Before & After: Understanding the Role of Psychological Assessments in Bariatric Surgery

Bariatric surgery is a potentially life-changing procedure that helps individuals struggling with severe obesity achieve significant weight loss in order to improve their health. However, the journey doesn’t start or end with the surgery itself and can have just as big an impact on the mind as it does the body.

One of the most common questions I get asked is “why do I need to get a psych screening for surgery?”

Fair questions, because most likely if you have had other surgeries they have not asked you to see a mental health professional. So why is this any different?

Because unlike say a gallbladder removal, where you might have to change you diet but not much else, bariatric surgery patients have a complete lifestyle change ranging from physical needs like vitamins to emotional changes like the potential for body dysmorphia. My role as a psychological evaluator is to guide clients through the education process of what they can expect with surgery.

In addition, my aim for the evaluation is to raise awareness to any potential strengths, resources, and/or challenges in their recovery. Because lets be real, this surgery is not a magic pill. If you struggled with debilitating depression prior to surgery, loosing 50+ lbs. is not going to necessarily make you happier (actually suicide rates post surgery rise, but I will talk about this taker).

My goal is to help you maximize your recovery success, PHYSIACLLY and MENTALLY, and the best way I can do that is to bring awareness to potential stumbling blocks as well as help you problem solve how to overcome them so you do not get tripped up by surprise if/when they show up.

My role as evaluator is not to gatekeep anyone from surgery — in fact the surgery decision is entirely out of my hands and up to you and your doctors). My goal is to ensuring that patients are mentally prepared for the challenges ahead and providing support to enhance long-term success. The aim of this article is to dive a bit deeper into what you can expect from a psychological evaluation, to demystify the process but also shed light onto it’s benefits and role for your surgery and recovery.

Pre-surgery Evaluation: Mental health and readiness assessment

Before undergoing bariatric surgery, patients undergo a comprehensive mental health evaluation. This assessment helps healthcare professionals determine if the patient is emotionally prepared for the procedure and the lifestyle changes that will follow. .

When you go for a bariatric surgery psychological evaluation, you can expect to answer a series of questions and provide information that will help the evaluator understand your readiness for the surgery and your approach to weight management. The Bariatric Clearance Questionnaire typically covers a range of topics designed to assess your psychological and emotional preparedness for the surgery.

You will be asked about the type of bariatric surgery you are considering, such as gastric bypass or sleeve gastrectomy, and to provide details on your weight history including your highest and lowest adult weights. The evaluation will delve into your past dietary and exercise experiences, asking you to list diets you have tried, the types of exercise you have engaged in, and any current health conditions that might affect your ability to stay active.

The questionnaire will also explore your current eating habits, including what foods you struggle with and how often you eat. You will be asked to reflect on your past coping strategies for weight management and to describe your knowledge of the surgery’s impact, including the physical changes it will bring and the lifestyle adjustments needed for success.

In addition, the evaluator will inquire about your current life stressors and support systems, such as whether you have a support system in place for post-surgery care. They will want to know your motivation for undergoing the surgery, your expectations for post-surgery life, and if you have any specific goals or concerns related to the procedure.

Overall, the purpose of these questions is to ensure you have a realistic understanding of the surgery’s demands and are prepared for the changes it will bring. The information you provide will guide the evaluation and help the psychologist prepare the clearance letter for your surgical team.

In addition to gathering background information about your weight loss journey and bariatric surgery plans, an evaluator will also conduct a in depth biopsychosocial evaluation to look for any potential mental health challenges and strengths that can impact the recovery process. It typically involves screening for conditions such as depression, anxiety, eating disorders, and substance abuse, which can impact both the decision to proceed with surgery and post-operative outcomes

Again, this screening is not intended to exclude anyone from surgery, but to ensure that they are well prepared and resourced for the recovery journey.

For example, legal issues such as being on probation or pending incarceration are not necessarily an exclusion for surgery. It is important to note however that it may be very difficult for an inmate at a prison to receive proper medical follow up care, or adequate protein intake while incarcerated, so a patient and their doctor might discuss what needs to happen to optimize for a successful surgery and recovery.

Here is a bit more of what you can expect:

During the biopsychosocial intake portion of the psychological evaluation, you’ll discuss why you’re seeking counseling and how your current issues, like anxiety or depression, impact your daily life. You’ll share details about your mental health history, including past diagnoses and treatments, and talk about any experiences of trauma or abuse.

The counselor will also explore your family’s mental health and substance abuse history, your personal substance use, and any legal issues you may have had. You’ll cover your childhood experiences, current living situation, and support networks, as well as your gender identity, sexual orientation, relationship status, and spirituality. Finally, a risk assessment will be conducted to evaluate any thoughts of self-harm or harm to others. This session helps the counselor understand your background and plan effective future support for you.

