Endocrine Abstracts

Objective: A case study that demonstrates the importance of thorough psychiatric assessment, intervention and follow-up in morbidly obese patients presenting for Bariatric surgery and risk of addiction transfer.

Background: Positive correlation between psychiatric disorders and obesity is documented. Cases of addiction transfer have been reported complicating outcome post Bariatric Surgery.

Case description: A 29 year old Caucasian female with a BMI of 51 kg/m² and background of previous episodes of depression, anxiety and previous paracetamol overdose referred for Bariatric Surgery. She had history of binge eating and alcohol dependence both were not active at time of review. She has been assessed by psychiatric team and was deemed suitable for surgical intervention hence had Roux-en-Y Gastric Bypass surgery.

2 weeks postoperatively she had relapse of binge eating and purging and was unable to comply with recommended vitamins and minerals supplements. She reported feeling ‘out of control’, had started binge-drinking and developed a compulsive-shopping habit. She also reported episodes of ‘wild behaviour’ where she would engage in sexual activity with strangers. Unfortunately her financial situation had spiraled out of control and she had been evicted from her home after falling into arrears. She was living with her mother and had been unable to attend appointments due to financial constraints. She was re-referred to psychiatry for urgent assessment. She failed to attend further reviews but re-engaged 3 months later when she called to inform the dietitians she was pregnant. Under the care of the specialty midwife team she was able to bring her alcohol intake under control but continued to binge eat throughout pregnancy since she felt this was her only coping mechanism. She was found to have multiple nutritional deficiencies mid-pregnancy which required urgent correction. She eventually delivered a healthy baby but continued to require support from social services and family in caring for her child. Most recently having sought a second psychiatry opinion she was diagnosed with bipolar disorder and was started on treatment.

Of note is that postoperatively she achieved up to 60% loss of excess body weight which was relatively maintained at 2 years follow-up (56.1% excess body weight loss) but unfortunately despite her ongoing difficulties she reported not having adequate psychological support through her journey.

Conclusion: Addiction transfer is a documented risk after gastric bypass surgery in vulnerable candidates. High vigilance is required in patients with prior history of alcohol dependence and eating disorders even if no longer active. Bariatric surgery can help losing weight but might complicate mental illness. Psychological follow-up and support should be a routine in managing patients at high risk post Bariatric Surgery.

Keyword: Obesity, Addiction transfer, Bariatric surgery, Psychiatry