by Cynthia Buffington, PhD
Morbid obesity not only increases the risk for health problems but for psychological distress as well. Studies have found that as many as 90% of morbidly obese presurgical patients are clinically depressed and that such depression not only causes relationships with family and friends to suffer, but also leads to further weight gain and disease.
Depression associated with morbid obesity is known to alter the production and activity of specific regulators of appetite and food preference, causing an increase in the desire for 
carbohydrates (particularly sweets) and contributing to emotional overeating, binge eating, and other aberrant eating patterns. The net result is increased food intake and increased body weight. Voluntary muscle movements and the desire for physical activity are reduced by depression, resulting in decreased energy expenditure and number of calories burned.
Depression affects health status, increasing significantly the risk of all obesity-related diseases, as well as the risk of surgical complications and lengthened hospital stay. Additionally, depression has even been found to reduce weight-loss success following diet or surgery.
Surgery resolves or improves depression and many of its causes and effects, (i.e. health problems, reduced mobility, low self esteem, social discrimination.) Over time, however, some patients will have a reoccurrence of their depression, along with the associated eating abnormalities (high carbohydrate craving, binge eating) and weight gain.
If you and/or your family suspects that you are suffering from clinical depression, seek medical attention immediately. Your bariatric surgery program uses a multidisciplinary clinical approach to determine the most effective care for managing pre and postoperative depression. The psychologist can identify and address causative factors. The exercise physiologist can determine the most appropriate exercises for reducing depression and anxiety. The dietitian can address the association between nutritional status and mood. In addition to traditional medicine, depression may be addressed with alternative therapy such as spiritual counseling, massage, hypnosis, positive imagery, and wellness counseling to assist patients in improving quality of life.
