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Psychosocial Evaluation of Bariatric Surgery Candidates: A Survey of Present Practices

From the University of Virginia Health System Departments of Psychiatric Medicine (A.U.B., L.A.G.-F., L.A., M.-Y.R., M.W.) and Surgery (A.M., B.S.), Charlottesville, Virginia; and the Virginia Commonwealth University, Departments of Psychiatry and Surgery, Richmond, Virginia (M-E.O.).

Address correspondence and reprint requests to Andrea Bauchowitz, PhD, Behavioral Medicine Center, Department of Psychiatric Medicine, University of Virginia Health System, Box 800223, Charlottesville, VA 22908. E-mail: ab4sc{at}virginia.edu

Objective: Successful outcome for bariatric surgery is largely dependent on patients’ ability to adhere to postoperative behavior changes. A thorough psychological evaluation is often required before patients’ approval for surgery. In addition to a standard psychiatric interview, assessment of behavioral components specific to this surgery seems indicated. No uniform guidelines exist on how to conduct such an evaluation. This survey was designed to collect information on the level of involvement of mental health professionals with bariatric surgery programs and their approach to evaluating bariatric surgery candidates.

Methods: Surveys about psychological evaluation practices were mailed to 188 bariatric surgery programs. Eighty-one surveys were returned.

Results: Eighty-eight percent of programs require patients to undergo a psychological evaluation and almost half require formal standardized psychological assessment. Current illicit drug use, active symptoms of schizophrenia, severe mental retardation, and lack of knowledge about the surgery were the most commonly cited contraindications, preventing patients from gaining approval for surgery.

Discussion: The majority of programs use psychological evaluations; however, the exclusion criteria for surgery vary greatly. Establishing uniform guidelines for the screening of bariatric surgery candidates is necessary. Suggestions on how to begin this process are provided. More research about behavioral and cognitive predictors of postsurgical success is needed.

Key Words: bariatric surgery • gastric bypass • psychological evaluation

Abbreviations: OCD = obsessive compulsive disorder.

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