The role of psychological functioning in morbid obesity and its treatment with gastroplasty

Background: The authors evaluated the psychological characteristics of the morbidly obese. The condition-specific and quality-of-life characteristics of a large sample of vertical banded gastroplasty (VBG) patients were evaluated. The role that these psychological characteristics play in moderating the success of gastroplasty surgery, as well as the impact of surgery on quality of life, was examined. Methods: This is a cross-sectional evaluative study of a clinical sample, with longitudinal followup and with non-surgical comparison groups. 89 morbidly obese individuals were assessed before VBG (but after having been accepted for surgery) and again 1.27 years after surgery. This group represents 98% of the patients who received VBG (ie. a 2% dropout rate). We used established psychological measures (quality of life, adjustment to obesity, functional impairment, and eating attitudes), including a scale developed by our group specifically for morbid obesity, to identify distinct psychological profiles of the morbidly obese before surgery. Results: The three profile groups differed significantly in psychological characteristics, ranging from high functioning (little emotional distress, functional impairment or dysfunctional eating) to poor functioning (high emotional distress, functional impairment and dysfunctional eating). The subgroups did not differ on pre-surgical weight, and did not differ from morbidly obese groups not seeking surgery. For the surgery group, regardless of pre-surgery psychological profile, VBG produced significant weight loss, maintained at 1 year after surgery. As well, surgery resulted in significant improvements in quality of life and psychological adjustment, especially in the profile group initially presenting with psychological disturbance. Conclusion: There was no evidence to suggest that those with pre-surgical psychological difficulties did more poorly with VBG. These data call into question screening out individuals with psychological problems from gastroplasty surgery. Furthermore, psychological difficulties, if they exist, appear more related to the nature of morbid obesity than to the character of the individual. Psychological difficulties pre-surgery were normalized following surgery.