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Psychosocial
support needed by bariatric patients
By Kathryn Blair
Toronto,
ON— Patients would be better able to keep their weight
down and adjust to their new body image if they were given more
psychosocial support, said Lincoln D’Souza, Nurse Clinician,
and Brian Kunimoto, MD, a Vancouver dermatologist, at the annual
meeting of the Canadian Association of Wound Care.
Since 1996 the McGill University Health Center (MUHC) Bariatric
Clinic has treated more than 1,400 bariatric patients with the isolated
gastric bypass. Many have difficulty adapting to new eating habits,
and in the long term some do not lose or keep off as much weight
as they had anticipated, leading to dissatisfaction and, in some
cases, depression. Alternatively, some patients overcompensate;
each year one or two patients may develop anorexia.
Those who do reach and maintain their desired weight may have trouble
adjusting to their new body image. Sometimes they—and their
partners—no longer know who they are. “Divorce is an unexpected
outcome for some bariatric patients because their relationships
may be partially or completely based on weight,” Mr. D’Souza
said.
Before surgery, patients are introduced to a nutritionist. “But
we don’t spend a lot of time reinforcing nutrition at the start,”
he said. Participation in the pre-operative teaching sessions is
mandatory along with post-operative followup. Post-operative group
therapy sessions are also available and patients are encouraged
to attend.
Group therapy has a higher profile on the West Coast. “I work
with a psy-chiatrist who believes morbid obesity is a result of
self image and stress,” Dr. Kunimoto said. “She manages
[bariatric patients] in group therapy for food addiction.”
These patients are mentally healthier before undergoing bariatric
surgery, said Dr. Kunimoto, a dermatologist at the Wound Healing
Clinic, Vancouver Hospital, and Clinical Assistant Professor, Division
of Dermatology, The University of British Columbia. More group therapy
would be ideal, Mr. D’Souza agreed. “Our problem is funding.”
Two psychologists at the MUHC have been available for bariatric
patients. Several group therapy sessions for patients from Quebec
are funded by the MUHC Bariatric Program. After a few visits, patients
must assume the cost of psychological treatment. Each session can
cost $100.Mr. D’Souza and colleagues are lobbying to increase
funding.
Out-of-province patients must assume the entire cost of the surgery
as well as of group therapy until reimbursed by their province of
origin. The MUHC is treating increasingly more patients from outside
Quebec. “Ontario is now transferring patients to us. It only
has two surgeons who perform this particular type of surgery.”
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