Today I met with a health psychologist who conducts preoperative mental health evaluations for gastric bypass surgery candidates. This surgery is for individuals who require extreme weight-loss but unlike many medical procedures patients cannot self-select for the surgery. Often primary care physicians recommend high risk patients with obesity to weight-loss centers. These patients undergo a long process of assessment, spanning 6-months to 1-year before receiving the final recommendation for surgery and scheduling the procedure. An extensive treatment team contributes to success rates and assessment includes attending informational seminars in which patients identify themselves as a good candidate, followed by a review of medical history to identify risk factors (e.g., substance abuse, hospitalizations, trauma, or borderline personality disorder), individual and group sessions with a nutritionist, and finally a two-session mental health evaluation.
Many patients never make it to the final steps of the assessment. Those who do meet with the psychologist will experience an extensive intake targeted an ensuring that patients have the resources and strategies to adhere to post-op behavior changes required for a successful weight-loss and maintenance of healthy weight in the future. The intake is designed to get a picture of the whole person as well as understand how obesity has impacted their life. Questions consider the following: history of obesity, attempts at weight-loss, education, employment, relationships, support systems, beliefs, knowledge of general health habits (i.e., diet, nutrition, and exercise). The psychologist correlates subjective responses with results from the Million Behavioral Medicine Diagnostic (MBMD) that assesses psychosocial factors that may effect treatment and compares results to bariatric norms. The outcome is a final report and recommendations to the medical team that indicate if the patient is in the ideal stage of change, has motivation to continue with on-going changes, and has realistic expectations from the surgery itself and the impact this change may have on their life.
Though the initial assessments are important, the treatment team places greater value on the mental health evaluation and follows the recommendation of the psychologist. I wondered if there were cases in which the patient was as such high risk from obesity that exceptions would be made on the mental health evaluation. The psychologist said “no,” and further mentioned two patients that passed away during the assessment period from related causes such as heart attack. Additionally, the psychologist noted that inadequate results on the assessment lead to a high probability of complications from the surgery and long-term risks. In these cases, where an assessment determines if the patient receives a life-changing procedure, responses on an objective evaluation would give greater confidence to decision-making when there is pressure to provide a recommendation for surgery. The implications for an individual’s well-being and safety warrant this lengthy assessment process and promote reliability through use of several assessment methods.

For more information on Bariatric Surgery Evaluations and the MBMD, check out:
http://www.move.va.gov/download/Resources/BariatricSurgery/NCPRecsforPreOpPsychEvalforwebposting706.pdf
http://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=PAg503

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