Disability and psychological burden in severe obesity: results from a structured psychosomatic assessment of candidates for metabolic and bariatric surgery

Abstract

Background: Metabolic and bariatric surgery (MBS) is an evidence-based treatment for severe obesity and obesity-related disease. A psychosomatic assessment is widely recommended as part of the preoperative evaluation; however, standardized approaches remain limited. This cross-sectional study evaluated a structured assessment combining detailed interviews, psychometric questionnaires, and measures of psychosocial functioning and disability.Patients and methods: A total of 220 adults with severe obesity who underwent a structured preoperative psychosomatic assessment during routine evaluation for metabolic and bariatric surgery between 2019 and 2022 at Saarland University Medical Center were included. Patient-reported outcomes were obtained using the PHQ-D (including PHQ-9 and PHQ-15), GAD-7, WHODAS 2.0 (12-item version), AUDIT, OPD-SQS (12-item), and EDE-Q. Therapist-administered ratings included GAF, GARF, and diagnostic assignments.Results: Of the 220 patients, 69.1% were female and 30.9% male, with a mean age of 41.8 years (SD = 11.6) and a mean BMI of 51.8 kg/m² (SD = 8.4). A prior history of mental illness was reported by 37.7%. Over 60% met DSM-IV Axis I criteria for current psychopathology, predominantly affective (54.5%), anxiety (24.5%), and eating disorders (19%). The mean WHODAS score was 20.3, with 76.7% showing clinically significant disability (≥25%). Emotional distress related to health problems was most frequently endorsed (64.5%). Somatic comorbidities included prediabetes or type 2 diabetes in 31.8%. Moderate-to-severe depressive symptoms were observed in 47.1%. WHODAS scores correlated significantly with PHQ-9 (r = .57, p <.001) and PHQ-15 (r = .58, p <.001) but not with BMI (r = .05, p = .49). The EDE-Q total mean was 3.3 (SD = 1.1), indicating abnormal eating behavior. The OPD-SQS mean was 16.8 (SD = 9.8), with relational difficulties moderately correlated with disability (r = .33, p <.001).Conclusion: Candidates for MBS showed substantial psychological and functional burden. Disability was more strongly associated with depressive symptoms, somatic distress, and psychosocial functioning than with BMI. These findings support the integration of structured psychosomatic assessment into routine preoperative bariatric evaluation and emphasize the importance of individualized perioperative mental health care.