The American Society for Bariatric Surgery lays out, pretty clearly, the suggestions for pre-surgical psychological assessment of bariatric surgery candidates. All of the questions asked during the evaluations originate from this document: https://asmbs.org/app/uploads/2014/05/PsychPreSurgicalAssessment.pdf
Topics of discussion for the evaluation process include:
Behavioral Evaluation
1. Diet
2. Exercise
3. Drug/Alcohol Use
4. Medical Non-Compliance
5. Legal History
Cognitive and Emotional Evaluation
1. Cognitive Issues
2. Checking Your Understanding
3. Psychological History
Evaluation of Present Situation
1. Stress
2. Social Support
Motivation and Expectations
1. Your Motivation
2. Education on Your Chosen Surgery Type
An overview of the evaluation you will go through is below. Once that evaluation is completed, you will be informed of any additional treatment that is needed before you can be cleared for surgery, this isn’t a very common occurrence, but does happen from time to time if mental health concerns are not being treated. A report with insurance required information will be prepared and sent to your surgeon’s office, usually same day.
The Evaluation
Behavioral Evaluation
1. Diet
During the evaluation, you will be asked about any previous attempts at weight loss. Many people may be ‘professional dieters’ and have tried nearly every diet they could find. Insurance companies want specific names, so please be patient and try your best to remember the names (if they have one) or the specifics of the diet. Most of the time, based on the description, it can be determined which diet you are referring to.
With this, eating styles will be discussed, including problematic eating patterns (night eating, binge eating, etc.). You will be asked about the ways that you have attempted to correct these problematic behaviors.
2. Exercise
Similar to diet, you will be questioned on your past and current physical activity habits. This is an excellent area to talk over any physical limitations you may have due to health problems.
3. Drug/Alcohol Use
You will be asked about your drug and alcohol use, and if your usage has ever led to addiction. Past addiction to drugs or alcohol will not disqualify you from bariatric surgery, but due to the high probability of cross addiction and the increased stress, your likelihood for relapse needs to be assessed. Be prepared to talk about what you are doing to remain sober and where you will go for help if the urge to return to prior addictions becomes overwhelming.
4. Medical Risk Taking Behaviors
Bariatric surgery requires strict adherence to the guidelines the surgeon will give to you. Following these guidelines is for your safety. This is why the evaluation will include questions on any previous or current health issues and how well you are complying with doctor’s orders.
5. Legal History
A long history of legal problems is indicative of impulsive behavior patterns. Having a criminal record won’t exclude you from undergoing bariatric surgery, but expect to be asked about what you learned and how you plan to avoid legal problems in the future. If you are having current legal complications, it may not be the best time for you to go through the surgery.
Cognitive and Emotional Evaluation
1. Cognitive Issues
You need to understand the implications of bariatric surgery. If there are any learning difficulties or issues with cognitive functioning, these should be addressed before the surgery so the right people can be brought in to help you better understand everything. This includes language barriers so that the surgeon is aware to provide you with educational materials in your language of comfort.
2. Checking Your Understanding
During the evaluation, you will be asked to identify, in simple terms, what the surgery will do to your body. You will be expected to know how bariatric surgery will work to help you lose weight, and the changes you will need to make after surgery to be successful. Your explanations do not need to be detailed, but you should understand the basics. The details will be covered after your understanding is assessed.
3. Psychological History
Having prior issues with your mental health will not make you ineligible for bariatric surgery. It is important going forward that these issues are brought up to better help you cope with things you may face during recovery. You will be asked about any mental health treatment you have gone through, how that treatment was sought out, and if you completed that treatment.
Your present mental health will also be evaluated. Prepare a list of any current medications or ongoing treatment. If you are experiencing psychosis, debilitating depression or anxiety, or any other severe mental health issue at the time of the evaluation, it will be in your best interest to delay bariatric surgery and obtain treatment.
Past trauma will also be discussed because of the high association of trauma victims and obesity. This would include abuse or neglect in your childhood, military experience, or domestic violence. Additional therapy may be recommended as part of your recovery.
Evaluation of Present Situation
1. Stress
We all struggle with stress sometime in our life. In the interest of ensuring that you have the best possible surgical outcome, you will be asked about events occurring in your life that may be causing you stress. If these events are consuming your life, the concern is that you may not be able to focus on recovery.
2. Social Support
Having a network of friends and family willing to help you through the recovery process and beyond will be vital to your long term success. For this reason, a conversation regarding people who can support you through the bariatric surgery recovery period will be a part of the evaluation. If you have friends or family members who have gone through bariatric surgery, be sure to bring this up when discussing your support system.
Motivation and Expectations
1. Your Motivation
Motivation can come from many many places, but for the bariatric surgery process, the most important source of motivation comes from you. It can be challenging to maintain the needed motivation for years after the surgery, so you will be asked what is driving you to succeed. It can be helpful if you spend some time thinking about this in advance, and prepare a list of things you hope to accomplish with the surgery. These internal motivating factors could be (but not limited to) related to your improved health, increased physical ability, or becoming able to live your life again.
External motivation can come from people in your support network, but these things may change over time. If you are going through bariatric surgery to please someone else, you may find yourself disappointed in the future and face a relapse back into old habits.
2. Education on Your Chosen Surgery Type
Knowledge regarding the type of bariatric surgery you are considering going through is needed for you to make the best choices. You may have one or two preferred surgery methods in mind. Part of the evaluation process will be focused on providing you with some details to make sure that you understand the surgery and what will be expected of you.