THE ROLE OF PSYCHOLOGICAL-FACTORS IN BARIATRIC SURGERY FOR MORBID-OBESITY - IDENTIFICATION OF PSYCHOLOGICAL PREDICTORS OF SUCCESS

This paper deals with two important questions in the outcome of surgic al treatment for morbid obesity. First, what is the impact of bariatri c surgery on psychological functioning or quality of life? Second, and perhaps more important, can pre-surgical factors be identified that p redict the outcome of surgery? These questions are answered by a syste matic review of the current literature in this area. Throughout this p aper the need for methodological rigour is stressed, and conclusions a re based only on empirically sound findings. It is concluded that surg ery is generally associated with improved psychological functioning an d quality of life for most individuals. While a significant minority o f morbidly obese individuals do not respond positively to surgery, the re is no evidence to support the theory that obesity is a psychologica l defense mechanism, and therefore that bariatric surgery will produce widespread psychological problems. On a less positive note, while som e studies identify pre-surgery psychological factors that predict weig ht loss following surgery, there has been no attempt to systematically replicate findings across studies, and no consistent findings have em erged from the literature. Due to the fact that the predictor variable s examined have not been selected on theoretical grounds, the interpre tation of isolated findings is difficult. On the basis of this review, however, distress over obesity appears to be a potentially important psychological predictor of the success of surgery. Unfortunately, ther e currently is no measure to specifically measure distress over obesit y. What is needed at this time is a theoretically derived approach to the development of a scale to assess distress over obesity.