Psych Evaluation Before Weight-Loss Surgery: How It Helps

Planning to have bariatric surgery? Be prepared to go through a psychological evaluation before taking that step. The goal: to increase your chances of achieving long-term weight-loss success.

What Is a Pre-Bariatric Psychological Evaluation?

Before scheduling you for a gastric bypass, sleeve gastrectomy or duodenal switch weight-loss operation, your surgeon’s staff will send you to a mental health professional. That person will sit with you for at least an hour, and up to eight hours over a period of time.  You’ll be asked a lot of questions to assess where you are in psychosocial terms — how your thoughts, behaviors and social environment work together. Your evaluator is likely to be a behavioral health professional, and might be a psychologist, psychiatrist, social worker or psychiatric nurse.

The evaluation might be required by your insurance company, your surgical team or both.

Most of the time, you’ll meet with a mental health professional who works with weight-loss patients regularly. Each person has a list of basic evaluation tools, whether a curated list of discussion topics developed personally over time, or   a “psychometric instrument” — a set list of questions with specific scoring criteria — provided by an outside entity such as a professional association.

You likely will be asked about an array of topics, including:

• Past types of weight-loss attempts, and how long they lasted
• History of smoking, substance abuse, anxiety and depression
• Current or past psychiatric medications and hospitalizations
• Your behavior patterns and diagnoses, such as poor impulse control or attention deficit disorder
• Your understanding of what post-surgical life will entail, including dietary restrictions
• Current and past life traumas

There are no wrong answers. In fact, few people are rejected outright, yet many are sent for mental health counseling before they’re scheduled for weight-loss surgery. If that happens to you, embrace it as an opportunity.

If you have certain unresolved issues, you might struggle after the surgery whether because of temporary physical discomfort, a highly restricted diet or struggles to adapt to a smaller body. These experts know what to look for and how to help people conquer tough issues. Do the work, and you’ll be ready for the next step soon enough.

What Do Doctors Learn from a Psych Evaluation?

You may be overweight for a variety of reasons: binge eating, night eating, genetics, health conditions, poor sleep, limited access to exercise opportunities, thyroid issues and emotional factors. Most causes will not affect your eligibility for weight-loss surgery.

The psych evaluation helps the surgical team in many ways:

• It’s a way to identify people who have severe psychological problems, such as psychosis or binge eating, so they can address those issues beforehand.
• It’s a chance to spell out clearly what the procedure will do and how patients will need to change their dietary habits after the operation.
• It gives doctors an idea about what, if any, psychological treatment patients will need after surgery to help them cope with the way their bodies will change, and how they’ll be seen differently in public.
• The evaluation will also show off your strengths. That might be a strong support system among friends, a discipline for choosing healthful foods or a regular exercise routine.

Knowledge is power. Identifying, and addressing, potential obstacles — even depression and anxiety — will increase your chances of losing weight after surgery and maintaining emotional health along the way.

How Can I Prepare for the Psych Evaluation?

You are who you are, so just show up, answer the questions honestly and be open to any suggestions the mental health counselor offers.

It’s in your best interest not to keep secrets. Over time, the experts have learned who fares best after weight-loss surgery. If you need help before your procedure, consider yourself lucky to know beforehand. Get the help that’s recommended, then return and start your journey to becoming thinner and physically healthier.

Once the mental health professional approves you to proceed, get yourself on the surgical schedule. You are far more likely to have a positive post-surgical experience when you begin in the right place psychologically.