# Beyond Metabolism: Psychiatric and Social Dimensions in Bariatric Surgery Candidates with a BMI ≥ 50—A Prospective Cohort Study

## TL;DR

This study compares patients with BMI ≥ 50 and lower BMI undergoing bariatric surgery, finding unique clinical and psychosocial differences that suggest the need for tailored care.

## Contribution

The study identifies distinct clinical and psychosocial profiles in super morbidly obese bariatric surgery candidates.

## Key findings

- Patients with BMI ≥ 50 had higher rates of obesity-related health issues and worse metabolic profiles.
- Despite similar psychiatric screening scores, they reported fewer prior depression or eating disorder diagnoses.
- The study highlights the need for multidisciplinary preoperative assessment for this subgroup.

## Abstract

Background: Super morbid obesity (SMO), defined as a body mass index (BMI) ≥ 50 kg/m2, represents a distinct and increasingly prevalent subgroup of patients undergoing bariatric surgery. Compared to individuals with lower BMI, patients with BMI ≥ 50 kg/m2 often exhibit unique clinical, psychological, and social characteristics that may influence treatment outcomes. Objective: This study aimed to compare demographic, metabolic, and psychiatric profiles of patients with BMI ≥ 50 kg/m2 and non-super morbid obesity (NSMO; BMI < 50 kg/m2) who were evaluated prior to bariatric surgery. Methods: A total of 319 patients were recruited between December 2022 and December 2023 at a bariatric center in Gdansk, Poland. All participants underwent a comprehensive preoperative assessment, including laboratory testing, psychometric screening (BDI, PHQ-9), and psychiatric interviews. Patients were stratified into class IV obesity and NSMO groups for comparative analysis. Results: Patients with BMI ≥ 50 kg/m2 were significantly older and more likely to report a history of lifelong obesity, family history of obesity, and childhood trauma. They had higher rates of obesity-related health problems such as hypertension, obstructive sleep apnea, and chronic venous insufficiency, as well as worse liver function and lipid profiles. Although the overall psychiatric burden was high in both groups, patients with BMI ≥ 50 kg/m2 reported fewer prior diagnoses of depression and eating disorders, despite similar scores on screening tools. Conclusions: Patients with BMI ≥ 50 kg/m2 represent a clinically distinct population with elevated metabolic risk, complex psychosocial backgrounds, and possibly underrecognized psychiatric burden. These findings underscore the need for multidisciplinary preoperative assessment and individualized treatment strategies in this group of patients.