Endocrine Abstracts

Surgery is the most effective way of treating morbid obesity. The laparoscopic gastric bypass (Roux en-Y) is the preferred bariatric surgical procedure performed at our hospital. This combines restriction of intake with a profound sensation of early satiety.

Ideally, multi-disciplinary team involvement (including psychological assessment), over a period of at least six months, is a prerequisite for bariatric surgery referral. The more psychotherapeutic work that has been done before surgery, the better the psychological adjustment after surgery. Unresolved issues can surface in the lives of patients that were not sufficiently addressed prior to surgery. If food was being used to address unmet emotional needs and the patient has not begun to practice appropriate ways to meet these needs, psychological problems will ensue. A patient, whose eating behaviour fits an addictions model, is at risk of substituting food for another substance, such as alcohol, to self-medicate emotional pain.

During the period 2001 to 2004, 40 gastric bypass procedures were performed. A retrospective study of this group demonstrated the emergence of new addictions in 4 patients (eg. alcohol, smoking, shoplifting).

Examination of psychometric test scores of the four patients who developed new addictive behaviours, when compared to the rest of the post bariatric surgery group, revealed some notable differences. These four patients all had higher scores on two facets of the Neuroticism personality domain–depression and impulsiveness. The four also had lower scores on the Conscientiousness personality domain, which includes measures of competence, achievement striving, self-discipline and deliberation.

This highlights the need for ongoing psychological monitoring for the emergence of alternate addictive behaviours in this increasing patient group.