Pre-Operative Psychological Testing
There are two possible reasons for pre-operative psychological testing prior to bariatric surgery. One is to weed out those with significant psychopathology in whom surgery would be contra-indicated, the other to pre-select those in whom the surgery is likely to be a success.
Studies of severely overweight persons conducted before their undergoing bariatric surgery have shown: a) that there is no single personality type that characterizes the severely obese. b) that this population does not report greater levels of psychopathology than do average-weight control subjects; and c) that the complications specific to severe obesity include body image disparagement and binge eating.
Studies conducted after bariatric surgery and weight loss have shown 1) that self-esteem and positive emotions increase; 2) that body image disparagement decreases; 3) that marital satisfaction increases, but only if a measure of satisfaction existed before surgery, and 4) that eating behavior is improved dramatically. The results of bariatric surgery are superior to those of dietary treatment alone. Practitioners should be aware that severely obese persons are subjected to prejudice and discrimination and should be treated with an extra measure of compassion and concern to help alleviate their feelings of rejection and shame.
Accordingly, routine pre-operative psychological evaluation should be required in patients who have a history of severe psychiatric disturbance or who are currently under the care of a psychologist/psychiatrist or who are on psychotropic medications. Such patients, and those under the age of 18 years should be required either to have psychiatric clearance in writing from their counselor or to undergo a psychiatric evaluation before bariatric surgery. Other patients who wish to have the benefit of psychologic counseling before surgery should be encouraged to do so.
Questions for Your Primary Care Doctor
You should work with your doctor to document your weight loss attempts, including all previous weight loss programs or efforts in which you have participated. You should also carefully record any obesity-related health conditions you suffer from that may be alleviated with weight loss surgery.
- Are these health conditions getting worse?
- Are you continuing to sleep poorly?
- Are you having more and more trouble walking?
- How high is your blood pressure compared to two or three years ago?
- Is your Body Mass Index in the 40-60 range?
- Is your Body Mass Index in the 35-39 range with life threatening co-morbidities?
- Are you 75 lbs. overweight?
These records will help you decide if weight loss surgery is an option for you. They will also help provide the health history necessary to obtain insurance reimbursement for weight loss surgery.
Other questions to ask your doctor:
- How would I benefit from weight loss?
- What are my best options now?
- Am I a candidate for weight loss surgery?
- What are the next steps I should take?
- Can you refer me to a bariatric surgeon?
Questions for Your Bariatric Surgeon
Being a well-informed patient is good for you and good for your doctor. Here are some of the questions you should your bariatric surgeon:
- What types of weight loss surgery procedures have you performed?
- How many of each bariatric procedure have you performed?
- Can bariatric surgery be performed using minimally invasive techniques?
- Can I be considered a candidate for bariatric surgery even though I have one or more associated health conditions related to my obesity?
- Which procedure is best for me?
- Why?What are the risks involved?
- How long will I be in surgery?
- What is the length of my anticipated hospital stay?
- How long will it be before I can return to pre-surgery levels of activity?
- How will my eating habits change?
- Do you have information about bariatric surgery costs and payment options?
- What are the typical excess weight loss and improvement of associated health conditions for your other patients?
- Do you have patients who are willing to share their experiences, both positive and negative?
- What information can you give me to help family and friends better understand bariatric surgery?
- What type of long-term, aftercare services (such as support groups and counseling) can you provide for me?
- What do you expect from me if I decide to choose a surgical solution?