Mental health assessment and psychosocial interventions for bariatric surgery

摘要: Obesity rates in the US have risen to near epidemic levels. While caloric restriction, exercise, and behavioral modification remain mainstays for the treatment of overweight individuals (BMI 25 to< 30), these strategies have not produced sustainable long-term weight loss in the severely obese (BMI≥ 40). Bariatric surgery has become increasingly popular for the treatment of severe obesity, and has been linked to sustainable weight loss. A variety of surgical procedures have been used to induce weight loss for severely obese patients. They result in weight loss via different mechanisms: mechanically restricting the size of the stomach, bypassing a portion of the intestines, or by a combination of these mechanisms. Additionally, there is evidence that these procedures generate alterations in gastric and neuropeptides that play a role in weight loss and early satiety. Currently, the most common procedures performed are done laparoscopically, and they include gastric banding (adjustable gastric band), gastric bypass (Roux-en-Y gastric bypass (RYGB)) and gastric sleeve. The biliopancreatic diversion and vertical banded gastroplasty (VBG) are performed infrequently and are primarily done by select surgeons and centers (specifics of these procedures will not described in detail). Gastric banding achieves weight loss by creating gastric restriction. The uppermost portion of the stomach is encircled by a band to create a gastric pouch with a capacity of 15 to 30 cc. The band consists of an inflatable doughnut-shaped balloon whose diameter can be adjusted by adding or removing saline via a reservoir port beneath the skin. The bands are adjustable …