Abstract
BackgroundBariatric surgery is seldom accessed by people with serious mental illness, despite high rates of obesity in this population. It is sometimes assumed that patients with complex psychiatric histories will have poor post-surgical weight loss or exacerbation of psychiatric symptoms, although this is unsubstantiated.ObjectivesA qualitative descriptive study to explore personal experiences and the impact of bariatric surgery on physical and mental well-being and life-quality in individuals with serious mental illness.MethodsNine adults with a history of bariatric surgery and concurrent severe depressive disorder, bipolar disorder, or schizoaffective disorder were interviewed about their experiences of bariatric surgery and its outcomes using semi-structured interview schedules. Data were transcribed and inductive thematic analysis undertaken.ResultsFive broad themes emerged: (1) surgery was highly effective for weight loss, and resulted in subjective improvements in physical health, quality of life, and mental health described as being able to live a life; (2) recovering from surgery was a tough road, notably in the post-operative period where negative sequelae often anteceded benefits; (3) post-operative support was important, but sometimes insufficient, including from families, mental health services, and surgical teams; (4) most considered surgery life-changing, recommending it to others with mental illness and obesity, two had different experiences; (5) participants considered it discriminatory that people with mental illness were not referred or declined weight loss surgery.ConclusionsParticipants benefited from bariatric surgery and felt it should be offered to others with mental illness, but with additional care and support.
Highlights
People living with serious mental illness (SMI), including psychotic disorders and bipolar disorder, have a high prevalence of obesity—nearly twice the rates of the general population (1, 2)
The datasets generated for this study are available on request to the corresponding author. This small sample with a long follow-up showed the substantial benefit of bariatric surgery accrued to this group with severe mental illness and obesity, which extended beyond physical domains
Bariatric surgery was effective for weight loss, it improved quality of life, and our participants recommended it to others with serious mental illness
Summary
People living with serious mental illness (SMI), including psychotic disorders and bipolar disorder, have a high prevalence of obesity—nearly twice the rates of the general population (1, 2). Experiences of Bariatric Surgery in People with SMI obesity, dyslipidemia, hypertension, and hyperglycemia (3–5). This contributes to the elevated mortality from cardiovascular diseases (1), with the presence of SMI itself being a risk for adverse cardiac outcomes over and above that predicted by other established risk factors (6). Obesity and its correlates are major contributors to the dramatic reduction in life expectancy in this group (7, 8). This means evidence-based interventions for weight loss need to be carefully considered, researched, and promoted for those with SMI. It is sometimes assumed that patients with complex psychiatric histories will have poor post-surgical weight loss or exacerbation of psychiatric symptoms, this is unsubstantiated
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