Pre-Surgical Psychological Assessment of Bariatric Surgery Candidates
There are two possible reasons for pre-operative psychological testing prior to bariatric surgery. One is to weed out those with significant issues 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 anti-obesity 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 surgical treatment and weight loss have shown 1) that self esteem and positive emotions increase; 2) that body image disparagement decreases; 3) that marital satisfaction increases, butonly if a measure of satisfaction existed before surgery; and 4) that eating behavior is improved dramatically. The results of surgical treatment 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.(55) In addition, numerous studies in the literature attempting to identify patient characteristics related to outcome have been reported, but no reliable psychological predictors of success have been identified. (See Vallis and Ross 1993 (56) for a comprehensive review of this area). Only two general recommendations emerge from this study. (1) The more distressed patients are by their obesity , (reflected by exogenous depression) the more likely they are to lose weight and (2) Serious psychiatric disturbance, to the extent that psychiatric treatment or admission is required, appears to be a negative predictor of outcome. While other psychological variables have been shown to be associated with post-surgical weight loss, none have been replicated in independent studies.(56) 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 psycho-tropic 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 psychiatric evaluation before surgery. Other patients who wish to have the benefit ofpsychologic counseling before surgery should be encouraged to do so. Post-operative support can be extremely important, especially for those with preoperative psychological difficulties, and should be actively pursued by patient, surgeon and psychologist/psychiatrist.
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