Bariatric (weight-loss) Surgery Pre-operative Evaluation

When a surgeon assesses patients for bariatric surgery, he/she ascertains their general health, with the idea of identifying those for whom surgery is too risky and those who have conditions that need to be treated, stabilized, or managed for surgery to be worth its risk. Behavioral health specialists can no more “predict” a particular psychological outcome than the physician can “predict” a surgical or medical complication. We can, however, via the pre-operative behavioral health assessment, identify psychosocial risk factors and make recommendations to both the client and surgical group that are aimed at facilitating the best possible outcome for the patient.

Patients are typically faced with initial dietary restrictions, permanent changes in eating and dietary habits, altered body sensations and experiences, shifting body image and self care behaviors, new cognitions and feelings, and an emerging and different lifestyle. In addition, they may realize sometimes unexpected and significant changes in relationships that may result in marked stress. Bariatric surgery is a highly effective procedure that not only reconfigures and/or restricts a patient’s stomach, but significantly affects their psyche as well. Generally patients will need a secure identity, sound psychological resources, resiliency, effective coping strategies, and willingness to access meaningful support from others.

When problematic pre-surgery psychosocial factors are identified, the clinician is able to alert the treatment team and the patient, and make appropriate recommendations. Recommendations may include pharmacological interventions, psycho-education, psychotherapy to address potential post surgery stumbling blocks, nutritional consultation, close aftercare monitoring, and/or bariatric surgery support group attendance.

Reference

Sugggestions for the pre-surgical psychological assessment of bariatric surgery candidates
American Society for Bariatric Surgery, October 2004

Evaluation Procedure

The bariatric surgery pre-operative evaluation procedure involves an initial clinical diagnostic interview, and typically a second appointment during which certain testing may be administered. The evaluation seeks to learn more about the candidate's current life situation, motivation, expectations of surgery, mental health, personality, thought processes, and developmental history. The evaluator will score and interpret the information collected, and provide a report and recommendation to the surgeon and hospital bariatric services coordinator regarding the candidate's appropriateness, from a mental health perspective, for bariatric surgery.