Mental Health Is a Critical Consideration in Bariatric Surgery Success

By Paul J. Watkins

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Bariatric surgery is a safe, effective tool for patients who want help achieving their weight-loss goals. However, an excessive amount of weight is not the only determinant of a patient’s eligibility for surgery. The patient’s mental health is another important consideration.

“Anxiety, for example, can be a driver for failure to lose weight after bariatric surgery,” says Guillermo Medrano del Rosal, MD, a board-certified general surgeon who is fellowship trained in bariatric surgery and bariatric revision surgery. He practices at Alamo City Bariatrics in San Antonio. “It can also be a cause for people to gain weight because they use food as a soothing mechanism.

“The same goes for depression, for which food can be a soothing mechanism as well as a reward mechanism to help the patient feel better. Depression also tends to have a component of poor motivation. People who are depressed tend not to seek help because they feel tired and unmotivated to get better. Being able to identify mental health issues prior to surgery helps ensure the best possible results from any bariatric procedure.”

The surgeon adds that mental health also includes substance abuse, and patients considering bariatric surgery shouldn’t be using any illegal drugs. “We’re less strict with recreational drugs,” he notes. “As long as the substance, such as alcohol or marijuana, isn’t being abused, we can work with the patient, but we do have to make sure the patient isn’t on any drug that might deviate them from losing weight.”

According to Dr. Medrano del Rosal, most patients do not have to undergo an evaluation by a mental health professional prior to being approved for bariatric surgery, unless their medical insurance requires it. “Otherwise, we just do a screening while talking with the patient, assessing their needs and concerns, and going over their medical history. If we do see signs of a mental health issue, we refer the patient to a specialist for evaluation and possible treatment. After the patient is stable, we can proceed with the surgery.”

Patients who have severe morbid obesity, meaning a body mass index (BMI) greater than fifty, may not achieve their weight-loss goals with their initial bariatric procedures, and their comorbidities often remain relatively the same. In such cases, Dr. Medrano del Rosal may perform a duodenal switch, a bariatric procedure that can help these patients lose the remaining weight.

“The remission rates of Type 2 diabetes at two years after surgery tend to improve diabetes to ninety-nine percent, making the duodenal switch virtually a cure for the disease.”

Dr. Medrano del Rosal says that once patients undergo bariatric surgery, most experience improved mental health as well as physical health.

“These patients are walking rather than using a motorized wheelchair, they’re wearing different clothes, and their faces look different – not just because of the weight loss but because they’re happy,” the surgeon concludes. “They’re able to chase their kids or their grandkids, get out into the world, and enjoy their lives. It’s one of the reasons it’s worth it to me to keep doing this work.”

For more information or to make an appointment, please call (210) 625-3167 or visit

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