Therapists Role in Gastric Bypass Procedure

A Therapists Role in A Pre-Surgical Interview for a Gastric Bypass Procedure Abstract The purpose of this paper is to determine the role of the psychologist when evaluating a patient seeking a gastric bypass procedure. To this date there is no standard avenue given to those conducting the interview. Due to the limited knowledge of long term success post-surgery a guideline is given for psychologists to follow. Continued research is needed to determine what may be needed in the interview that is not being addressed at this time.

A Therapists Role in A Pre-Surgical Interview for a Gastric Bypass Procedure A huge problem in the United States for the average individual is obesity. While traditional weight loss programs are failing and more extreme methods are being used, psychologists are being called upon to determine if individuals are mentally fit to have a procedure called Bariatric surgery (ie, gastric bypass). This procedure is used for populations of people whom are extremely obese. Therefore extremely obese patients are turning to this unconventional method to lose weight.

Unlike traditional weight lose methods whose risks are low, gastric bypass procedures have high health risks involved. In order for this surgery to be successful patients need to reframe their thinking after surgery to continue to maintain the weight that is lost due to the procedure. There have been no clear assessment tools psychologists’ use for pre-op assessment but many psychologists are using a standard assessment to determine if the individual is a candidate for bar iatric surgery.

Even though a patient may not want to undergo a psychological evaluation it is a necessary criterion in order to undergo this extreme weight loss procedure. The information a psychologist collects in the pre-op procedure is why they are seeking surgery, diet and weight history, what are their habits currently in regard to eating, educating patient that future lifestyle changes associated with behavior modification therapy, history and current social supports, and any psychiatric symptoms (current and past) (Snyder 2009).

The psychologist’s 3 responsibilities during the assessment is to collect a history about the patient, act as an educator providing information to patient about the psychological aspect of the surgery, and the therapist motivating the patient to seek post surgical behavior modification treatment while helping the client deal with emotions that may come up during the evaluation (Snyder 2009). The psychologist’s initial question is the patient’s reason for surgery and what are they hoping to accomplish.

The therapist therefore will determine the clients expectations to assess if the client has unrealistic expectations centered around the surgery results (ie. motivation due to only changing physical appearance). The results may suggest the patient may not be a candidate for surgery. Researchers have learned the motivation for surgery should be strictly for health reasons (Bauchowitz, A. , 2007). Patients that have unrealistic expectations regarding weight loss are prone to issues of depression when the surgery and outcome is not what they expected. The second area assessed is a review of the patients eating habits past and current.

Researchers found that clients learned messages from family that were contributing factors to weight gain (ie. eat everything on your plate) (Gibbons, L. M. , et al. , 2006). Psychologists’ also determine if a client has had past failures with diets and if not the client is encouraged to try dieting before seeking surgery. The philosophy behind this way of thinking is due to getting used a healthy lifestyle with food intake. The role of the psychologist here is to educate the patient with what will be needed in the future to maintain their ideal weight.

They are warned going back to old behaviors with eating behaviors and habits could result in gaining all their weight back. Also, psychologists help the patient if they are dealing with shame for failed diet attempts in the past. Another area of assessment is determining the patient’s current eating behavior. It is important for the therapist to determine the motivation for behavior modification and also seek out eating disordered clients. The patient is also questioned about their plan for exercise post surgery.

The biggest finding about non-compliance among failures with post treatment was the lack of motivation for exercise (Snyder 2009). Psychologists also determine if a client is bulimic due to the dangers of a bulimic client can have with gastric bypass procedures. Psychologists at this point educate the patient on the importance of exercise for long term benefits of surgery (Snyder 2009). The psychologist also educates the patient to help them to understand what they are agreeing to when seeking gastric bypass. The therapist also should point out the consequences of going back to the past ifestyle with eating behavior (Snyder 2009). Another area of importance is the social network of family and friends the patient has when having surgery. The social network can make or break a patient’s success or failure. Therefore, it is important for the psychologist to understand the patient’s social network in the past and present. Negative consequences of the surgery (ie. affair) can lead to jealousy of the spouse and present sabotaging behavior of the spouse. Therefore it is important for a psychologist to address issues that could present themselves if applicable (Snyder 2009).

One of the primary reasons an interview is conducted pre-surgery is to determine if there are any psychiatric disorders that might interfere with success of surgery. Symptoms of anxiety, depression, psychosis, mania, suicidal ideation, substance abuse, history of abuse, family history of mental disorders, and any treatment regarding mental health issues are assessed. An examination called a Mini-Mental Status is given to the patient to determine any psychiatric complications that can present themselves (Fabricatore, Crerand, Wadden , et al. 2006). The MMPI-2 is a psychological test given to pre-surgical candidates for a gastric bypass. This is a way to validate that the psychologist’s assessment interview are the same as compared to the MMPI-2. The psychologist should instruct the client to answer all questions honestly so the test results will be accurate. If the clients’ results show defensiveness with the test results the test may have to be taken again (Walfish, S. , 2007). The Millon Behavior Medicine Diagnostic allows for norms within the population that have undergone surgery.

These two tests have been selected for psychologists to use even though there are other tests available. In conclusion, it is important for patients to be assessed before having surgery. The psychologist role is to understand the readiness of a patient and how emotional issues can challenge long term success. The psychologist’s role also is to educate the client on all possible issues that they may face post surgical. Overall, this demonstrates how important a pre-surgical evaluation is needed to increase success for the patient short and long term. References Allison G.

Snyder (2009) Psychological Assessment of the Patient Undergoing Bariatric Surgery. The Ochsner Journal: Fall 2009, Vol. 9, No. 3, pp. 144-148. Bauchowitz, A. , L. Azarbad , K. Day , and L. Gonder-Frederick . Evaluation of expectations and knowledge in bariatric surgery patients. Surg Obes Relat Dis 2007. 3 5:554– 558. Devlin, M. U. , J. A. Goldfein , L. Flancbaum , M. Bessler , and R. Eisenstadt . Surgical management of obese patients with eating disorders: a survey of current practices. Obes Surg 2004. 14 9:1252–1257. Fabricatore, A. N. , C. E. Crerand , T. A.

Wadden , et al. How do mental health professionals evaluate candidates for bariatric surgery? Survey results. Obes Surg 2006. 16 5:567–573 Gibbons, L. M. , D. B. Sarwer , C. E. Crerand , et al. Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery? Obesity (Silver Spring) 2006. 14 suppl 2:70S–76S. Walfish, S. Reducing Minnesota Multiphasic Personality Inventory defensiveness: effect of specialized instructions on retest validity in a sample of preoperative bariatric patients. Surg Obes Relat Dis 2007. 3 2:184–188.