Choosing to have surgery as a method to lose weight is a difficult decision, normally surgery will not be considered unless many years of failed weight loss programs have been attempted, affecting self-concept and relationships with others.
Pre-surgical psychological assessment is an important part of the process of determining if the risk of surgery is worth the health benefits gained. Psychological issues related to the surgery and about future adjustment to changes after the surgery can be discovered and a plan to change can be developed considering emotional, cognitive and behavioral factors. The pre-surgical assessment includes objective personality testing, which compares the patient’s personality characteristics with other general population adults, and can identify possible personality issues that can be addressed during the evaluation process.
The pre-surgical assessment can be eye-opening as issues related to coping mechanisms, diet and exercise are explored. The patient's experiences with restricting calories or types of food, and their successes and failures with changes of their diet are detailed. Feelings about food and making changes that involve food are explored and the patient can mentally prepare for the changes they will be expected to make after the surgery is completed. The patient and the doctor will be better prepared for issues that may develop and start finding resources or options that can make adjustment easier.
During the pre-surgical interview and through questionnaires, the motivations for having the surgery and expectations of what the surgery will achieve can be discovered. The patient's expectations need to be realistic as unmet expectations can be disappointing and a sense of failure will lead to giving up and regret for having the surgery. Patients who understand that the surgery will be a support for their efforts in changing their diet and modifying eating behavior will be better prepared for the changes they will have to take responsibility for.
With the pre-surgical assessment, the patient can be educated about psychological issues associated with the surgery that may not have been considered. The patient may have been coping with depressive symptoms and attributing disappointment and stress to being overweight, but that may not always be the case. Being in therapy or taking psychotropic meds does not mean a patient is not a good candidate for bariatric surgery, but how diagnosed mental illness may affect post-surgical adjustment will be an issue to prepare for as the surgery is planned. The patient can start adapting to the team approach to surgery that will include the surgeon, nutritionist, and other representatives of disciplines that will demonstrate a holistic approach to change that the surgery will entail.
By Rebeca Bright, PsyD.