Controversies and challenges of bariatric and metabolic surgery in patients with psychiatric disorders

With the rising prevalence of obesity and related metabolic diseases, increasing attention has been paid on the patients with psychiatric disorders, who carry a disproportionately high burden of metabolic dysregulation. The relationship between obesity and psychiatric conditions is complex and bidirectional, which contribute to disease progression, reduced treatment adherence, and adverse long-term outcomes collectively. Bariatric and metabolic surgery is an effective therapeutic option for severe obesity and metabolic abnormalities. However, this population frequently presents with disordered eating behaviors, emotional instability, and limited social support, which pose challenges to perioperative management and follow-up. Preoperative comprehensive assessment is essential, including evaluation of psychiatric stability, medication adherence, medication adherence and adjustment strategies, psychological and behavioral motivation, anesthesia risks, and postopera-tive symptom recurrence contingency plans. Multidisciplinary team plays a pivotal role in identifying risks and optimizing surgical procedure selection and timing. Surgical decisions should be based on a comprehensive assessment of psychiatric status and other factors. In terms of overall outcomes, patients with psychiatric disorders exhibit postoperative weight loss, metabolic improvement, and early complication rates comparable to those of the general bariatric population, with most individuals experiencing stable or improved mood symptoms. Although approximately 10%-15% of patients experience depressive relapses, the sustained postoperative monitoring is required. Postoperative adherence in patients with psychiatric disorders can be affected by multiple factors, so strengthened behavioral interventions and sustained psychological support remain essential. In summary, bariatric and metabolic surgery is safe and feasible for patients with psychiatric disorders under compre-hensive assessment and multidisciplinary management. These patients can accept significant benefits. In the future, it is necessary to establish a standardized diagnosis and treatment system and optimize the whole-course intervention strategy.