For more information on what to expect in your pre-surgical psychological assessment, call me (Alexandria) for a free 15 minute consultation: 908-379-8110 or email info@body-mindcounseling.com

Impact on Weight Loss Success: Psychological factors

Research consistently shows that psychological factors play a significant role in the success of bariatric surgery. Patients who receive pre-surgery psychological assessments and post-operative support tend to have better outcomes in terms of weight loss and overall health improvement.

Positive psychological factors that contribute to success include:

1. Motivation and Commitment: Patients who are internally motivated to make lifestyle changes and adhere to post-surgical guidelines are more likely to achieve and maintain weight loss.
2. Emotional Resilience: The ability to cope with setbacks, stress, and emotional triggers without resorting to unhealthy eating behaviors is crucial for long-term success.
3. Social Support: Having a strong support network of family, friends, and healthcare professionals can provide encouragement, accountability, and practical assistance throughout the weight loss journey.

In contrast, untreated psychological issues such as depression, anxiety, or unresolved emotional eating patterns can hinder weight loss efforts and increase the risk of post-surgical complications. The reality is, though surgery changes the way your body processes food, it will not change how your mind processes thoughts– that is unless YOU make and effort to monitor and address any unhelpful thoughts that arise.

I mentioned in an earlier section that if someone is struggling with a mental health concern pre-surgery, there is a good chance they will continue to struggle with these thoughts/mood post surgery, unless addressed by a mental health professional. In fact it is not uncommon for some people to experienced worsened symptoms, specifically depression, post surgery for various reasons:

1. They expected surgery to “fix” their problems and it did not
2. They realize that people are treating them differently post surgery
3. Excessive feelings of fatigue
4. Post-surgery recovery is difficult and not what they expected
5. They are not obtaining the desired results in the time they expected post surgery.
6. Changes in marital relations, including libido
7. Sometimes, those with extreme depression and suicidal thoughts actually get more energy after their surgery which gives them the energy to act on thoughts of self harm.

Common Mental Health Questions That Come Up

“What’s with the mood swings post surgery?”

Rapid weight loss can lead to emotional changes due to the body’s processing of estrogen stored in fat cells. Here’s how these changes typically manifest and what you can do about them:

What is “Cross Addiction” and why does it go up post surgery?

After surgery, the risk of developing an addiction increases by about 20% compared to the general population. While the exact reasons are unclear, theories suggest that people might replace their previous reliance on food with new substances or behaviors due to unmet emotional needs or unfulfilled life experiences.

Potential Causes:

• Emotional Replacement: If food was previously used for emotional comfort, people might turn to other substances or behaviors to fill that void after surgery.
• Unmet Life Experiences: Some individuals might try to compensate for perceived missed experiences, like college parties, leading to risky or irresponsible behavior.
• Alcohol Use: Post-surgery, alcohol may cause euphoria, which might lead to its misuse as a way to manage stress or escape reality.

Identifying Addictions:

• Substance Addictions: Look for patterns such as increased alcohol or drug use that disrupt daily life, relationships, or legal standing.
• Behavioral Addictions: These are often harder to recognize and include:
  • Gambling: Excessive betting or gambling activities.
  • Debting: Spending money irresponsibly or accumulating debt.
  • Sex/Attention-Seeking: Engaging in risky or harmful behaviors for attention or validation.
  • Rage Seeking: Provoking conflicts to justify harmful actions.
  • Adrenaline Seeking: Participating in dangerous or illegal activities for excitement.
  • Video Gaming or Internet Addiction: Excessive use that interferes with daily responsibilities.
  • Plastic Surgery Addiction: Frequent cosmetic procedures driven by dissatisfaction.

Understanding these risks and signs can help in managing or preventing cross addiction after surgery.

The Psychological Assessment Psychoeducation Section

During this evaluation, healthcare providers like myself also assess the patient’s understanding of the surgery, their expectations, and their commitment to making necessary behavioral changes. This is to ensure they are no surprises when it comes to surgery day and the post-op experience.

During this section of the evaluation patients are encouraged to discuss their motivations, fears, and support systems to ensure they have realistic expectations and adequate emotional support in place.

Below I have listed some examples of what the psychoeducation section portion of the evaluation will look like:

Example: Hair Loss Post Surgery

Hair loss is a common occurrence following bariatric surgery and is primarily due to the body’s adjustment to rapid weight loss. One of the main causes of this hair loss is protein prioritization; as you lose weight quickly, your body focuses protein on maintaining muscle rather than supporting hair growth. This process results in normal shedding of hair, which is a natural part of the weight loss journey and not indicative of permanent baldness.

