Is bariatric surgery a crime? A systematic review and meta-analysis of postoperative psychiatric symptoms and eating disorders.

Abstract

Bariatric surgery can lead to significant weight loss and improved physical health. Still, it often also brings about complex psychological effects, including changes in self-esteem, body image and emotional well-being that require careful monitoring and support. This systematic review with meta-analysis aims to analyse the relationship between bariatric surgery and postoperative improvement in psychiatric and eating disorders. MEDLINE, EMBASE, COCHRANE Library and other specialized databases were searched in July 2024. Observational studies included individuals who had undergone any bariatric surgical treatment with a preoperative evaluation of eating disorders, depression and anxiety and at a postoperative measure of the same variables selected. Thirteen studies that met the eligibility criteria were included for qualitative synthesis and eight studies for meta-analysis. Two reviewers independently screened for eligibility. The mean difference was calculated using the random-effects model. Bariatric surgery was found to be effective in improving eating disorders (-0.81%, 95% CI -1.61 to -0.05; I2 = 98%, p < .05), depression (-0.56, 95% CI -1.09 to -0.04, I2 = 97%, p < .03) and anxiety (-0.74, 95% CI -1.17 to -0.31, I2 = 94%, p < .00). The literature reveals high heterogeneity between studies, particularly in assessing psychological factors, with a common reliance on self-reported questionnaires rather than gold-standard assessments. Nonetheless, based on the findings of this study, there was a genuine effect on eating disorders, depression and anxiety when those participants underwent bariatric surgery.