[Does bariatric surgery affect addiction to overeating and eating disorders?]. / Beeinflusst bariatrische Chirurgie Sucht und Essstörungen?

BACKGROUND: Bariatric surgery is the most effective treatment to reduce weight permanently which is essential to avoid, to improve or even to cure life-threatening comorbidities. Little is known about changes of the psychological etiology and risk factors. METHODS: The present study concentrated on psychological variables which are considered to cause or promote obesity. The changes of symptoms were measured by the AD-EVA test inventory. A total of 60 patients (24 male/36 female, age 18-71 years) were tested prior to gastric bypass or gastric banding (body mass index BMI M=44.95, SD=6.91) and postoperatively (BMI M=33.92, SD=7.23). RESULTS: Following surgery the variables addiction (t=11.15, p<0.01) and binge eating disorder (t=2.13, p<0.05) showed significant changes across all patients and therefore confirmed a positive effect but restrained eating and bulimia remained unmodified after surgery. There were significant differences between the two bariatric methods (p<0.01). DISCUSSION: A precise interdisciplinary evaluation is a prerequisite for deciding between gastric banding and the bypass technique as well as to define the need for preoperative and postoperative psychotherapy.

[Psychological aspects of bariatric surgery]. / Psychologische Aspekte in der Adipositaschirurgie.

Experience with gastro-restrictive obesity showed the necessity of detailed research in three main tasks: 1. characteristics of morbidly obese people 2. psychological effects of surgery 3. interaction of these characteristics and effects of surgery. We carried out 7 studies with a total of 650 participants. Clinical interviews and tests measuring personality, eating behaviour, self esteem, addiction factors and quality of life were performed. Morbidly obese differ significantly from normal weight people with the exception of most personality scales. Effects of surgery can be summarized that patients learn to avoid overeating but they do not learn to nourish on healthy solid nutrition and they do not learn to exercise more than before. By paradox learning process 30-50 % of gastric banding patients establish vomiting behaviour or eating pulp and sweets. These who show low self esteem, high addiction score and high disinhibition behaviour are more at risk. Different psychological, nutritional as well as physiotherapeutic interventions are needed to help these patients.