Preparing for a Pre-Operative Bariatric Surgery Psychological Evaluation

Preparing for bariatric surgery can be a challenging journey. Regardless of whether you'll undergo a gastric bypass, sleeve gastrectomy, gastric band, or duodenal switch, your surgeon will require an evaluation of your psychological and physical health. It is important to evaluate these factors because they impact the operation’s success, as well as your healing, and adjustment post-surgery. Understanding the impact of the procedure is vital for mental and physical preparedness.

What's the significance of a psych evaluation?

Undergoing bariatric surgery is a life-changing event that will impact your physical health, the way you eat, the way you see yourself, and the way others treat you. Any life-changing event - even a positive one - can be difficult to cope with. Statistically, people who undergo bariatric surgery are more at risk for developing depression, personality disorders, anxiety, body dysmorphia, and eating disorders. Both your doctor and your insurance company want you to have the best possible outcome, so a psych evaluation is often required. 

A psychological assessment before bariatric surgery enables you to get treatment for any mental conditions before the surgery to improve outcomes post-operation. Furthermore, when your doctor knows you are a high-risk patient for depression, eating disorders, or personality disorders, they will ensure you get the required care before the situation gets out of hand post-surgery.

The primary purpose of a psychological evaluation is not to qualify or disqualify patients for surgery. On the contrary, it is an additional phase of preparation for the surgery.

Your psychological evaluation is intended to screen for several things:

Increased Susceptibility to Depression

People with obesity often have high levels of insulin due to consuming foods rich in carbohydrates, like sugary snacks. Insulin does more than regulate blood sugar – it also encourages the brain to release serotonin, a neurotransmitter associated with feelings of happiness, contentment, and positivity.

After bariatric surgery, your diet changes and you consume fewer carbs. This leads to a significant drop in insulin levels, which also affects serotonin levels. With less serotonin at hand, your body starts releasing stress hormones. These hormones trigger a stress response, which we commonly feel as anxiety. If this anxious state persists, it can create an environment that's more likely to lead to depression. If you were already prone to depression before the surgery, the changes in insulin and serotonin levels could increase the chances of developing depression after bariatric surgery.

Mood Dysregulation

After undergoing bariatric surgery, your body goes through various adjustments, including changes in how insulin works. Insulin is a hormone that helps regulate your blood sugar. With the changes in your diet and body, sometimes your pancreas - the organ that produces insulin - might release more insulin than actually needed. This can happen because your body is getting used to the new way of eating.

Before the surgery, when you had high sugar levels due to obesity, your body was used to working in that condition. Your brain adapted to this situation for optimal functioning. However, insulin also has an impact on your mood. When your insulin levels are low, it can lead to feelings of anxiety, mental fatigue, confusion, and even depression. When the levels of insulin in your body start to change due to your new diet, it can cause your mood to swing in different directions. This is why you might experience mood changes after bariatric surgery. If you are already predisposed to mood dysregulation, this could hit you much harder.

Eating Behavior Disorders

Bariatric surgery can heighten the risk of problematic eating patterns. Studies indicate that individuals who had eating disorders like emotional eating or food addiction before the surgery are more likely to face challenges with their weight after the procedure. This makes it crucial to assess patients for eating disorders both before and after surgery to ensure their ongoing health and well-being.

Furthermore, the changes that come after the surgery can sometimes lead to unhealthy eating behaviors. For example, 40% of patients with a newly resized stomach pouch experience vomiting as a side effect. Unfortunately, some individuals might intentionally eat certain foods that trigger this response as a misguided attempt at weight loss. It's important to recognize and address these behaviors to support patients in maintaining a balanced relationship with food after bariatric surgery.

Personality Disorders

Bariatric surgery can influence the development or exacerbation of certain personality disorders. Conditions like borderline personality disorder and multiple personality disorder are more prevalent among individuals with obesity. These disorders can either contribute to or stem from obesity. Traits such as impulsivity, lack of constraint, and challenges in self-regulation can amplify overeating behaviors and eating disorders that contribute to obesity. Even after surgery, these personality traits can continue to undermine efforts to manage weight.

Studies indicate a rising trend of personality disorders emerging in individuals who have undergone bariatric surgery. The onset of these disorders tends to occur after the surgery and can interfere with effective weight management strategies. Recognizing and addressing the potential impact of personality traits on post-surgery outcomes is essential for providing comprehensive care and support to individuals who have undergone bariatric surgery.

Body Dysmorphia

After bariatric surgery, adjusting to changes in body weight can be a complex experience. Many patients have grown accustomed to their overweight bodies over time, and the sudden shift to a thinner physique can feel unfamiliar and disorienting. 

This transformation in body weight can trigger mental discomfort for some individuals, leading them to actively avoid looking in mirrors. On the other hand, some patients might still mentally perceive themselves as overweight, potentially driving them towards harmful behaviors like self-starvation or self-induced purging. The journey of reconciling one's altered body image after surgery requires careful consideration and support to address the potential development of body dysmorphia.

What can I expect during the evaluation?

The psychological evaluation focuses on your behavior, psychological symptoms, and understanding of the surgery. For instance, the psychologist may ask about your depression history or food relationship to determine what triggered your weight gain. Additionally, the psychologist also needs to know your motivation behind the surgery. Sometimes the reason is much more problematic, making the intervention dangerous. The psychologist may ask about substance use to identify the risk of food and substance addiction post-surgery.

Everything shared during the assessment remains confidential between you and the psychologist. Your doctor and surgeon only get to know what is significant for your surgery. You'll also be asked to complete various questionnaires to assess aspects of your life linked to surgery. The psychologist wants to know if you can handle surgery, recover, and maintain a healthy lifestyle after surgery. All these depend on your mindset, attitude, and mental resilience.

What disqualifies you from surgery?

Psychological Evaluations for Bariatric Surgery in CA & NV

If you've been told that a psychological evaluation is needed before undergoing bariatric surgery, we're here for you! Reach out to us by phone or text at (833) 624-5400, send us a message using our online contact form, or to register as a new patient get started here.


The information provided in this blog is for educational and informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Reliance on any information provided in this blog is solely at your own risk. Always seek the advice of your physician or a qualified mental health provider with any questions you may have regarding your medical or mental health. If you don’t currently have a therapist, we can connect you with one who is qualified to give you safe, professional, and ethical advice regarding your mental health.

If you or someone you are responsible for is experiencing a medical emergency, is considering harming themselves or others, or is otherwise in imminent danger, you should call 9-1-1 and/or take them to the nearest emergency room.