Basics of Bariatric Assessments: A Clinician’s Guide
As rates of obesity continue rising, more of our clients are considering weight loss surgery, or “bariatric surgery,” as a treatment option. As mental health professionals, we play a key role on bariatric surgery eligibility assessments. Our job is to dig deep into a client’s psychosocial functioning to determine if they have the readiness to make and sustain the profound lifestyle changes required post-surgery. In this blog, I’ll provide an overview of some key areas we need to cover in bariatric mental health evaluations.
Understanding the Surgery
While we don’t need an in-depth knowledge of the surgical procedures themselves, having a basic understanding of the anatomical and physiological changes the surgeries cause can help inform our assessments. The three most common types are:
– Gastric sleeve: Reduces stomach size by ~75% so patients feel full faster
– Gastric bypass: Reroutes the digestive system so less food is absorbed
– Lapband: An adjustable band placed around the upper stomach to create a small pouch
No matter the specific surgery, clients must follow a strict post-op diet and cannot return to old eating habits without putting their health at risk.
Key Areas for Psychosocial Evaluation
Pre-Surgery Eating Behaviors: Assess current eating patterns, such as binge eating, night eating, and emotional eating. Identify triggers and motivations related to food. Problematic behaviors increase surgical risks.
Body Image: Uncover body image concerns and distortions that could impact post-op adherence. Weight loss may worsen perceptions as their body may not look like what they picture in their mind, especially considering stretch marks and excessive skin. Some clients may also worry about losing too much weight and looking sickly or not like themselves.
Depression/Anxiety: Screen for mood disorders and determine impact on lifestyle change abilities. Emotional struggles may persist post-op.
Coping Skills: Determine if clients have healthy coping strategies for stress and emotions. Surgery leads to periods of heightened stress.
Social Support: Assess if clients have adequate personal and professional support to navigate changes. Support is paramount. Referrals to bariatric support groups or individual therapy are common with these evaluations.
Substance Use: Screen for any substance misuse, as post-op risks increase with use. Most physicians will require clients to stop smoking tobacco products before qualifying for surgery.
Cognitive Function: Determine capacity to understand surgery changes needed. Deficits require further capacity evaluation. Bariatric procedures are major surgery and life changing so it is important for our clients to have a thorough understanding of both short and long-term consequences it can have to their life.
I hope this general overview of bariatric psychosocial assessments provides a helpful starting framework. There are many additional considerations we must make to ensure our clients get the thorough, compassionate evaluations they deserve. As the demand for these surgeries increase, so too will our opportunities to help.
