Bariatric Surgery and Mental Health

By Goldman, Rachel L. | Clinical Psychiatry News, August 2014 | Go to article overview

Bariatric Surgery and Mental Health


Goldman, Rachel L., Clinical Psychiatry News


Many patients ask why they have to see a mental health professional before getting bariatric surgery.

The value of the preoperative psychosocial evaluation for surgical candidates is well documented. A National Institutes of Health Consensus Panel concluded a few years ago that a psychiatric evaluation was not needed in every case but should be available if indicated (Ann. Intern. Med. 1991;115:956-61). More than 80% of bariatric programs require such evaluations. In addition, major insurance companies in the United States require a "comprehensive/presurgical psychological/psychiatric evaluation as part of a mandatory work-up before approving surgery" (Am. J. Psychiatry 2009;166:285-91).

Undoubtedly, before surgery, we can make recommendations to the patients and the bariatric surgery team by identifying the patients' strengths and potential barriers or challenges, and using this information to develop interventions to assist the patients in being successful. For example, if the patients are participating in any eating disorder behaviors, (such as skipping meals, emotional eating, binge eating, or night eating), we can raise their awareness and help them get control of these behaviors before surgery.

We also can assist patients in anticipating difficulties that might arise as their lifestyles change, including ways in which their body image changes will affect work and social relationships. This is different from the pragmatic approach of the surgeon and nutritionist, whose roles are more circumscribed.

Because of the uniqueness of each individual, patients' different lifestyles and backgrounds, and continued stressors, the mental health provider specializing in bariatric care also is uniquely positioned to assist patients in coming up with a plan that will work for them.

But what happens after the patients have the surgery? Theoretically, our work with the patients before surgery prepared them for the psychological and physical transformation they are likely to undergo. Just as the surgery is a procedure, the postsurgical period is a process. In light of this, I would submit that bariatric patients should be under the care of mental health professionals after surgery.

One of the main psychological issues that often arise with patients is distress around the excess or loose skin that is left behind after excess weight loss. …

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