Still More on the Mind and Bariatric Surgery

Psychological blocks and disturbances segue into more worrisome psychiatric problems, all in need of professional help. Patients experience eating disorders, stress, anxiety, depression, low self-esteem, and multiple concerns about how their bodies look and function.

Some people start out with psychological problems that drive them to overeat. Others overeat through habit and ignorance, with possibly an overlay of cultural norms, and then develop psychological problems because they are obese.

Mental and emotional kinks that existed before the weight loss surgery will, if left untreated, remain after the surgery and may even, as we saw in the previous post, become worse. Until ways are figured out to help all patients get their heads straight, bariatric surgery can never be celebrated as a magic bullet.

A couple of years ago, Rahesh Sagar and Tanu Gupta wrote for The Indian Journal of Pediatrics that increasing attention is being paid to the mental health of obese children. This quotation sums up the case:

Co-morbid psychosocial and emotional problems of obesity generally act as causal or maintaining factors of obesity and thus significantly affect the treatment outcome. Therefore it becomes imperative for the clinicians/pediatricians to broaden their clinical assessment and include screening of important psycho-social factors within the clinical examination of childhood obesity.

One writer noted that the psychological effects of bariatric surgery are more profound in the young, than in adults:

Studies indicate that the chances of depression in adolescents after gastric banding are high… When they gain weight even after surgery, people can feel shame and guilt, which adds to the obesity burden. Some studies also point towards an increased incidence of teenaged pregnancies two years after bariatric surgery in female adolescents.

Elsewhere, pediatrician Stephen R. Cook reminds the profession that after bariatric surgery, just like with an organ transplant, adequate followup care is essential. For a procedure that is both transformative and stressful, all surgical candidates need mental health support. Particularly for children, a stable home environment is essential.

In Britain, a financial services company started a campaign to resist the stigma around mental health problems, and support mental health in the workplace. The method they decided on was sport. As Childhood Obesity News has mentioned, Paralympian (and Baroness) Tanni Grey-Thompson speaks to groups about how frequent, vigorous exercise positively affects a person’s state of mind.

With a base of improved mental health to work from, a person will much more easily adopt a lifestyle that improves the body’s health. Although, of course, the two concepts are inextricably entwined, weight loss is not an explicit goal of exercise, but an inadvertent side benefit.

The CEO of Legal and General (the company name) Nigel Wilson is quoted as saying,

It is just so difficult to come up with the right solutions in the mental health area.

Very many primary care physicians and other health professionals would second that emotion. The psychological component is the elephant in the room. Progress cannot be made until obvious obstacles are addressed. To put it succinctly, a child will never be able to fight obesity, while living with parents who fight about obesity.

It may be plain as day that one parent is tuned in to all the important concepts of healthful living, while the other insists on sabotaging the good work by sneaking treats to the child out of misplaced spite, or even in a genuine, if pathetic, attempt to buy love. What, in the course of a 15-minute appointment, is a primary care physician supposed to do about that?

Your responses and feedback are welcome!

Source: “Psychological Aspects of Obesity in Children and Adolescents,”, 11/18/17
Source: “Weight Loss Surgery Helps 8-Year-Old Lose 7.6 Kg in 20 Days,”, 01/08/19
Source: “Should Children Have Weight Loss Surgery?,”, 01/09/18
Source: “Tanni Grey-Thompson urges athletes to share their mental health struggles to help reduce stigma,”, 10/23/17
Image by Chris Isherwood/Flickr

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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