In the multidisciplinary team treating obesity, mental health is not just a side effect, but a central pillar for long-term success. Because obesity and mental health disorders are in a bidirectional relationship, unresolved psychological barriers can often sabotage physical progress
(Ref: Dandgey S, Patten E. Psychological considerations for the holistic management of obesity. Clin Med (Lond). 2023 Jul;23(4):318-322; Jankowska, P. (2025). The Role of Stress and Mental Health in Obesity. Obesities, 5(2), 20).
Key Aspects of Mental Health
- Common Comorbidities: Up to 60% of patients in obesity cohorts show evidence of psychiatric diagnoses. Depression, anxiety disorders, ADHD and eating disorders such as binge eating disorders are particularly common.
- Stigma & Self-Esteem: Weight-related stigma and discrimination often lead to social withdrawal, low self-esteem, and chronic physiological stress, which further hinders weight loss.
- Stress & Emotion Regulation: Chronic stress increases cortisol levels, which increases cravings for high-calorie comfort foods and promotes fat storage.
(Ref: Psychological considerations for the holistic management of obesity, Clinical Medicine, Volume 23, Issue 4, 2023, Pages 318-322)
The Role of Psychological Professionals on the Team
- Diagnostics: Identifying psychosocial factors and screening for trauma.
- Cognitive Behavioral Therapy (CBT): Supporting patients in changing eating habits, managing emotional eating, and reducing negative thought patterns.
- If necessary, eating disorders treatment.
- Pre-Surgery Preparation: Assessing psychological readiness and stability prior to bariatric surgery.
- Interdisciplinary Consultation: Supporting other team members (e.g., dietitians, physicians) to ensure holistic and non-stigmatizing care.
(Ref: Psychological considerations for the holistic management of obesity, Clinical Medicine, Volume 23, Issue 4, 2023, Pages 318-322) - The inclusion of psychological support has been shown to correlate with better therapy adherence and sustainable weight loss results.
Additional psychiatric task:
- Management of Psychotropic Medications
- Many psychotropic drugs (e.g., for depression or schizophrenia) affect metabolism and can cause significant weight gain.
- High-Risk Medications: Certain antipsychotics, such as clozapine and olanzapine, as well as antidepressants like mirtazapine or amitriptyline, are particularly problematic.
Management Strategies:
- Switching Medications: If possible, switch to weight-neutral alternatives such as aripiprazole, fluoxetine, bupropion or lamotrigine.
- Combination with GLP-1 receptor agonists (such as semaglutide); methylphenidate with comorbid ADHD.
- After bariatric surgery (especially gastric bypass), the pharmacokinetics of psychotropic medications may change drastically. The risk: The medications may be less effective, have a shorter duration of action, or lead to sudden toxicities.
Why do drug levels drop or fluctuate?
- Reduced absorption surface: The active ingredient has less time and space to be absorbed in the small intestine.
- Altered pH: Many psychotropic medications require an acidic environment in the stomach to dissolve. Surgery increases the pH, which reduces solubility (e.g., of antidepressants).
- First-pass effect: Due to the anatomical changes, metabolism in the liver can be accelerated, which lowers the drug level in the blood.
Practical Recommendations:
- Switching to liquid or immediate-release tablets: In the initial period after surgery, drops or orally disintegrating tablets should be preferred, as these are absorbed more quickly.
- Therapeutic Drug Monitoring (TDM): It is essential to measure the drug plasma concentrations before and several times after surgery in order to adjust the dose individually.
(Ref: Pasi P, Kröll D, Siegfried A, Sykora M, Wildisen A, Milone C, Milos G, Horka L, Fischli S and Henzen C (2023) Plasma concentrations of SSRI/SNRI after bariatric surgery and the effects on depressive symptoms. Front. Psychiatry 14:1132112)