**4. Psychological conditions of bariatric surgery patients**

According to a recent systematic review [5] about one-third of bariatric surgery candidates present a psychological disturbance, such as depression and anxiety and there is a high prevalence of Binge Eating Disorder [6]. Other mental health conditions related to bariatric candidates are psychosis, PTSD substance abuse and personality disorders.

Although the prevalence of mental health conditions among bariatric patients is higher than in the normative population, there is no clear evidence that preoperative mental health conditions are associated with poorer post-operative weight loss [7]. Nevertheless, prospective studies showed that pre-operative depression and anxiety predict poorer outcomes after surgery [6].

Unfortunately, long term successful weight loss could be less than optimal, and partially depends on the individual's ability to implement consistent lifestyle changes. For these reasons the psychological evaluation of bariatric surgery candidates is requested for monitoring and addressing psychological factors pre-and-post surgery.

In a recent review [8] aimed to explore the present practices adopted by clinics to assess bariatric candidates, it has been highlighted that, in many cases, the presence of uncontrolled symptoms of schizophrenia, drug and alcohol abuse, mental retardation and lack of knowledge about surgery are considered contraindications to surgical approval. Other factors that most frequently are considered limitations to surgery include the presence of symptoms of bipolar disorder and history of suicide attempts, lack of compliance to medical recommendations, unrealistic expectation to surgery outcome, while the age of patients as well as the lack of social support are often considered no-contraindication to surgery. Possible contraindications that could represent a limitation to surgery are past criminal behaviors, the presence of eating disorders, and the inability to follow a diet over time. Finally, according to the programs included in the study, binge eating disorder, depression, obsessive–compulsive disorder, tobacco use, and history of sexual abuse are considered definite or possible contraindication to surgery.
