This PhD thesis of Johanna Pyykkö explores the impact of psychological factors on physical and mental health outcomes following bariatric metabolic surgery (BMS). Drawing on data from two longitudinal studies involving several hundred Dutch patients assessed before surgery and up to two years postoperatively, the research examines the roles of self-compassion, attachment style, chronic pain, self-esteem, and self-efficacy in shaping outcomes such as weight loss, diet, exercise, depression, and health-related quality of life (HRQoL).
Key findings show that higher levels of self-compassion were associated with reduced depression and improvements in HRQoL, body image, and eating behaviours after surgery. Patients with chronic pain reported poorer psychological health before surgery and showed less improvement in eating-related self-efficacy postoperatively, despite achieving significant weight loss. Insecure attachment styles—both anxious and avoidant—were linked to lower self-esteem and health-related self-efficacy at one year, which in turn predicted poorer adherence to dietary and physical activity guidelines at two years. Furthermore, distinct postoperative trajectories in BMI, HRQoL, and depression were identified, with some patients experiencing deteriorating mental health despite successful weight loss.
These findings highlight the critical need to integrate psychological assessment and support into routine BMS care. Early identification of patients at risk for suboptimal outcomes can facilitate timely, targeted interventions. A more personalised, psychologically informed approach is essential to promote long-term physical and mental health benefits and ensure sustainable success after surgery.
Johanna Pyykkö is part of Health in Context.
