Dear Doctor: How Can I Prepare for My Psychological Evaluation before Bariatric Surgery?

Answer Provided by Rachel Goldman, PhD, FTOS

Fall 2020

I think the term “psychological evaluation” can often be very misleading and can cause

pre-bariatric surgery patients to struggle with overwhelming and anxious feelings. First, let’s not look at this as an exam or an evaluation, but rather a consultation with a behavioral health professional.

Why Do I Need a Psychological Appointment before Surgery?

Many people ask why they have to see a psychologist or behavioral health professional prior to getting bariatric surgery. I tend to first explain this requirement by comparing bariatric surgery to other types of surgery. For instance, I explain that if you have a broken wrist, you need to get your wrist repaired. Of course, you will also need some recovery time and perhaps even some physical therapy, but that’s it. It’s done, you had the surgery, and you move on with your life.

Now, let’s think about bariatric surgery. This is not a surgery where you are simply repairing a bone in your body. This is a surgery that could potentially change your life. You made the decision to treat your obesity with bariatric surgery, so you will be provided with a tool that will assist you in living a healthier life. The surgeon will do his or her job and take care of the physical aspect of the surgery. However, the key to a successful surgery is how you will mentally prepare yourself and how you will use the tool the surgeon gave you. Similarly, when a doctor writes you a prescription, it is up to you to fill it and be compliant with that medication.

How Can a Mental Health Provider Help Me before and after Surgery?

You may still be wondering why a pre-op psychological evaluation is necessary, or why you have to see a mental health provider before having bariatric surgery.

Years ago, when I first started getting involved in this field, a colleague of mine said that the role of a bariatric mental health provider “is NOT to be the gatekeeper.” This is very true! It is NOT our job to simply say “Yes, you should have bariatric surgery” or “No, you should not.”

This is exactly why I don’t like to think of this appointment as an exam. Our job during the pre-op process is more complicated than simply coming to the conclusion that you “passed” or “failed.” It is the mental health provider’s job to make recommendations to you and your bariatric surgery team by identifying your strengths, potential barriers or challenges, and then use this information to help develop tools that will assist you in being successful.

For example, let’s say a patient is struggling with any of the below disordered eating behaviors:

• Skipping meals
• Emotional eating
• Binge eating
• Night eating

The patient’s bariatric mental health provider and bariatric surgery team could problem-solve together and come up with a plan to help the patient improve their health behaviors prior to having surgery.

Creating a Plan Fit for You

Working with a mental health professional is unique because they have the ability to help you come up with a plan. This will help you follow through with surgical recommendations and will also help you anticipate difficulties that may arise as your lifestyle changes. Because every individual is unique, with different lifestyles, backgrounds and stressors, we as mental health professionals can assist you in building a plan that will specifically work for you and help you achieve your goals.

Since bariatric surgery requires many new lifestyle changes, other changes may occur that an individual may not necessarily be prepared for. Therefore, another important part of the psychological evaluation for bariatric surgery is not just assessing and gathering information, but also providing education about these potential changes and assisting patients with building a plan to deal with them.

After someone loses a lot of weight and/or has bariatric surgery, there are many different changes that could possibly occur, including changes with:

• Eating habits
• Socializing
• Going to events where food is present
• Relationships
• Self-confidence

The more a patient can work with a mental health professional before having bariatric surgery, the easier and less overwhelming the experience will be afterwards.

Final Thoughts

Remember, bariatric surgery is not brain surgery. Similarly, bariatric surgery is not like any other surgery. Bariatric surgery is a treatment for obesity and a tool to help individuals become healthier. The surgeon is not changing your brain, your thoughts or your emotions. At the end of the day, individuals who choose to have bariatric surgery must work on their thoughts and behaviors in order to maximize the benefits of the surgery. The surgeon will do their job, but now it is time for you to do your job. So, don’t come to your pre-op psychological evaluation expecting to take an exam or to be told you can or cannot have surgery. Come with an open mind and ready to listen, learn and make changes.

Do you have more questions about this topic? Feel free to reach out to Dr. Rachel at drrachelnyc@gmail.com or follow her on Twitter (@AskDr_Rachel), Facebook (DrRachelNYC) or Instagram (drrachelnyc).

About the Author:
Rachel Goldman, PhD, FTOS, is a licensed psychologist specializing in the mind-body connection, including health behavior change, the treatment of obesity, weight management, eating behaviors and stress reduction. She is also the Clinical Assistant Professor in the Department of Psychiatry at Grossman NYU School of Medicine and has a private practice in NYC where she utilizes cognitive behavioral therapy to assist in behavioral changes, both with individual clients and corporate wellness. 

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