Psychological Evaluation Before Bariatric Surgery: An Important and Helpful Step

Bariatric surgery is life-changing and requires personal effort to be successful. Those who choose this approach to weight loss have likely given it considerable thought because it alters not only your body but also your daily life.

It’s helpful to understand that this procedure is not only physical, but also psychological in nature. For that reason, those undergoing bariatric surgery are asked to undergo a psychological evaluation.

What is the Purpose of the Psychological Evaluation?

The goal is not to discourage people from pursuing the surgery, but rather to help you determine your emotional and mental readiness for a major medical procedure – and to maximize your outcome so you can live a more fulfilling and satisfying life.

We know from multiple studies that bariatric surgery helps individuals suffering from various medical conditions. Unfortunately, a small number of patients do not improve their quality of life or sustain weight loss. Knowing your motivations and strengths, as well as areas where you might need support, can improve your experience and results after surgery.

What is a Psychologist Looking for in a Psychological Evaluation?

First and foremost, we are interested in a patient’s personal motivations and goals in pursuing bariatric surgery. These often include concerns about deteriorating physical health and desires to be more active and involved with their families. Many feel that previous weight loss efforts were unsuccessful and are looking for a tool to achieve their goals.

All of these motivations are admirable, and it is most important for the patient to give significant consideration as to why they are pursuing the procedure and to what extent they believe they can sustain their focus and determination to be successful.

Personal effort by patients is crucial. For some, diet and exercise habits are extremely hard to sustain due to time and physical limitations. The psychological evaluation process is designed to help gain insight into what factors hold you back and to what extent you believe you are capable of producing your own changes. No one is perfect.

However, making small changes early in the process often produces better outcomes as you become accustomed to changing eating habits, physical activity levels, and overall preparedness when surgery finally arrives.

What Happens During a Psychological Evaluation?

Most evaluations involve talking about your motivations for seeking surgery and the goals you hope to achieve. We will talk about past diets and exercises you have tried -- both successfully and unsuccessfully – and what factors hindered or helped your weight loss progress. It helps to understand how and why you accomplished your goals when you were successful in the past.

We also talk about your upbringing because factors from your childhood can contribute to weight gain.

These Factors May Include:

• Genetics
• Poor family eating habits
• Stressful living conditions

We’ll look at what “patterns” or “habits” you still follow as an adult (“I must clean my plate” or “I always have ice cream after the kids go to bed”). Exploring these thought processes can help you prepare for bariatric surgery.

What is Psychological Testing?

Psychological testing is a second component of a bariatric evaluation.

Psychologists Use These Assessment Tools to:

• Add to the evaluations objectivity
• To gain a comprehensive picture of a patient’s personality characteristics
• To understand a patients current psychological functioning and overall openness to change.

These are not “pass-fail” type tests. Rather, they help determine what strengths and weaknesses may be relevant in determining a course of treatment.

For example, a patient who struggles with anxiety may need additional counseling as they prepare for surgery. Similarly, a person who has few support systems may benefit from working with a dietitian, personal trainer or other healthcare professionals after their procedure.

What Psychological Barriers are There to Bariatric Surgery?

People who struggle with weight-related problems may also experience a number of mental health problems, such as depression, anxiety or social isolation. People with obesity may also struggle with mood disorders, eating disorders and substance abuse disorders.

Having one of these disorders does not necessarily disqualify you from having bariatric surgery. It's essential, however, to determine the potential impact a disorder may have on your ability to be successful after surgery.

In cases where eating disorders or substance abuse continues to be present and problematic, it is recommended that the psychological treatment be completed before pursuing bariatric surgery.

This is also the case with active psychosis, active suicidality and impulse control disorders. Given the psychiatric nature of these problems, it is recommended that they be addressed before undergoing a major medical procedure.

For those considering bariatric surgery, it's important to consider your options. Learn more about bariatric surgery by visiting CHI Health's Bariatric Surgery Program.