Although no formal standard exists, there is growing recognition of the important elements to be addressed to determine psychological readiness for bariatric / weight loss surgery. Unlike traditional diets for which risks are low and discontinuation can occur at any time, bariatric surgery has inherent risks and requires highly restrictive, long-term behavioural changes afterwards. Therefore, these patients typically are required to complete a thorough evaluation, including psychological assessment, to determine their appropriateness for surgery. Patients meet with a psychologist for a clinical interview that focuses on behaviour, psychiatric symptoms, and understanding of the surgery; they then complete psychological testing, which provides an objective measure of their presentation style, psychological adjustment, and readiness for surgery. This approach matches the growing body of evidence regarding the important elements for inclusion in this assessment.
Although patients often are hesitant and uncomfortable with the notion of seeing a psychologist before surgery, the information discussed during the clinical interview is critical not only for assessing their appropriateness for surgery but also for enhancing their success during the post surgery adjustment. The core parts of the clinical interview include reasons for seeking surgery, weight and diet history, current eating behaviours, understanding of the surgery and its associated lifestyle changes, social supports and history, and psychiatric symptoms (current and past). Most patients describe a desire to lose weight to improve current medical problems, enhance mobility and energy, and promote health and longevity. Further discussion of this issue is needed when patients report external pressure to have the surgery (which is not a good reason to have the surgery), an overemphasis on physical appearance, and unrealistic ideas regarding the changes that will come about in their lives following weight loss. If the reason for having the surgery is unrealistic and fails to match what the surgery can achieve, patients are at risk for possible mood issues and for noncompliance after surgery. Patients are also asked their goal weight and anticipated time frame for achieving that goal, which provides additional information about realistic expectations. Expectations must be realistic for patients to be satisfied with the surgery otherwise mood changes can occur eg. Depression, and it would be better not to have the surgery.
Patients have to understand the lifestyle changes required after surgery and must be psychologically assessed to ascertain whether they can make these changes.
Surgery is a drastic choice after all else has failed and psychological support from family and friends is required – it is not an easy option!