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For an increasing number of very obese individuals obesity surgery is the solution to losing excess weight when a program of diet and exercise has not succeeded, although it is definitely not an easy choice and leads to a wide range of outcomes in different patients. There are a variety of different surgical weight loss procedures available nowadays from a full gastric bypass involving the reduction of the size of the stomach and the bypassing of a section of the intestine to both restrict the amount of food eaten and the absorption of calories from that food to gastric banding which merely decreases the size of the stomach to once more restrict the amount of food which can be consumed. Whichever type of surgery is performed the fundamental principle is to make the body burn off a greater number of calories than can be ingested and so to reduce weight by using up the body's fat reserves. The real problem with bariatric surgery however does not lie in the surgery itself but is seen in the weeks after surgery when patients find that their lifestyle has to alter considerably and that they have to adjust to a whole new method of eating. For most people this is hard work but for a few it can result in severe problems which are quite simply too much to cope with. There are various different reasons for obesity but a couple of commonly seen problems demonstrate this point. The first is the problem of those individuals whose obesity has resulted from, or been exacerbated by, emotional eating. Here individuals resort to eating when they are under stress or when their emotions are low. Emotional or comfort eating becomes a very strong habit which is difficult to break and the psychological pressures which normally follow bariatric surgery are just the sort of pressures which will spark the desire for emotional eating in people who suffer from this difficulty. The second is the problem of those individuals who are prone to binge-eating and the uncontrollable disgust, guilt and depression which normally follow binge-eating episodes. It is only too easy to picture the great difficulty that such individuals will find themselves with in trying to deal with the significant lifestyle changes after gastric bypass surgery. When these and other factors are taken into account it is perhaps not surprising to discover that in the region of 20% of people being considered for bariatric surgery are unsuitable, or perhaps more correctly not prepared, for surgery which is where psychological obesity treatments come into play. A great deal of attention is paid to the need for patients to meet specific physical requirements for surgery (in terms of things like their BMI and the existence of other medical conditions associated with the fact that they are significantly overweight) but all too frequently only lip service is paid to very real psychological problems which are associated with surgery. For surgery to be given the very best possible chance for success then it is vitally important to pay close attention to the psychological requirements of patients and to provide them with the necessary pre-surgical assessment, counseling and, most significantly, treatment.
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