Mental Health Forum

After much thought, soul-searching, research, sharing and debate, you?ve finally made the decision to see a bariatric surgeon. While the reasoning seems apparent when your surgeon sends you to a cardiologist or a gastroenterologist, being referred for a psychological examination may seem puzzling and a little scary. Some insurance companies insist on a psychological evaluation, and many surgeons are now acknowledging the connection between a strong mind and a strong body and are routinely referring patients for evaluations.

Many patients who are considering weight loss surgery have never been to a psychologist or counselor. It is understandable that they might be apprehensive, given the portrayal of psychologists in popular culture. Having your head shrunk when you just want your body shrunk may feel like an unwanted and unnecessary step, but it can be just the thing to help you succeed at losing weight!

Some patients feel angry that they have to ?jump through one more hoop? or ?convince one more professional? that they are good candidates for surgery, and some wonder about ?how honest I should be.? Many mistakenly fear that the psychologist will want to know every deep, dark secret.

As a psychologist who regularly performs pre-surgical psychological examinations, I am always concerned about the impact of a patient?s preconceived notions on the examination itself. It is well known that patients censor what they say to achieve their goals. The irony is that being too discreet may actually result in your being denied, because you may appear defensive and dishonest. Hopefully, this is a time in your life when you are being more honest with yourself about your weight than ever before. Leaving your psychologist with the feeling that you are hiding something is not a good idea.

The psychologist is trying to determine if you truly understand what you are getting into. Some time ago, I had a polyp on my vocal cord removed. At the post-op consultation, I asked, ?What now, Doc?? His reply: ?Go home and forget about it; go back to your normal life.? When it comes to weight loss surgery, the exact opposite is true. After the operation, the hard work that leads to sustained weight loss is just starting.

You need to commit to follow-up treatment after weight loss surgery. If you choose gastric bypass, you will need to take certain supplements forever, and if you choose the adjustable band, you will need to return for adjustments. How have you been about regular health care in the past? Many obese patients avoid the doctor because they want to avoid admonitions to lose weight or because they are in denial about the impact of obesity on their health. Please do not fool yourself: if you are not compliant, success will be elusive.

One likely reason for your obesity is that you use food to soothe yourself. Since eating is one of our basic needs, it is not surprising that many turn to it as a means of comfort. Think about it: when you were a baby, the only way to communicate your needs was through crying, and one of the few options your parents had available was to feed you. Many families continue the ?feed you? philosophy indefinitely. So, what will you do for comfort instead of eating? Under stress, we do more of what we usually do, so if you already drink alcohol or smoke tobacco, I?m concerned, as a psychologist, that you will do it more often to soothe yourself in the absence of food. There are many reasons for not smoking or drinking to excess, and weight loss surgery just exaggerates them. Rather than promising that you will quit, develop a plan with your psychologist for controlling these behaviors.

Throughout my career I have worked with patients trying to lose weight. It has been both rewarding and frustrating. I?ve seen patients lose 50, 75 or 100 pounds, only to return to old behaviors and regain the weight. Most WLS patients remember their own failure and fear that even the surgery will not help them succeed. If you want to keep the weight off, you must reflect on past failures with a focus on learning what worked, what didn?t and why. Weight loss surgery helps you adopt new, more appropriate behaviors, but the behavioral and dietary changes needed for weight loss remain the same. Be willing to share your past attempts and see past failures as setting the stage for success. If we don?t learn from the past, we are likely to repeat the same mistakes.

So, what can you expect when you arrive for your psychological evaluation? You will probably be asked to fill out several questionnaires and have an interview with the psychologist. The questionnaires are likely to explore body image, depression, anxiety and drug use. Don?t be offended by the testing content; it is intended to spur a full and frank discussion. Expect to discuss the severity and duration of your obesity, your medical history, past attempts to lose weight, the potential complications of surgery, and your understanding of the behavioral and dietary changes needed for success. The psychologist will also ask about the reasons behind your desire for surgery and any past or present alcohol or drug difficulties that might complicate your prognosis.

Give thought to the issues outlined above and explore them with your psychologist. If you have WLS, you will be embarking on a wonderful but complicated journey, and your psychologist can be a valuable support system as you begin to make the adjustments that will change your life.

Did You Know?

• The vast majority of patients seen by a psychologist for a pre-surgical evaluation get the psychologist?s approval.
• Some patients get approval contingent upon supportive interventions like counseling or smoking cessation programs.
• A few patients are asked to postpone surgery until some changes occur.
• Even fewer are denied.

How to Choose an Evaluating Psychologist

1. Look for experience in the weight loss surgery field.
2. Find a professional who will show respect for you by being prompt for appointments and in reporting to your surgeon.
3. Seek a professional who offers support groups and individual counseling specifically for weight loss patients.
4. Choose someone who is clear and up-front about fees; know what the consultation will cost you in advance.

Michael L. Sakowitz, PhD, is a Clinical Psychologist in New Jersey specializing in the treatment of WLS patients. He can be reached at 973-696-0800.

Lynn C. Sakowitz, LCSW, is a Licensed Clinical Social Worker specializing in the treatment of WLS patients. She can be reached at 973-696-5668.

January 2008