Weight-Loss Surgery: The Psychological Screening Interview

Obesity is a national health emergency in the United States.
Surgical weight reduction 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.

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