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Mental health professionals are a key part of the team
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Bariatric surgery is considered the most effective treatment for severe obesity (defined as body mass index ≥ 40 kg/m²), resulting in average weight loss of 35 percent of initial body weight as well as marked reductions in multiple medical comorbidities.1
However, unlike many other common surgeries, bariatric surgery is closely linked to behavior and psychosocial factors. Eating and exercise behaviors as well as psychological and social factors may have caused, exacerbated or maintained the severe obesity. Further, bariatric surgery candidates are a psychiatrically vulnerable population with a high level of psychiatric and psychosocial comorbidity.2-3
Although surgery results in significant anatomical alterations, long-term success requires significant behavioral change and necessitates that individuals adhere to permanent lifestyle alterations in diet and exercise as well as reduce reliance on food to cope with life stressors. Because of these factors, mental health professionals are an essential component of the multidisciplinary assessment and treatment team at most bariatric surgery treatment centers.4
A behavioral health team of psychologists is fully integrated into the multidisciplinary care and research at Cleveland Clinic’s Bariatric and Metabolic Institute. We continue to focus our work on how to better identify, treat and manage psychosocial risk factors that may impede optimal success with surgery. The following reflects some of the research being conducted by our behavioral health team:
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Bariatric behavioral health is a relatively new specialty but is likely to continue to grow as the obesity epidemic continues. Our collaborative, multidisciplinary team affords us the opportunity to investigate and treat psychosocial factors in order to optimize outcomes for our patients.
Leslie J. Heinberg, PhD, is Director of Behavioral Services for Cleveland Clinic’s Bariatric and Metabolic Institute and Professor of Medicine at Cleveland Clinic Lerner College of Medicine.
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5 American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
6 American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed., text rev. ed. Washington, D.C.: American Psychiatric Publishing; 2000.
7 Marek RJ, Ben-Porath YS, Ashton K, Heinberg LJ. Impact of using DSM-5 criteria for diagnosing binge eating disorder in bariatric surgery candidates: Change in prevalence rate, demographic characteristics, and scores on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Int J Eat Dis. In press.
9 Marek RJ, Ben-Porath YS, Merrell J, Ashton K, Heinberg LJ. Predicting one and three month postoperative somatic concerns, psychological distress, and maladaptive eating behaviors in bariatric surgery candidates with the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Obes Surg. In press.
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