From Walmart.com |
This is not the first time I've heard this, and I've always thought this broad summation of a fairly diverse population with obesity was understandable, but unfair. Or was it?
I've rationalized to myself, with nearly 10 years of bariatric surgical care experience (both inpatient, intraoperative, and outpatient) that those comments were due to inexperience with seeing the full spectrum of care as I see it on a daily basis, with mixed types of patients on their journey toward wellness at various points along their preoperative and postoperative course.
There is something deeply satisfying about caring for this population, which we are all seeing, and acting as part of a multidisciplinary skilled team to assist them to wellness /"wholeness" if you will, in a way that no other health care facility in our area can. Good stuff.
Are we occasionally effected by a "nutsy" patient, or a difficult patient care situation? Do similar or even more dramatic situations occur in a Family Practice or ER setting, or other similar venues? Most assuredly, the answer to both questions is yes.
I would argue, though, that the patient's BMI is not the common denominator in most of these cases.
Which brings me to the subject of this Blog: What does the literature say about the psychological profile of the morbidly obese?
I looked up just such an article recently, and it had some interesting descriptors of the morbidly obese. The article was written in 2004, but did have a nice systematic literature search on the subject and came to some interesting conclusions.
As the article states, Bariatric surgery does in fact represent 'forced' behavior modification. However, the surgery does not result in equal results in each patient. Psychological factors do play an important role in these results. The degree that patients can successfully adapt to use their "tool" that the surgery provides, quite directly reflects their success in losing weight and keeping it off after surgery.
The article went through the published results on the morbidly obese, as studied in terms of Personality, Psychopathology, Eating Behavior, Social Integration, and Quality of Life.
Let's start with the first two.
Personality
Personality studies in the morbidly obese described three main interactions. Firstly, personality may predispose to overeating and weight gain. Secondly, existing with long term obesity can certainly influence personalty. Also, personality and weight can also relate in a way that is a combination of the two.
No specific personality was found that was consistent in the majority of the population studied. There was a wide variety of traits discovered as commonly associated.
*Passive-dependent as well as Passive-aggressive
*Overly sensitive interpersonally, and most had difficulties expressing their aggressive feelings
*Poor impulse control
*Despondency and Hopelessness
*Eccentric, Anxious, and Dramatic cluster traits
*Tended toward Somatization
*Passive Coping Behaviors, with a 'wait and see' approach
Psychopathology
This was reported as difficult to assess, as even the methodology as to discerning whether specific pathology exists is highly controversial. More recently, this is becoming more acceptable as an identified co-morbidity, either leading to the obesity primarily, or becoming a diagnosed condition secondarily.
Some studies seemed to show what was described as psychopathology as the result of the burden of obesity, whereas others did not show that direct of a link. Some researchers noted a 40-50% prevelance of psychiatric disorders in the obese. The most common disorders were
*Depressive Disorders
*Anxiety either associated with above, or as a singular entity
In terms of family relationships, many obese patients studied had a history of early parental loss, parental alcoholism, and also have marital dysfunction in their own lives. The presence of sexual and non-sexual abuse was also common. One study did comment, however, that the rates were not all that different than that of abuse in the general, non-obese population.
Also, females, more than males, were shown to be more likely per capita to have preoperative pathology, in terms of depression, interpersonal sensitivity, somatization, obsessions-compulsions, anxiety, as well as hostility.
For the next segment, we will go over the findings on Eating Behavior, Social Integration, and Quality of Life.
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