Evaluations & Counseling for Bariatric Surgery

There are multiple causes of morbid obesity including genetics, certain health conditions, hormonal imbalances, medications, environment, physical injuries, and yo-yo dieting.  Whatever the reason for your condition,  you and most likely your healthcare providers have decided to pursue Surgical Weight Loss.   Surgical Weight Loss is a serious life-altering procedure and like any other major healthcare decision,  should not be taken lightly.  Riley Therapy is here to provide you with the services you will need to ensure that you are an appropriate candidate for this procedure and if so that you are as prepared as possible for what is coming.

We provide comprehensive evaluations (a prerequisite for surgery) as well as ongoing counseling to help ensure successful and healthy weight loss.

Frequently Asked Questions

WHY DO I NEED A PSYCHOLOGICAL EVALUATION FOR WEIGHT LOSS SURGERY?

There are actually two reasons for the evaluation. The first is that it is a requirement based on guidelines established by the National Institute of Health for all patients before bariatric surgery can be offered. The second reason is that surgeons as well as the insurance companies also require it to ensure your health and safety. Weight Loss Surgery is a life altering procedure. As with any major surgery, weight loss surgery can have complications including death, and in the case of the gastric bypass procedure, it is irreversible. For these reasons, the decision to go forward with surgery should not be taken lightly.

An evaluation ensures that you are:
1. able to make such a decision 
2. understand the consequences of your decision 
3. have no underlying psychological or environmental conditions that would prohibit you from adhering to the life changes that are required following surgery.

WHAT PSYCHOLOGICAL CONDITIONS WOULD CAUSE PROBLEMS WITH WEIGHT LOSS SURGERY?

There are a wide variety of psychological disorders that may indicate that weight loss surgery is not in a patient's best interest. In general, we are looking for problems that would prevent a person from adhering to life-changing behaviors for the long term.  This includes conditions such as impulse control problems,  addictions, or untreated mental illness including eating disorders.  

WILL NORMAL EPISODES OF ANEXITEY OR DEPRESSION PREVENT ME FROM HAVING SURGERY?

Most people at some time in their lives have experienced psychological problems. These episodes are typically treated with medication and/or psychotherapy. Normal anxiety and depression would not disqualify you for weight loss surgery.

WHAT DOES A PSYCHOLOGICAL EVALUATION ENTAIL?

An evaluation includes a self-report questionnaire, a clinical interview and psychological screenings.   The entire process takes approximately 1 and 1/2 to 2 hours with the clinical interview lasting 45-50 minutes.

WHO SHOULD DO THE EVALUATION?

To have weight loss surgery is an important decision, and it is to your benefit that the evaluation be done by a clinician specifically trained in this area.  In fact, many insurance providers and surgical weight loss programs will not accept an evaluation performed by a clinician who is not trained to do them.  In addition,  the education and tools that you will learn from Riley Therapy clinicians will assist you in making the necessary behavior changes and could help you prevent relapse and increase your chances of long term success.

WILL MY INSURANCE PAY FOR MY EVALUATION?

Each insurance company is different, however, the cost of the evaluation may be fully or partially covered by your health insurance. There are a few things to keep in mind. First, the evaluation is not typically related to a mental disorder, and as such the claim may need to be submitted to your medical benefits, not your mental health benefits.   We will provide you with a detailed receipt to submit to your insurance carrier.

HOW WILL I KNOW IF I PASSED THE EVALUATION?

The evaluation is not about passing or failing. The process identifies potential problems that might cause you difficulty if you have the surgery. If there is a concern it will generally be discussed at the time of the evaluation.  You will receive a detailed treatment plan outlining recommendations and possible changes you will need to make if you are to be recommended as a candidate for surgery. Following the evaluation a report is provided to the surgeon and to your primary care physician.  Ultimately, it is the surgeon who makes a decision as to whether or not to proceed with the surgery. 

WHAT IF I AM TAKING MEDICATION FOR A MENTAL ILLNESS?

You will be asked about current medications that you are taking. For the most part you will continue taking the medication after surgery. Many psychiatric medications cannot be abruptly stopped. However, if the medication is time released and you are seeking a gastric bypass a substitute medication will need to be prescribed by your treating physician. Your physician will instruct you about making changes or substituting medications.

