The Bariatric Pre-Surgical Psych Evaluation: What To Expect and What You Need To Know.
It all begins with an idea.
So, you have decided to have Bariatric Surgery to help improve your health and wellbeing. Your surgeon now tells you that you will need a psychiatric evaluation done before you can have your desired surgery and several questions immediately run through your mind. Why do I need a psych evaluation before Bariatric Surgery? What exactly does a Bariatric Pre-Surgical Psych Evaluation consist of? Can I fail the Bariatric Pre-Surgical Psych Evaluation? I’m taking an anti-depressant; will that disqualify me from having Bariatric surgery?
Why Do I Need to Have a Psych Evaluation Before Bariatric Surgery?
The American Society for Metabolic and Bariatric Surgery has set standards of care for bariatric patients to ensure the best possible outcomes; this includes a mandate for a psych evaluation before bariatric surgery.
While the medical benefits of bariatric surgery with its subsequent weight loss have been well documented, there is always the possibility that things may not go as planned. After surgery, a person may struggle to cope with post-op dietary restrictions, changes to their body and/or how their body processes food, fears of gaining weight, or concerns about their rate of weight loss. These struggles can lead to “food fear” and not eating properly which may result in medical issues like malnutrition.
These same struggles after surgery put patients at a greater risk of developing depression, anxiety, eating disorders, addiction, or switching of addiction from “food for comfort” to alcohol or another vice for comfort. If a patient is already struggling with depression, anxiety, an eating disorder, or addiction the poorer their outcomes will be.
The goal of the bariatric pre-surgical psych evaluation is not punitive or to invade your privacy but to help ensure that you meet your goals of living a healthier and happier life after surgery.
The American Society for Metabolic and Bariatric Surgery has set standards of care for bariatric patients to ensure the best possible outcomes; this includes a mandate for a psych evaluation before bariatric surgery.
What Should I Expect During My Bariatric Pre-Surgical Psych Evaluation?
You should expect to spend 1-2 hours with your evaluator. During this time, your evaluator will need to calculate your BMI, inquire as to which bariatric procedure you intend to have, and obtain the name of your surgeon and the facility where you intend to have your procedure done.
You will also be asked about several different topics including:
- Your mental health history will include:
General outpatient treatment including any medications for mental health purposes past or present,
Active engagement in therapy
Previous psychiatric hospitalizations,
Rehab, intensive outpatient, partial hospitalizations,
Non-suicidal self-injurious behaviors or suicide attempts in the past 5 years.
- Your previous attempts at weight loss and the results of those attempts
- Your current work with a nutritionist and any support groups you may be attending.
- Your general feelings toward food and history of eating disorder
- Your motivation for having surgery and your expectations for your surgery
- Your understanding of the risks of the procedure you will be having and your understanding of possible post-op complications
- Your anticipation of any difficulties with post-operative recovery, dietary restrictions, and exercise
- The financial and emotional support you have in place to help you through the recovery process.
Your evaluator will also have you complete several standardized mental health screenings aimed at assessing you for current symptoms of mental illness, eating disorders, and active addiction.
Can I Fail The Bariatric Pre-Surgical Psych Evaluation?
I have seen some online sources say that you “can’t fail” the Bariatric Pre-surgical Psych Evaluation and report that this psych evaluation is merely a tool to help your surgical team prepare you for a good outcome, but the American Society for Metabolic and Bariatric Surgery guidelines have established 3 mental health conditions that are considered contraindications for bariatric surgery. These are:
1) Active Psychosis
2) A history of a suicide attempt in the past 2 years or several attempts within the past 5 years even if those attempts were more than 2 years ago
3) Active Addiction
Remember that the Bariatric Pre-Surgical Psych Evaluation is to help ensure that you have the best possible outcome after your surgery. Being honest during your Psych evaluation is in your best interest even if it means a delay in having the procedure. Keep in mind that having a mental health diagnosis or being on medication for a mental illness will not in and of itself prevent you from having your surgery, but these conditions need to be stable, and you need to tolerate your current regimen without side effects.
I Failed the Bariatric Pre-Surgical Psych Evaluation, Now What?
Most individuals pass the psych evaluation without any difficulty, but if you have been told that you are not cleared for surgery it can be very frustrating and anxiety-provoking. In most cases, the mental health provider doing your pre-surgical psych evaluation will recommend that you be re-evaluated in 3-6 months. At that time, your symptoms and any medication regimen will be reassessed. Depending on the assessment and reason for the surgical clearance rejection therapy may also be recommended.
If you were denied clearance due to a recent suicide attempt or multiple attempts during the past 5 years, you will need to wait 2 years to be re-considered for Bariatric Surgery.
If you were denied due to active addiction, you will need to have been clean/sober for at least 1 year and engaged in an active recovery program. The risk for developing alcoholism and/or the switching of addictions is very high in bariatric surgery patients.
If you were denied due to active psychosis you will need to have had complete resolution of psychosis with no recurrence for 2 years.
As disappointing and frustrating as it may be to “fail” the evaluation try to remember that it is better to delay your surgery than to have a poor outcome.