Weight-Loss-Surgery: The Psychological Consultation

Dr. Jennifer J. Sowle

Obesity is a national health emergency in the United States. Weight-loss-surgery is one of the ways many Americans are choosing to deal with the battle of the bulge. Because of the high demand for bariatric surgery (gastric bypass and lap-band are two of these procedures), new protocols are being established to help assure the safety and appropriateness of these medical procedures.

Many medical tests are required before a patient is given the go-ahead for this surgery. The psychologist has become an integral part of the medical team. Both insurance companies and surgeons require a psychological consultation for each patient they are screening for bariatric surgery. Because eating issues are complicated and the emotional stability of the patient is important, the psychologist helps assess the patient’s readiness for surgery.

For those patients seeking this pre-surgery consultation, you can expect the psychological consultation to address these important areas of mental health:

1. Details of the patient’s personal history such as family background, education, marital status, home situation, work history, and current living situation.

2. A complete and detailed history of the patient’s obesity history, from childhood to the present, including any and all efforts the patient has made to lose weight. This would include any history of eating disorders or any issues or problems with weight and eating.

3. Information from the patient about their exploration of bariatric surgery as an option. What do they know about the procedure? Do they understand the risks of the surgery? Does the patient realize that they will be making life-long changes in their eating? Have they thought about the details of the diet, exercise program, and vitamin regimens they will use?

4. A complete and detailed psychiatric history, including any treatment the patient may have received for psychological problems, current psychotropic medications, and current psychological and/or marriage and family problems. Having a psychological or emotional problem does not necessarily keep a patient from having the surgery, as long as they are being adequately treated. This history includes past substance abuse and current alcohol, tobacco, or drug use.

5. An assessment of the patient’s personality characteristics and emotional resources which indicate that the patient will be compliant with post-surgery instructions and will be able to deal with the trauma of major surgery and subsequent recovery.

6. What are the current stressors in the patient’s life, and what kind of support will the patient have during and after the surgery? What are the patient’s expectations and fears? Would the patient consider psychological help if they needed it as they go through their weight loss?

Some psychologists may use objective psychological tests to help with the evaluation of a bariatric patient. Most, however, use their professional skills and training in a clinical interview to make sure the patient is able to understand and make informed choices about his or her health.

The primary focus of the consultation is to assess whether this patient is emotionally stable and psychologically capable of undergoing the surgery. While it is not possible to predict with absolute certainty that an individual will sail through such a procedure with no emotional complications, the psychologist can provide valuable insights that contribute to the overall assessment of a patient for bariatric surgery.

Weight-Loss-Surgery. See also Emotional Eating