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The popularity of weight loss surgery has increased dramatically. While this surgery may sound like a miracle for those who have been fighting obesity for many years, even decades, the decision to have gastric bypass surgery or a similar weight-loss surgery is not one that should never be taken lightly.

For someone to be approved for bariatric surgery (for example, lap band or gastric bypass surgery), most bariatric surgeons (those specializing in weight loss surgery) and insurance carriers require that an individual’s risks of obesity outweigh the risks of surgery. Usually, this means that a patient is 100 pounds or more overweight or has a Body Mass Index (BMI) of 40 or greater (click here for the BMI Calculator from the Centers for Disease Control and Prevention). Patients of lesser weights are sometimes approved if they have a "life-threatening" co-morbidity such as diabetes, high blood pressure, severe sleep apnea, etc.

Those who are not typically considered for bariatric surgery include women who are pregnant, alcoholics and drug addicts, and patients with very severe and poorly controlled psychological disorders (however, psychological disorders do not disqualify someone).  In addition, limited intelligence, extremes of youth and age, inability to exercise, and poor motivation to change may also disqualify an individual for these surgeries.

Because of the significant psychological and emotional implications of bariatric surgery, it is not surprising that psychologists often play a significant role in the process (both before and after surgery).  In fact, many bariatric surgeons and insurance companies require that patients seeking weight reduction surgery be evaluated by a psychologist prior to scheduling the surgery.  The usefulness of psychological evaluation of gastric bypass surgery candidates and post-surgical psychological support services has been well documented (e.g., Glinski, Wetzler, & Goodman, 2001; Virji & Murr, 2006). In fact, The American Society for Bariatric Surgery recommends that patients have a psychological consultation prior to weight loss surgery. Therefore, in considering a selection of a bariatric surgeon, it seems wise to choose one who acknowledges and understands the very significant emotional and non-medical factors and consequences involved in such a life-changing procedure. A surgeon who refers patients to a psychologist for a pre-surgical evaluation and possible continuing support and those who offer services of nutritionists and support groups clearly are considering you as a whole person who is facing a life transformation.

The Psychologist’s Role in Weight-Loss Surgery

Most psychologists are well-trained and qualified to complete comprehensive psychological evaluations and to administer and interpret psychological tests. A number of psychologists have additional experience and training specific to assessing and treating individuals who are coping with obesity and considering (and experiencing) weight-loss surgery. The psychologist's role in terms of pre-surgical evaluation is to assess the  patient's current adjustment and capacity to cope with the demands of surgery and the resulting lifestyle changes.

The pre-surgical evaluation will involve looking at many aspects of your life and individual situation. For example, the psychologist will look at whether or not you have a full understanding of the impacts of this type of surgery and realistic expectations regarding weight loss. The psychological evaluation will also look at your commitment to making the essential post-surgery lifestyle changes. At the end of the assessment, the psychologist will send a report to your surgeon which may include recommendations regarding lifestyle changes and emotional or family issues you might need to address prior to surgery. A psychologist may also play a role in both education and pre- and post-surgical emotional support (as you go through the many positive and negative changes that can occur, not only to your body but in many other areas of your life).

What is involved, more specifically, in the initial psychological evaluation?

• The psychologist will obtain your history and ask questions about you in general, your feelings about your weight, and your relationship with food. He or she will also look at your ability to understand the risks of surgery, your emotional stability, and the coping skills you have available to deal with many stresses and adjustments that come with any significant life style change. The psychologist will also examine your motivation and commitment to comply with post-operative care, as well as your willingness and ability to learn new life skills and to make wise self-care choices.

• As part of the evaluation, the psychologist will give you one or more psychological tests (typically tests that are referred to as “objective tests” which means that the results are relatively free of the psychologist’s subjective opinions). You may be asked to take a comprehensive personality test and other psychological tests designed to assess your feelings and behaviors related to food, your self-concept, and emotional state. The purpose, overall, is to find a baseline measure of the patient’s emotional status.

• The psychologist conducting your evaluation will also be trying to assess your need for basic education and skills training. In particular, the psychologist is interested in whether or not the individual has the set of skills necessary to face the challenges and difficulties of everyday life after surgery (for example, whether he or she has realistic weight expectations).

If you are interested in setting up an appointment with Dr. McBee for a pre-surgical assessment or other service related to obesity or weight-loss surgery, you may contact her office at (770) 834-0995.