You Are Why You Eat: A Psychological Primer

Providers will often ask, "Do you have A Psychologist see them before or after surgery?"

Not to be disrespectful, but it's often asked in a semi-judgmental tone, implying to me that we best check "under the hood" before we do surgery to assess the likelihood of future success in a surgical candidate with obesity, and/or try to uncover the reason why they are overweight on the first place.  There's got to be one...right? (There are likely many reasons, actually...)

Sticky stuff...

Well, it's like the ads for Prego Sauce in the past: It's In There!

We have as part of our preoperative evaluation a mandatory Psych evaluation and clearance, which is and has been a standard of care for Bariatric Surgery programs, especially Centers of Excellence.

During the preoperative Psychological screening, as performed by a qualified Psychologist or Mental Health Care provider, many components are discussed.

After obtaining a brief medical history and a history of their weight issues, patients are asked about prior mental Health issues or treatments, Social History, and a brief MSE is usually done. 

Insight into their weight issues as well as their understanding regarding the "tool of choice" /i.e. their surgery, is also elicited, to ensure that they understand the behavioral imperative that accompanies their surgical procedure, in order to lose weight.

Support systems are reviewed, as well as PsychoSocial stressors, as well as asking about current alcohol, smoking or drug use.

Their report is a summation, as long as there are not any absolute contraindications to surgery,that  the patient is usually cleared to have surgery from a Psychological standpoint.  Should they not be cleared, they will be told why and proceed toward resolving the inhibiting issue as much as able, in order to be reconsidered.

Interestingly enough, there have been no conclusive studies demonstrating which patient will do the best after surgery, from a behavioral/social/economic/intellectual or demographic standpoint. The same stands true for which patient is more likely to be successful with which procedure choice.

And, as a final word, it is not uncommon for a patient to return to see a Psychologist or counsellor or Social Worker after surgery for an exacerbation of underlying issues brought on by their rapid weight loss, or for help with coping behaviors.  The changes in their world are usually relatively rapid and profound, and although most are for the better, they can be overwhelming to some patients.