Psychiatric assessment of patients undergoing bariatric surgery

1. PSYCHOLOGICAL ASSESSMENT OF
PATIENTS UNDERGOING
BARIATRIC SURGERY
The pre-operative psychological evaluation should consist of:
1. Review of medical records
 Must be over the age of 18
 BMI (body mass index) greater than 35
 Co-morbid conditions directly related to obesity
 The patient must have previous unsuccessful attempts at
conventional and/or supervised weight loss
2. Psychiatric interview
 Psychiatric history and current mental state. Including the
current eating habits, history of mood disorders, substance
abuse and risk taking behavior.
 Assessment of capacity.
 Patient’s level of motivation and expectations.
 Patient’s insight and comprehension of the surgical
procedure alternatives, risks, benefits, dietary requirements
and lifestyle changes required.
 Indicate whether they can comply with post-surgery
following-up psychiatric outpatient clinic appointments.
 Determine the current life situation; support of their family
and/or friends for complying with post-surgical
requirements and level of stressors.
3. Psychological evaluation
Include Minnesota Multiphasic Personality Inventory (MMPI),
Questionnaire on Weight and Eating Patterns-Revised (QEWP-R©)
and other testing according to each case.

2. Classification of patients
1) Psychological criteria to consider excluding patients from
consideration for surgery:
• Active psychosis present
• History of multiple suicide attempts within the past 5 years
• Alcohol or other substance use disorder within past 6 months
• Borderline personality disorder as indicated by medical record and/or
clinical interview
• History of poor adherence with medical regimens: appointment
keeping, follow-up instructions.
2) Delay consideration for surgery pending response to further
psychological treatment:
• Poorly controlled mental illness(es) or cognitive impairment that may
interfere with ability of patient to comply with necessary instructions
and follow up (e.g. poorly controlled OCD, severe depression/anxiety,
severe bipolar disorder, dementia)
• Severe binge eating disorder
• Unstable social environment (homeless or lack of social support)
• Very low self-efficacy/self-motivation/personal responsibility
• Other severe behavioral problems.
3) Acceptable for surgery; provide ongoing psychological treatment
before and after surgery.
• Mild-Moderate Binge Eating Disorder
• Moderately low self-efficacy/self-motivation/personal responsibility
• Reasonably well-controlled mental illness, including schizophrenia,
depression, bipolar disorder, anxiety disorders, OCD, alcohol or
substance use disorders in remission
• History of an isolated suicide attempt
4) Acceptable for surgery; provide psychological treatment on an as-
needed basis.
• Any patient that does not fall into one of the above categories.

3. Recommendation after evaluation should focus
on the following:
 Patient’s level of motivation.
 Appropriateness for bariatric surgery based upon psychological status.
 Likely compliancy with post-surgical requirements.
 Patient’s support network.
 Any mental health issues that may disqualify the patient from bariatric
surgery.