The Dual Reality of Psychological Outcomes and Mental Health Trajectories After Metabolic and Bariatric Surgery: A Scoping Review of Desirable and Less Desirable Experiences.

purpose of reviewTo map, within a single integrated framework, the full spectrum of desirable ('feel-good') and less desirable ('feel-bad') psychological outcomes and mental health trajectories after metabolic and bariatric surgery (MBS), and to identify the knowledge gaps that emerge only when both sides are viewed together. RECENT

findingsAcross 251 included studies, the desirable arm comprised four interconnected domains: improved mental health (depression, anxiety, mood, eating disorders); enhanced physical-health domains supporting psychological well-being; improved body image, self-esteem and relational functioning; and gains in occupational, educational and economic participation. The less desirable arm comprised three themes: a spectrum of adverse outcomes; the negotiation of self and existential tensions; and a 'lonely struggle' against insufficient support, encompassing the most serious outcomes of suicide, self-harm and alcohol-use disorder. Thirty-seven studies contributed to both arms, and benefits and burdens frequently coexisted within the same patient over time. Recent studies show that these gains are smaller and less durable than group averages suggest. Improvements in depressive and anxiety symptoms are largest in the first year and smaller thereafter or partly reversed; symptoms persist or worsen in a subset of patients; relationship, work, body-image, and weight-stigma outcomes run in both directions; and the benefits differ by sex, ethnicity, age group, and pre-surgical psychiatric history. The psychological aftermath of MBS is a dual reality rather than a uniformly positive or negative one. Reframing psychological success as the net balance between the two trajectories supports biopsychosocial, multidisciplinary, long-term care, and points to a research agenda built on within-cohort, dual-outcome longitudinal designs.