Upala and Sanguankeo had commented on our article ‘Deterioration of mental health in bariatric surgery after ten years despite successful weight loss’.1 They correctly note that most research in the field of bariatric surgery show a significant positive influence on overall quality of life. In our sample, 10 years after the operation, the total quality of life (SF-36 total) was better than before surgery, but the difference was only reaching significance. In fact, after 10 years participants still showed gains in the Physical Composite scale of the SF-36 (which is in line with previous research), but mental health benefits (Mental Composite) were not present any longer. Considering the individual SF-36 scales, 10 years after the operation, the only observed significant improvement was in ‘limitations in physical activities because of health problems’, and there were trends toward improvement in ‘limitations in usual role activities because of physical health problems’ and in ‘bodily pain’. ‘Vitality’ reverted to baseline levels. As reported, there was a trend toward deterioration in ‘general mental health’. Interestingly, despite the gains in the physical aspects of health, the participants’ ‘general health perceptions’ significantly deteriorated below baseline. In our sample, gains in the social functioning (‘limitations in social activities because of physical or emotional problems’) reverted to baseline. Similarly, ‘limitations in usual role activities because of emotional problems’ had also reverted to baseline. This pattern of results suggests that bariatric surgery has a positive influence on the physical aspects of quality of life, also improving the usual role activities. However, our study is raising the possibility that the other aspects of quality of life, that is, mental health and social functioning, may remain unaffected by the operation or, even worse, deteriorate. Deterioration below baseline levels was more prominent on measures that specifically assessed different aspects of mental health: psychological distress, neuroticism, sense of control and fear of intimacy. Our study stresses the importance of a comprehensive assessment of bariatric patients, including additional instruments other than the traditional quality-of-life questionnaires. Improving evaluation in clinical practice (in the screening phase as well as follow-up) and in research may improve the outcomes of bariatric surgery.
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