Pre and Post-Weight Loss Surgery Mental Health Care: The Impact on Patients

Abstract: It is imperative for patients to maintain their mental health prior to and after bariatric

weight loss surgery, including how mindset, mental wellness, and emotional health can help

maintain weight loss post-surgery.

For many, the decision to undergo weight loss surgery took a great deal of support and

courage, as it had been a lifelong struggle for others. Some weight loss surgery patients discover

that surgery is one of the few evidence-based methods for maintaining long-term weight loss and

combating life-threatening diseases. According to the Centers for Disease Control and

Prevention (CDC), about “42% of American adults were obese in 2017-2018” (2021). Patients’

decision for weight loss surgery is due to comorbidity relative to “obesity-related conditions such

as heart disease, stroke, type 2 diabetes, and certain types of cancer” (Centers For Disease

Control, 2021). Mental and emotional health can affect obesity pre and post-bariatric surgery.

Due to behavioral and emotional aspects that may affect mental health stability throughout the

weight loss journey and be detrimental to future outcomes; a patient with unstable mental health

or particular psychiatric histories may not be an ideal candidate for weight reduction surgery

(Snyder, 2009). Maintaining good mental health after weight loss surgery is essential for long-

term success.

The bariatric surgery psychological evaluation is pertinent to understanding whether a

patient is ideal for weight loss surgery. According to Dr. Berman, Ph.D., they are intended to

determine risk factors that might compromise a patient’s ability to have a successful surgery and

post-operative adjustment (Schulz, 2013). Bariatric psychological evaluations are important to

identify “contraindications for surgery” and “to better understand their motivation, readiness,

behavioral challenges, and emotional factors that may impact their coping and adjustment

through surgery and the associated lifestyle changes” (Snyder, 2009).

A patient’s mental and emotional health can improve if they engage in consistent mental

health therapy as needed or address any emotional and mental health concerns that may affect

their weight loss progress. Another approach would be to identify eating triggers in order to

learn healthy coping skills for managing emotions related to or coinciding with eating, as well as

to address any core issues that may be related to the patient’s emotional eating or mental health

stability. Post-bariatric surgery and emotional health are just as important as pre-bariatric

surgery. Bariatric surgery necessitates lifestyle changes for various reasons. As a certified

bariatric counselor, I find it is important to encourage patients to begin lifestyle changes pre-

bariatric surgery. This will assist with preparing and familiarizing themselves with transitioning

into post bariatric surgery lifestyle changes. Engaging in lifestyle changes early on can help with

mindset and tackling any emotional or mental struggles early on. Support throughout the process

can be helpful as well, not only in attending classes and meeting with a dietician, but attending

bariatric support groups, friends and family support, and attending medical appointments as

recommended.

One of the most important things in terms of mental health when working with patients

considering bariatric weight loss surgery is to gain knowledge of their motivation to engage in

weight loss surgery. A strong motivation for surgery or a patient’s “why” can help with being

consistent with lifestyle changes long-term. Usually, this will help with maintaining the lifestyle

changes needed to have the success desired. This is critical because weight regain was detected

in nearly 50% of patients within 24 months following surgery (Magro, D. et al., 2008). It is

critical to have a level of commitment to grasp the preparations and lifestyle changes required,

such as healthy eating, keeping medical appointments, exercising or moving, and other

commitments in accordance with medical advice.

Patients may have a misconception of what the bariatric psychological evaluation is and

its importance in the weight loss surgery process. The majority of patients who undergo bariatric

psychological examinations are approved for weight loss surgery. It can be helpful when they

have the evaluation following completion of classes, meetings with a dietitian and their surgeon.

The patient then has a better understanding of the lifestyle adjustments that come with bariatric

surgery and what they must do to keep the weight off after participating in the pre-weight loss

surgery requirements. This makes for a smoother conversation during the evaluation when the

patient explains their understanding of weight loss surgery and lifestyle changes needed to

maintain progress (Goodpastor, 2019).

Risk factors such as binge eating or severe depression can have an impact on a patient’s

chances of success, and in those cases, mental health therapy can help with the lifestyle changes

that are recommended, as well as the emotional wellness that the individual requires, which is

critical in the process (Schulz, 2013). Due to the emphasis on physical wellness, patients may

lose sight of their mental and emotional health during the process. In terms of processing

lifestyle changes, processing traumas or concerns that may have resulted in overeating, depressed

mood, or anxiety, learning healthy coping strategies, developing strong supports, and addressing

mental and emotional health prior to bariatric surgery can be a preventative measure.

Maintaining mental health and emotional wellness pre and post-bariatric weight loss

surgery is pertinent to ensure positive progress throughout a patient’s weight loss journey.

During the bariatric psychological evaluation, patients are provided education and

recommendations to support and encourage them in maintaining the weight loss and lifestyle

changes. Patients who seek mental health counseling pre and post-bariatric weight loss surgery

can be proactive in weight loss maintenance by addressing emotional wellness issues that may

relate to eating habits, emotional eating, learning healthy coping skills, recognizing triggers, and

healing areas of concern.

If you are seeking a bariatric psychological evaluation and reside in New Jersey, I can help. I provide same-week appointments and next-day approval status faxed to your medical doctor/surgeon. I am a certified bariatric counselor and licensed professional counselor in the state of NJ. Performing bariatric evaluations for weight loss surgery approval is my specialty and helping clients transform their lives is my passion. For more information visit my bariatric specialty page here . You can schedule your appointment directly from our website or give us a call at 856.441.5216.

References

1. Centers for Disease Control and Prevention. (2021, February 11). Adult Obesity Facts.

Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/data/adult.html.

2. Schulz, K. (2013, September 13). Concerns about Psychological Evaluations for

Bariatric Surgery Patients. Bariatric Times. 2013;10 (9):24-25.

3. Goodpastor, K. Far from the Easy Way Out: Early Psychological Complications of

Bariatric Surgery. Bariatric Times. 2019; 16 (8):10-11.

4. Magro DO, Geloneze B, Delfini R, Pareja BC, Callejas F, Pareja JC. Long-term weight

regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008 Jun;18(6):648-

51. doi: 10.1007/s11695-007-9265-1. Epub 2008 Apr 8. PMID: 18392907.

5. Snyder AG. Psychological assessment of the patient undergoing bariatric surgery.

Ochsner J. 2009;9(3):144-148.

Author: Rosana Lamontagne, LPC, CBC

Author Affiliation: Ms. Lamontagne is a Licensed Professional Counselor and Certified

Bariatric Counselor. She is the owner and therapist at 4th & Grove Counseling in Sewell, NJ

specializing in trauma therapy and bariatric psychological evaluations.

Funding: No funding was provided

Financial Disclosures: The author has no conflicts of interest relevant to the content of this

article.