WLS and Psych Eval

There have been a few posts lately about what to disclose and what not to disclose when trying to get approval for weight loss surgery. The following is my opinion, but I have talked with numerous persons, and have seen for myself, what happens. Do not lie or try to "cheat" your way into this surgery. You will regret it later on. Whether you "omit" something or straight out lie, it will come back to haunt you. ANY emotional problems you have prior to this surgery will be magnified ten-fold afterward. You MUST deal with those problems before you make this life-altering change. There is a reason the doctors and insurance companies require a psych eval prior to approval. They want/need to make sure you are emotionally capable of handling the changes your body will go through. IT IS VERY HARD. You may think, "nah I can handle it." How do you know, you haven't been there yet. Work your problems out, learn to deal with them, then go for it. Ya'll can flame away at me, but I am firm in this belief. You will regret your decision if you try to "get away with" not being honest with yourself and your doctor. I truly wish everyone a "pothole-free" journey. Patty

I'm not about to flame you, in fact I agree totally. I've seen too many people who didn't realize the commitment it takes and they outeat the surgery, or run into some of those nasty complications, and they are unprepared to handle it. The psych eval is there for the patient's protection! Depression, for example, is a very real side effect that can plague some people! Jan

im gonna disagree with you but not flame you... ill just say my experience... before surgery i was a very unstable bipolar on meds... forget about without... i had my surgery jan 17 and didnt get meds in the hospital... they just didnt give them to me... since then... ive been VERY STABLE WITHOUT MEDS... now.. if i would have told my physch dr everything ( like you are suggesting) there would have been no way in hell i would have been able to have my surgery... i dont know if it was the surgery or what.... but i am so thankful i am stable and without meds... its a whole new life... dont get me wrong... i still have my depressive DAYS.. not weeks or months... and i love being stable... its the most awsome thing in the world... and yes i go to weekley therapy... thats just my opinion... but everyone is diffrent

Good reminder Patty. I was upfront about my mental health past and it not deter me nor hinder me in having surgery. The more the doctor's know about your overall general health, the better they can assist you with your physical health. All of my complications triggered my OCD in an overwhelming way, but because my surgeon, PCP and psych had worked so closely together through the pre-op process, they were able to get me stable very quickly post-op and I didn't have to needlessly suffer with something no one knew about. ~ Trish

I Agree with you as well. And I did deal with my problems, but... i think everyone who is overweight has an additction to food, Thats why we all got this way. Well not all some maybe because of a past accident or just the way we are, but when i addmitted to being a binge eater, at the time i was also on meds for depression, and they to trigger alot of overeating. NOONE can tell me that they dont or that there not addictive etc... I have been on antidepressants for 17 years. Paxil was the worst of them to try and get off of. I found once off paxil and on something else no more food binges.. So the same doctor that put me on the crap denied my surgery. He was against it from the begining. Needless to say I do not have him as a psyc doc anymore. But Patty your right about dealing... i agree but alot of us do not have the luxory of getting better for some its a matter of life or death....

One of the biggest problems with trying to get approval is not having a psych doctor who understands what an obese person goes through or how their life is. All they see is depression. Most obese people are depressed and they are that way because they are obese. It is a vicious circle. The psych doctors need more education on qualifiying a patient for this surgery. They need to understand that yes we have problems but help us and then let us have the surgery we desperately need. I'm not quite sure what can be done to remedy this, having said that I still think honesty is the best policy. Patty

