Psychological considerations of the massive weight loss patient

Plastic surgery after bariatric surgery

BACKGROUND

Massive weight loss after bariatric surgery often results in excess skin, which can lead to stigma due to appearance and pronounced physical and psychological impairments. This review considers the evidence base for post-bariatric plastic surgery and the treatment options that are available.

METHOD

The article is based on a literature search in PubMed with the keywords «bariatric surgery» AND «plastic surgery», in addition to the authors' experience with a large number of patients.

RESULTS

Body contouring surgery after massive weight loss is offered primarily for the treatment of troublesome skin conditions. The surgery can help to improve quality of life and functional status. However, there is little scientific evidence regarding indications for surgery, choice of surgical techniques and risk of complications, and the surgeon's own opinions and clinical experience often play a major role. Many plastic surgeons limit body contouring surgery to those with BMI < 28 kg/m². However, most patients who have undergone bariatric surgery have BMI ≥ 30 kg/m², and requests for body contouring surgery for these individuals are often denied, except when there are compelling medical grounds.

INTERPRETATION

Plastic surgery can lead to improved functioning and increased quality of life. The evidence base with respect to indications, treatment methods and outcomes should be strengthened through well-planned prospective studies and a patient registry. There is a particular need for documentation of treatment outcomes in the large group of patients with BMI ≥ 30 kg/m².

Assessing Improvement in Quality of Life and Patient Satisfaction following Body Contouring Surgery in Patients with Massive Weight Loss: A Critical Review of Outcome Measures Employed

Body contouring following massive weight loss is a rapidly expanding field in plastic surgery. However, healthcare payers are reluctant to fund such procedures, viewing them as purely cosmetic. This has resulted in a flurry of studies assessing quality of life (QoL) and patient satisfaction following body contouring surgery in this cohort of patients to establish an evidence base to support the idea that body contouring is as much (or even more) a functional procedure as it is cosmetic. However, the methods employed in these studies are seldom ideal, and hence the conclusions are unreliable. The gold standard to assess QoL and patient satisfaction is to use patient specific psychometrically validated patient reported outcome (PRO) measures. Developing such measures consists of a three-step process which includes a review of the current literature, qualitative patient interviews to determine what patients consider the most important, and expert opinion. This study aims to appraise the currently available literature on assessment of QoL and patient satisfaction in body contouring surgery patients. This will hopefully provide an understanding of methodological weaknesses in current studies and inform future investigators of the design of ideal instruments for assessing QoL and patient satisfaction in body contouring patients.

Post surgical review of bariatric surgery patients: a feasibility study of multidisciplinary follow up using videoconferencing

Background:

Bariatric surgery is an effective means of managing weight and reducing medical co-morbidities in the obese patient. However, psychological difficulties are common and adequate multidisciplinary support is vital for post-surgical success. Videoconferencing is potentially a vehicle for the delivery of support to patients residing in remote areas.

Methods:

Ten patients were invited to attend a videolink session utilising videoconferencing technology to allow clinicians to connect audio-visually with patients from two remote locations. Seven patients attended. A Consultant Surgeon, Clinical Psychologist and Specialist Dietitian reviewed the patients. Patients and clinicians completed a post-session evaluation questionnaire and commented on their experience.

Results:

The videolink session was evaluated as acceptable and useful to both patients and clinicians. Patients and clinicians were satisfied with the user-friendliness of the technology.

Conclusion:

Videolink technology may be a viable and accessible means of delivering specialist multidisciplinary input to bariatric patients. Further research is necessary.

Morbid obesity: significance of psychological treatment after bariatric surgery

Conservative interventions for weight reduction are not very effective in many cases of morbid obesity. For this reason, bariatric surgery plays an increasing role in the treatment of these patients. Bariatric surgery, however, is not the solution but an important precondition for successful management of morbid obesity. Psychological evaluation of the weight loss surgery patients is recommended because of the prevalence of psychiatric comorbidities and of eating disorders in individuals with morbid obesity. Morbid obese eating disordered patients with co-morbid psychiatric disorders, especially with personality disorders, show greater difficulties in adapting to the new demands, including the need to cope with stress and other problems in a new way, to relearn how to eat, distress over weight loss plateaus, failure to achieve a normal-looking body etc. Therefore, psychological and/or psychiatric treatment seem to be needed in some obese patients to gain an early postoperative understanding of possible psychological or eating problems. Various kinds of psychological support are available at Innsbruck Medical University Hospital before and after bariatric surgery, such as pharmacotherapy, individual psychotherapy, small-group psychotherapy, and the "Obesity Club". The reasons for the relatively low degree of willingness to take part in psychological treatment programs are demonstrated.