Depuis quelques années, la prise en charge des sujets obèses s’est fortement développée, et le nombre de patients bénéficiant de la chirurgie bariatrique continue d’augmenter. Le nombre croissant de traitements chirurgicaux de l’obésité morbide induit un intérêt grandissant pour les conséquences à court, moyen et long terme de l’intervention. La surcharge pondérale massive comme son traitement chirurgical peuvent influencer la santé mentale des patients et avoir un impact sur le risque suicidaire et le taux de suicide de la population obèse, d’une part, et de la population opérée par bypass gastrique, d’autre part. En effet, le taux de suicide après la prise en charge de l’obésité est majoré, et si la littérature est prolixe sur la qualité de vie après un bypass gastrique, elle l’est beaucoup moins sur les causes de suicides postopératoires. Les théories exposées jusqu’ici par la littérature sont nombreuses, mais aucune ne peut expliquer à elle seule cette surmortalité évitable. Ce constat soulève de nombreuses questions quant à la prise en charge des candidats au bypass gastrique : faut-il revoir les critères d’inclusion ? Est-il possible de déterminer, en préopératoire, de façon plus précise les capacités de compliance du patient ? Faut-il rendre le suivi psychiatrique obligatoire après l’intervention ?

In the last few years, the flourishing number of surgery for morbid obesity induces a growing interest in the short, medium and long-term consequences of the operative procedures. Both massive overweight and its surgical treatment such as gastric bypass can influence the mental health of patients and have an impact on their risk of suicide and suicide rates. Indeed, the suicide rate after the surgical treatment of obesity is increased; although medical literature is prolific on the subject of quality of life after gastric bypass surgery, less is known about the causes of postoperative suicide. There are few theories that allow discussion or hypothesis making and among these none can explain alone the excess of preventable deaths. This raises many questions about the management of candidates for gastric bypass: Is it possible to improve preoperative screening of patient's compliance? Should psychiatric follow-up become compulsory after surgery? It appears obvious from the current literature that suicide rates are higher among gastric bypass patients than the general population. It is reasonable to assume that this finding is related to the psychological difficulties experienced by patients, the impact on their quality of life and social functioning, on emotional and on a professional level. The intervention and massive weight loss can often destabilize an already precarious balance. It seems necessary to strengthen the psychiatric treatment of candidates for bariatric surgery and discuss the value of mandatory postoperative follow-up, as well as to promote patient compliance. Bariatric surgery patients with a history of psychiatric comorbidities should benefit from strict preoperative consultations and appropriate medication in order to rigorously balance their condition before surgery. Postoperative measures should include monitoring of high-risk populations such as patients with psychiatric comorbidity, as well as considering couple psychotherapy or support groups for patients and their relatives.