The Truth About the Psychological Evaluation for WLS

March 6, 2017

Regardless of whether you have fully committed to bariatric surgery or whether you are just beginning the process and considering the pros and cons, you are embarking on a major decision.  Most patients are required (by their insurance company and their surgeon) to have a psychological evaluation (clearance) prior to having surgery. Addressing the psychological and behavioral contributors to obesity and ensuring that you are prepared to undergo surgery is an important step in the process.

It is normal to feel nervous or anxious when you hear the words “psychological evaluation.”  Patients often wonder what the meeting will be about, what questions they will be asked, should they say the “right” thing or be honest. They do not want a psychologist to deny them for surgery.  However, the psychological evaluation is not to rule you out for surgery. The role of the psychologist is to identify emotional, psychiatric, cognitive, and behavioral factors that might relate to long-term success.

The psychologist can provide education and treatment to better prepare you for surgery as well as be available for long-term assistance. If you look at it this way, the psychologist can be viewed as your ally to surgery.

What Does The Psychological Evaluation Entail?

While there are differences in the way providers conduct the evaluations, many will have you answer a battery of questions about your mood, eating, and weight, and/or some personality questions.  They will then meet with you in person to discuss the factors below and make recommendations.

1. Eating and Weight History: The psychologist will likely discuss your eating patterns including your typical meals as well as assess for any binge, nighttime, and emotional eating behaviors. These behaviors are all important to manage as they are associated with long-term weight management. Many people have unhealthy eating habits and this is not a reason to deny someone surgery.  By going to a psychologist who specializes in this field, he/she will be able to help you identify your own unique triggers and challenges to eating, barriers that prevent you from staying on track, and the best plan to help get you on your way for post-surgical success.

2. Mood and Psychological History: The psychologist will also assess your mood and emotional stability, psychological history, and current ways of coping with stressors. If there are severe issues that may affect your stability, safety, or success, treatment may be required prior to surgery to help you become more stable and thus allowing for a better surgical outcome. It is normal for people to have ups and downs at times as well as normal bouts of sadness or anxiety. Since many people suffer from depression, anxiety, binge eating, and other problems, these are typically not reasons to delay or deny surgery.  Rest assured that the majority of psychiatric issues do not prevent someone from having surgery.  In fact, researchers are still studying the effects of psychiatric illness on post-surgical outcome. It is best to be honest for your own safety and so that you can have a solid plan for after surgery.

3. Alcohol and Drug Use: The evaluation will entail your current and history of drinking and drug use. The use of alcohol post-operatively can be dangerous (e.g., 1 drink pre-op might equal 4 drinks post-op).  It is important to stabilize current alcohol abuse dependence and learn other ways of coping with stressors so that you do not resort to these unhealthy behaviors after surgery.

4. Social Support: The psychologist will ask about your living situation, work, and friends/family. For example, if people in your life support your surgery, do you have people who may sabotage you, and how your social connections and relationships might change after surgery. Again, these are not pass/fail questions but will help you identify factors that can help or hinder your success.

5. Understanding of the Surgery: Finally, you will likely discuss your understanding of the weight loss surgery procedure, any risks involved, and the necessary long-term behavioral changes that you will have to make so that you are most prepared for success.

In sum, the evaluation is not a pass or fail test. The psychologist will assess your eating behaviors and make recommendations, diagnose any psychiatric issues and make a treatment plan if needed, help you understand your ways of coping and make sure that you understand the procedure and the lifestyle changes.

The majority of patients undergoing the surgery process are ready to have surgery and are not delayed or denied from a psychological perspective, other than in the rare instances when the risk of surgery may outweigh the benefits. It is best to be honest so that you can better prepare for a more successful and safe outcome.  Ultimately, your surgeon will make a decision as to whether he or she will proceed with the surgery.

How Do I Choose A Psychologist?

Your surgeon will likely have some recommendations for you. You have put a lot of time, thought, and money into this surgery and you want the evaluation performed by a clinician who thoroughly understands bariatric surgery.  Eating disorders, weight loss, and bariatric surgery are a specialty. Just like you are having a bariatric surgeon perform your surgery, look for a psychologist who specializes in this field to perform your evaluation.  This person will be knowledgeable about eating and weight issues as well as the benefits of surgery (without being biased) and organize a specific plan for you to help you adjust post-operatively.

Finally, it is helpful to have a relationship with a therapist should you need support before or after surgery. Nobody expects to be one of the people who struggle or re-gain weight after surgery, but unfortunately, some people have difficulty. Successful weight loss maintenance requires many lifestyle and behavioral changes and adherence to the post-operative recommendations is paramount.

ABOUT THE AUTHOR Dr. Jennifer Shapiro is a licensed clinical psychologist and certified eating disorders specialist (CEDS). Her practice (drjennifers.com) is exclusively devoted to eating disorders and obesity since 1999. She is on the Executive Board of the San Diego Chapter of IAEDP and a member of the Academy for Eating Disorders, The Obesity Society, National Eating Disorders Association, and the American Society of Metabolic and Bariatric Surgery. Read more articles from Jennifer!

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