It is important to understand that hair loss after surgery is temporary. You may experience phases of hair loss, regrowth, and even another cycle of shedding, but rest assured that hair will eventually regrow. The timing and extent of hair loss and regrowth can vary among individuals, so each person’s experience will be different.

Example: Excess Skin and Skin Removal Post Surgery

After significant weight loss, the development of excess skin is a common concern, but it is not a guaranteed outcome for everyone. Genetics play a major role in determining whether you will have excess skin following bariatric surgery. While some individuals may experience this issue, it is not a universal consequence of weight loss.

To help manage or minimize excess skin, there are a few recommended practices to follow. First, staying hydrated by drinking plenty of water can improve skin elasticity and overall skin health. Regularly moisturizing your skin also supports skin health and may help maintain its firmness. Additionally, ensuring that you eat enough protein is crucial, as adequate protein intake supports both skin and muscle health.

If you do end up with excess skin, it is important to document any related skin issues, such as rashes, infections, or other problems, as this documentation is essential for potential insurance claims for skin removal surgery. Keep thorough records, as insurance coverage for such procedures may change over time, and having comprehensive documentation will support any future claims for medical necessity.

Post-surgery Support: Dealing with lifestyle changes

Now for many patients, the psychological assessment is a one time event meaning there is no follow up needed. In some situations however, it is not uncommon for patients to request or the counselor to recommend a few follow up therapy sessions to address any mood/lifestyle related changes post surgery.

These changes can include but are not limited to including dietary modifications, physical activity requirements, and adjustments to their everyday routines. Psychological support during this phase is essential for helping patients adapt successfully.

Below are some examples of potential support options post surgery:

Mental Health Counseling may focus on coping strategies for managing stress, dealing with food cravings, and maintaining motivation. Support groups provide patients with an opportunity to share experiences, seek advice, and celebrate successes with others who understand their journey.

Patients may also work with nutritionists and exercise specialists to develop personalized plans that support their weight loss goals while promoting overall health and well-being. Fay Nutrition is a easy and affordable way to see in network insurance providers from the comfort of your own home.

Managing Expectations: Realistic outcomes and mental health

It’s important for patients undergoing bariatric surgery to have realistic expectations about the outcomes and the challenges they may face. Psychological assessments help in setting these expectations by providing a clear understanding of what the surgery can and cannot achieve.

1. Weight Loss Expectations: While bariatric surgery can lead to significant weight loss, the amount and rate of weight loss vary among individuals. Factors such as adherence to post-operative guidelines, metabolic differences, and pre-existing health conditions all play a role. Psychological assessments help patients understand these variables and set realistic weight loss goals.
2. Body Image and Emotional Well-being: Bariatric surgery can also have a profound impact on body image and self-esteem. Patients may experience changes in how they perceive themselves as they lose weight. Psychological support is crucial in helping patients navigate these changes and develop a healthy relationship with their bodies.
3. Mental Health Maintenance: Beyond weight loss, maintaining overall mental health is crucial for long-term success. Patients may face challenges such as adjusting to a new diet, coping with social situations involving food, or managing stress without turning to emotional eating. Psychological assessments guide healthcare providers in developing strategies to support patients in maintaining mental well-being throughout their weight loss journey.

Conclusion:

In conclusion, psychological assessments are integral to the success of bariatric surgery as they address the complex interplay between mental health and weight loss outcomes. By evaluating patients’ readiness, identifying potential challenges, and providing tailored support, these assessments ensure that patients are equipped with the tools they need to achieve and maintain their weight loss goals.

Moreover, psychological assessments help in fostering a holistic approach to patient care, recognizing that successful bariatric surgery outcomes go beyond mere weight reduction. They encompass improved mental health, enhanced quality of life, and sustained behavioral changes that support long-term health.

Ultimately, integrating psychological assessments into the bariatric surgery process not only enhances individual patient outcomes but also contributes to the broader understanding and management of obesity as a multifaceted health issue. By prioritizing mental health alongside physical health interventions, healthcare providers can optimize the overall success and well-being of patients undergoing bariatric surgery.

Next Steps:

Are you eager to begin your transformative journey towards a healthier lifestyle via bariatric surgery? Take the first step today by emailing me (info@body-mindcounseling.com) to schedule your pre-surgical bariatric surgery psychological evaluation. This evaluation is an essential part of preparing for bariatric surgery as during the evaluation, we’ll explore your mental wellness and readiness for the surgery ahead.

Don’t hesitate to reach out – I’m here to support you every step of the way. Email me now to schedule your pre-surgical bariatric surgery psychological evaluation and embark on a path to a healthier, happier you!

Not ready to book an evaluation just yet? No worries, let have a no commitment, low pressure chat about it. Learn how to schedule your free 15 minute phone consultation here.