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Obesity surgery should be last option

Published Oct 30, 2007

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By Amy Norton

Researchers at Rhode Island Hospital and Brown University in Providence found that of 500 candidates for so-called bariatric surgery at their centre, nearly one-fifth did not pass their initial psychiatric evaluation.

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That decision, the study found, was made with a high degree of reliability - meaning that different psychiatrists looking at the same information reached the same conclusion.

The findings are published in the Journal of Clinical Psychiatry.

Bariatric, or weight-loss, surgery can be an option for people who are severely obese and cannot shed the kilograms through diet and exercise. Weight-loss surgery can be performed in several ways, but the common goal is to change the structure of the digestive tract to limit the amount of food a person can eat.

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In gastric bypass, for example, staples are used to create a small pouch in the stomach, and a portion of the small intestine is attached to the pouch so that food bypasses the rest of the stomach and part of the small intestine.

Candidates for surgery have to be committed to lifelong lifestyle changes, drastically altering their eating habits and sticking with follow-up care. So along with medical evaluations, many patients go through psychiatric screening before they can cleared for surgery.

"The goal is not to prevent them from having surgery," said Dr. Mark Zimmerman, the lead author of the new study. "The goal is to identify anything that could interfere with the success or the safety of surgery."

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In this study, he told Reuters Health, one of the most common reasons that patients were not cleared for surgery was "emotional eating." In these cases, people use food to deal with stress and negative emotions. The problem, Zimmerman explained, is that after surgery, when people are strictly limited in when and how much they can eat, they will need to find other ways to cope.

Among the other common reasons study patients did not pass their psych evaluation were diagnoses of binge-eating disorder and uncontrolled depression - which, like emotional eating, could make patients unable to deal with the aftermath of surgery.

Failing this initial screening does not mean it's the end of the road for surgery candidates, however. "It's not a red light, it's a yellow light," Zimmerman said.

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Nearly all of the study patients who were not cleared were referred for treatment of the underlying issue. With emotional eating, for example, it's important for people to learn "alternate coping strategies" before having surgery, Zimmerman said.

In a future study, he and his colleagues will track how many of these patients accepted their treatment referral and were ultimately cleared for surgery.

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