Most people are required to talk to a behavioral health professional prior to being approved as a candidate for Bariatric surgery as a Psychological Evaluation is a standard part of the pre-surgical process. This is due to the impact that an individual’s mental and emotional health can have on their ability to meet their post-operative needs and the importance of helping someone address areas of risk prior to surgery. While the basic content of these assessments is generally agreed upon among providers, each clinician who does them has their own approach. As a Health at Every Size (HAES) provider and an advocate for Intuitive Eating (IE), my evaluations come from a weight and food neutral perspective that supports body acceptance and personal autonomy. That means clinically, I don’t practice from a place that sees any particular weight or food as “better” or “worse” than another and my goal for those I work with is to help them accept the body that they have (with it’s strengths and challenges) while acknowledging their right to do with that body what they want so long as it doesn’t put them at inordinate risk.
Bariatric Evaluations with me are completed across at least three appointments where we will cover different parts of your personal history and surgical process. Before your first appointment, you will complete an intake questionnaire and take a number of assessments around your eating patterns, mood, and life experiences. At our first visit, we will complete your Pre-Surgical Psychosocial Evaluation, discussing your relevant family, education, work, mental health, and weight history. During our second visit, we will do your Bariatric Assessment, focusing on your surgical process specifically (motivations, knowledge and understanding, preparation, expectations, feelings, challenges, etc). Then for our third visit, we will develop a Surgical Support Plan for you so that if you choose to have surgery, you have a customized plan to guide you post-operatively. You and your surgeon will both get a copy of your plan and a recommendation for surgery will be sent to your surgeon’s office. Recommendations are valid for three months and can be updated when needed by scheduling a follow up appointment.
Please be aware that endorsement for surgery is not guaranteed, though most people who are committed to their decision and are engaged in the preparation process become stronger candidates. There are certain factors that have been shown to negatively impact someone’s long term post-surgical outcomes and due to the physical, psychological, and social health risks involved, should be addressed prior to surgery. Some examples of these factors include untreated or unmanaged mental health challenges, limited consistency meeting their personal nutritional needs, unrealistic expectations of surgery and it’s long term impact, low support from people around them, and limited experience caring for their emotional wellness without food. Should you not receive an endorsement once your evaluation is completed, appropriate recommendations will be made and follow up appointments for continued assessment can be scheduled as needed. It is not uncommon for someone to realize during the course of their evaluation that surgery is not best for them at this time and in those situations, recommendations are provided based on their identified needs.
It’s normal to be really excited about taking this step while also experiencing some fear and anxiety, but just as you wouldn’t decide to hike to the summit of a mountain without preparing, the same goes for having surgery. You want to talk to others, do your research, start conditioning yourself for the journey ahead, be sure you have all the tools and resources that you will need, and take each step at your own pace. I often tell people that “the right surgery at the wrong time can easily end up being the wrong decision for them” just as climbing a mountain without a flashlight or on a sprained ankle can put a hiker in a pretty compromised position. The more you do to ensure you are prepared prior to surgery the more capable you will be of achieving your long term goals post-operatively.