WHAT IF I AM CURRENTLY BEING TREATED BY ANOTHER PROVIDER?

If you are currently being treated you still need to be evaluated by an independent psychologist who is trained in conducting these evaluations. It would help, however, if your current provider would write a brief letter supporting your decision to have weight reduction surgery.

CAN I RECEIVE A COPY OF MY EVALUATION REPORT?

The report is typically faxed to your surgeon and to your primary care physician.  After your surgeon receives the report you may request a copy of the report from your surgeon. We typically do not provide reports directly to clients.

Bariatric Surgery is a Tool not a Magic Pill

Some people who choose bariatric surgery are under the impression that the surgery will solve all their problems and/or  improve their relationships with others. Bariatric surgery is not a magic pill.   It is a tool to help you get started on your weight loss journey.

Just as it is important to plan ahead for the changes you will need to make in your eating and exercise habits,  it is critical that you prepare yourself for some of the psychological issues that may arise as you begin to adjust to your new body and your new way of life.  As the saying goes,  "failure to plan is planning to fail."
 

Here are some tips to help you on your journey:

Set Realistic Expectations

Be sure to consider your expectations around weight loss goals, lifestyle and relationships.  Talk to your family, friends and treatment team about your goals and expectations. 

Make sure you are being honest with yourself and not setting yourself up for failure. This is not just about weight loss.  It is a long term lifestyle change. 

Issues around weight loss can be unsettling.  They range from feeling like you are losing control if the weight loss is happening quickly or you may feel discouraged or hopeless if you are not losing as much as you had expected.    Talk to others who are going through or have been through the process. Journal about your feelings. Reach out for support to your treatment team.  Do not avoid the feelings because this could lead to depression or anxiety.

After years of yo-yo dieting, this dramatic weight loss could lead to feelings of elatedness. It is often referred to as the “honeymoon phase” and frequently occurs during the initial 12 months post op.  You may feel as if your weight problems are over forever.  While it is important to celebrate your feelings,  it is equally important to be aware that you could be setting yourself up for disappointment when this phase is over and you are no longer losing weight.  If you gain any weight back,  you could feel depressed, shamed or extremely anxious or fearful that you will gain it all back.

If you experience any significant changes in mood, attitude or activity level,  it is critical that you seek professional help. You may feel ashamed or embarassed and as if you are a failure.  Your treatment team will understand and be there for you while you are experiencing these feelings.  If you repress your feelings,  you will end up relapsing into old behaviors (i.e. eating) to cope with your feelings.

You may feel a sense of loss after bariatric surgery. Food may have played a central role in your life. You likely spent hours planning, acquiring and thinking about food. This food obsession may have consumed your life. You may have used food to comfort yourself, to provide an activity or as a reward or to relieve stress after an exhausting day.  You will need to develop alternate coping tools to eating.  Journaling, exercise, crafts, gardening, spending time outdoors, getting together with friends for activities other than eating,  and talking to friends are great ways to cope with loss.

Food may have also been an integral part of your social life. How can you attend a party or go out to lunch with colleagues now that you can’t eat the way you used to?
You may have to say no to certain activities that revolve around food or to spending time with friends with whom you used to eat (sometimes referred to as "binge buddies.")  This can cause conflicts in relationships that used to be stable.

Bariatric-surgery regret may also occur. You may long for the old days when you could sit by the t.v. for hours eating your favorite snacks.  Former occasions that used to revolve around food will be challenging. You will have to find alternate ways to enjoy yourself in social situations, on vacation or during holidays.   

Disordered Eating

Believe it or not,  people who have bariatric surgery sometimes develop the type of disordered eating that can turn into an eating disorder such as anorexia or bulimia.
Hyper-focus on food, eating and exercise can lead to eating disordered behavior. The best way to prevent disordered eating or a full blown eating disorder is to stay honest with yourself and others,  work towards a "moderation mindset" with eating and exercise and seek professional help if you notice any of the following behaviors:

- vomiting after meals on a regular basis, chewing and spitting food
- becoming hyper focused exercise, the number on the scale or clothing size
- significant changes in your behavior such as avoiding activities or people you enjoy, isolating
- mood changes such as anxiety, depression or increased irritability

If there is any question that you might be developing an eating disorder,  refer to the eating disorder information on this website.