Evaluation for Metabolic and Bariatric Surgery

Childhood Obesity News has been contemplating the intersection of weight loss surgery with the workings of the human psyche. They meet when a patient is psychologically assessed to evaluate her or his capacity for being helped by MBS, or metabolic and bariatric surgery.

There are three varieties of recommendation: green light, yellow light, and red light:

(1) no psychological contradiction for surgery
(2) psychological or psychiatric treatment required prior to surgery
(3) psychological contraindication for surgery

Although the formula might seem straightforward, it is anything but. Jennifer C. Collins, M.A., M.S., and Jon E. Bentz, Ph.D. tell us:

Unfortunately, there is no single psychological characteristic or set of psychological characteristics of extremely obese individuals that is consistently predictive of success or failure following bariatric surgery, as several different psychological characteristics are likely associated with weight maintenance and relapse in obesity.

In other words, as so often happens, the situation is multifactorial. Eating disorders stem from a mixture of psychosocial, environmental, and biological (including genetic) factors in varying proportions. Moreover, there is almost always a vicious cycle of eating, guilt, low self-esteem, and more eating. Plus, if calorically dense foods are recognized as harmful, the environment we live in can, in all fairness, be described as toxic.

Feeling that improvement is too slow, or having body image issues, the post-op patient may experience a letdown; or just flat-out return to old, bad habits without even that much of an explanation. Something can be wrong without rising to the level of psychopathology. The authors say,

Not only is the role of a psychologist important for behavioral treatment of obesity and pre-surgical psychological assessment, but also following surgery to help them adjust to the post-operative lifestyle.

Patients often need to be reminded that […] they have to maintain control over their thinking and behavior to make healthy choices for the rest of their life.

Psychologists can assist these patients by utilizing cognitive restructuring to help them rationally evaluate their progress, as well as behavioral activation to aid them in making healthy behavior changes.

With or without surgery, the only formula for success is lifestyle modification, staunchly adhered to — in perpetuity. It’s like being a recovering alcoholic. Today, you don’t drink/overeat. Tomorrow, you don’t drink/overeat; and so on, forever.

How do patients escape from obesity? Cognitive therapy and cognitive behavioral therapy are helpful — with or without surgery.

Classical conditioning has to do with things like avoiding triggers, and possibly even people who exert negative influence; and then there is operant conditioning. It is in the interest of doctors, hospitals, and insurance companies to “identify patients who have significant psychopathology that may put them at risk for unsuccessful surgery.” The ideal patient would be psychologically stable, because that predicts a likelihood of success.

Next, we will ponder all these ideas in the light of patients who might be considered shockingly young.

Your responses and feedback are welcome!

Source: “Behavioral and Psychological Factors in Obesity,” JLGH.org, Winter 2009
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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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