When I thought about writing an article on the purpose of the bariatric presurgical psychological evaluation, I realized that I won’t be able to give you many “hard facts” about these evaluations. Unfortunately, there are no strict guidelines in the field of bariatric surgery on how to conduct these assessments. This lack of guidelines leads to a huge variety in how they’re done.
For example, your bariatric surgery program may have their own behavioral health provider (i.e. a psychologist, social worker, or licensed counselor), or you may have to find one in the community. You may meet with this provider once or multiple times. You may do a variety of psychological questionnaires or you may do none.
Because every bariatric surgery program is different, I strongly suggest that you ask your bariatric surgeon about their process. It may also be helpful to ask other patients from your bariatric program what they’ve experienced with the evaluation.
Purpose of the Psychological Evaluation for Bariatric Surgery
Despite all of the differences in how the bariatric presurgical psychological evaluation is done, bariatric surgery providers do seem to agree on why they’re done. The ultimate purpose of these evaluations is to identify any psychological factor(s) that may cause a bariatric surgery patient to have difficulty following the surgery. My next article will focus on what these specific factors are, but some may be significant depression or anxiety, eating disorders, substance abuse, or psychosis.
In my opinion, understanding your relationship with food is essential for success with bariatric surgery.
To give an example: If you have bariatric surgery while experiencing significant depression that is not being treated, you may have difficulty feeling motivated enough to follow the diet or engage in some type of exercise. Or, if you are binge eating regularly before bariatric surgery, you may continue to overeat after the surgery. Both of these examples may result in a lack of weight loss.
I know that many if not most bariatric surgery patients are not looking forward to their bariatric presurgical psychological evaluation. But I do feel that it can be an excellent opportunity for patients to learn more about their eating habits. And more importantly, to learn more about their relationship with food.
In my opinion, understanding your relationship with food is essential for success with bariatric surgery. I know some of you are probably thinking “of course I understand how and why I use food — this isn’t news!” But believe me— not everyone has thought about this. And the bariatric presurgical psychological evaluation is a great way to start thinking about it.
What to Expect at the Bariatric Presurgical Psychological Evaluation
Despite the variety, you can expect your bariatric presurgical psychological evaluation to consist of a clinical interview where you will likely be asked about the following:
-current psychiatric symptoms (i.e. depression or anxiety)
-past psychiatric symptoms
-current and past substance use
-past psychiatric treatment, including outpatient therapy or hospitalizations (you will likely need to give the behavioral health provider permission to obtain records from this treatment)
-current and/or past psychiatric medication
Your bariatric presurgical psychological evaluation will also probably include a discussion on current and past eating habits, including:
-severely restrictive diets/eating patterns
–snacking / grazing behaviors
You will most likely be asked about how you’ve prepared for bariatric surgery so far, who is supportive of the procedure, and what your previous weight loss attempts have been.
Your evaluation also may consist of psychological testing that could range from short questionnaires (I use one for binge eating and one for depression) to lengthier testing. Again, these are generally looking for any psychiatric issue that may cause problems following surgery.
Hopefully, this gives you an idea of what to expect from your bariatric presurgical psychological evaluation. Again, unfortunately, these evaluations vary significantly. So it may be helpful to get an idea from your bariatric surgical program itself about how theirs are conducted. Although I know this evaluation feels like yet another hoop to jump through during a long process, I do hope that you can find it to be useful in some way!
Wishing you freedom from food,
Kim Daniels, PsyD
“Ask the Psychologist” is a monthly column by Kim Daniels, PsyD. Content is the opinion of the author and does not constitute or is a replacement for medical advice.