the right advice to be given to this population, an open prospective study was conducted among 109 gastroplasty candidates. Evaluation of somatic and psychological parameters was performed before the operation and at 6 months, 1 year, 2 years and 5 years. The preliminary results are based on 98 operated patients. The mean BMI (Body Mass Index) decreased from an initial value of 42.08 +/- 0.7 kg/m2 to 29.96 +/- 6.68 kg/m2 at one year. The frequency of vomiting decreased with successive evaluations, but nevertheless constituted the major disadvantage of the operation. Evaluation of depression scores, using the MADRS (Montgomery and Asberg Depression Rating Scale), did not reveal any depressogenic effect of gastroplasty. The other assessment instruments (visual analogue scales and Subjective Quality of Life Profile) indicated a favourable change in numerous dimensions of quality of life. Although it is too early to define any predictive criteria, the author proposes a list of empirical criteria in line with those reported in the literature and defines the role of psychiatrists before and after the operation.