I thought about this and wanted to further elaborate on what I wrote: This is just my humble opinion. We don't get to be morbidly obese because we eat like birds. We have to maintain a caloric and food intake that supports whatever size we are, unless we have underlying medical conditions that make that impossible. To tell a psychiatrist that you do not overeat is like someone walking into a doctor's office stumbling and snot-slinging drunk denying they have been drinking. (Unless of course you have medical conditions that causes weight gain or severally inhibits weight loss or makes it nonexistant, I do know those conditions exist.) I think people get most confused when asked about binge eating and depression. Binge eating may mean something entirely different to me than it does to a professional psychologist/psychiatrist. Binge eating is a psychological disorder that you can read more about by researching it on the internet and see if you fit the profile of a binge eater. Think of a binge eater as being the polar opposite of an anorexic person. As an anorexic handles emotional problems by not eating, a binge eater handles emotional problems by binge eating. But, just as not everyone who diets themselves thinner is anorexic -- not everyone who overeats is a binge eater. I was an overeater, a big eater, but I wasn't a binge eater. I was depressed because of how obese people are treated in public, about my lack of self-esteem and self-consciencousness, but I wasn't depressed because I was a closet binge eater and had to carry that secret around with me on top of all of the other pain that made me depressed in the first place. There is a difference. But denying that you overeat is only going to make any psychologist or psychiatrist suspicious. How else did we gain the weight unless we over indulged more often than we didn't? Make sure you understand the terms depression, binge eating, over eating and eating disorder before your psych eval. If you don't understand them, before you answer the question "are you a binge eater," ask for a specific definition or characteristics so you know if you are or not. I tell people I binged on ice cream as a pre-op, but what I'm really saying is that it took a lot of ice cream to satisfy me and until I felt like I'd had enough. I didn't eat it until I got sick, I didn't eat it until I felt better about something. I ate it because I liked it and I would skip other meals to try and keep my caloric intake down so I could overindulge in ice cream. For example, I would skip breakfast and then eat a pint of Chocolate Chip Cookie Dough Haagen Daz as my lunch. I would eat a regular portioned supper and that would be my total food intake for the day. Was I lying when I said I only ate two meals a day? LOL No. But can you spot the obvious reason I wasn't losing but gaining or maintaining? I drank regular soda because I just don't like diet soda. I ate chocolate because I like the way it tastes, not because it makes emotional pain go away. It's sweet and gooey and yummy, that's why I ate it. I think there are some terms that are bantered about to the point we don't know what they mean in their professional settings. ~ Trish

Great post Shayna, thank you... Patty

I, too, believe one needs to be honest about both your physical and psycho/social history. That being said I also believe that any physician or therapist worth his/her salt should also discuss any issues they have with making a recommendation for surgery with you. They should give you the opportunity to answer questions or explain anything that seems questionable. I think they have a moral obligation to be honest and upfront with you and tell you under what conditions they would recommend you for surgery. I think then you have the option of 1) agreeing to their stipulations or 2) to seek a second or third or fourth opinion. Remember nothing says you have to give the therapist your surgeon's info coming in the door. They cannot send in a report if they do not know where to send it. Now in the case of a physician or therapist that will not discuss the reasons for not making the recommendation. I would find another therapist. This leads me to another issue -- some doctors only take evaluations from one therapist. I personally have a hard time with this. Sometimes it works out -- the therapist is great and they take your insurance and everything is cool. But many times it does not work out that way and IMHO that is just wrong. The surgeon has the right to determine the sort of assessment he will accept (if it is not already determined by the insurance carrier) ie testing, interview, etc. So as long as it is the same instrument, adminstered by a licensed professional, it should be acceptable. In cases like this I can see where one would really feel trapped. I still think in the long run your best interests are served by honesty. But -- and this is a biggie. I would be very careful about the terms I used. I would never -- ever -- ever--- ever-- ever----ever----ever------ever-------ever---- use a word like binge. Why do you ask? Because it means different things to different people. And the word itself carries such negative connotations. Also it is a symptom. Let the professional label you if they must. No need for you to label yourself. Stick to using words that are simply descriptive. Do not try to diagnose your problem. Let them ask the questions. If they ask "Are you a binge eater"-- ask them "what do you mean by a binge eater". Do not let them put words in your mouth with which to hang you. Do you see my point? It is the same thing with depression or compulsion or anything. Now some folks have been in treatment they know the jargon it is a little different for them. But for most folks just keep it very simple. Remember terms we throw around here everyday may have an entirely different meaning on the context of a clinical setting. So do not assume it is the same. Ask what they mean.

I agree with Red Haired about *asking* questions to fully understand what the evaluator means. I was so nervous about my eval because my doctor only allows an eval from the psychologist he wants you to see. But the psychologist has been there and done it herself, so she knows what she's looking for. I kept wondering if I should mention this, tell that, etc. I finally looked at myself and said - Just be honest! So I was. She did ask about binge eating, and I asked her what her definition of binging was. After hearing it, I admitted I did binge eat. I still passed. There aren't too many cases that benefit us by lying. I know how worried everyone gets over passing all the tests for WLS, especially the psych eval. I was nervous too, and I've been in treatment for depression for nearly 10 years. I think it's best to be as truthful as you can. Also, by being truthful, you don't forget what you've said prior, and risk the possibility of being found out. Cheers, K