[Morbidly obese patients: psychopathology and eating disorders. Results of a preoperative evaluation].

BACKGROUND: The prevalence of individuals who are overweight or obese has increased dramatically over the past decades, especially in high-income countries. However, the success rates of conservative therapies in morbidly obese patients are poor. Consequently, bariatric surgery is the treatment of choice for morbid obesity. Because many obese individuals who seek professional help show a high co-morbidity of mental disorders, including eating disorders, and psychosocial problems, a psychological evaluation before bariatric surgery is deemed. METHODS: The patient cohort included 547 morbidly obese subjects (389 females, 158 males). All patients were recruited from the Department of Surgery, Medical University of Innsbruck. An exact psychological evaluation, using a semi-structured interview and the Structured Clinical Interview for Mental Diseases (SCID), was carried out at the Department of Psychosomatic Medicine. RESULTS: The results of the preoperative psychiatric-psychotherapeutic evaluation of the morbidly obese patients revealed that more than half suffered from one or more mental disorders; these included in particular depression and adjustment disorders, as well as personality disorders, in particular Cluster C personality disorders. A majority of the patients showed one or more disordered eating patterns. Females showed a markedly higher rate of a "binge-eating"-disorder than males, while males tended to be classified as "overeaters" in many cases. CONCLUSIONS: An exact preoperative psychological evaluation can make an important contribution in identifying those patients who, on one hand, are not ideal candidates for bariatric surgery, or, on the other hand, need additional psychiatric and/or psychotherapeutic treatment to cope with the new demands postoperatively.