Tier 4 Psychological Assessment
The Bariatric Consultancy have developed a protocol for the psychological assessment of bariatric surgery candidates. For the past five years The Bariatric Consultancy have provided this service to Tier 4 surgery centres in both the NHS and private sectors.
This process informs the assessing clinician of a patient’s ability to adapt to the necessary lifestyle and dietary changes required for a good outcome from bariatric surgery. The assessment will also highlight any issues that are of concern that directly contraindicate the patient progressing on a surgical pathway. The assessment takes the form of a semi-structured clinical interview lasting 60 minutes. The psychological assessment is structured over the following areas:
Psychological EvaluationA history of enduring and unresolved mental illness
Psychotropic medication that impacts on weight gain
History of diagnosed eating disorder
Recent unresolved trauma
Risk factors on the Clinical Outcomes in Routine Evaluation (CORE) forms including, suicidal ideation, self-harm, aggression towards self and others
Emotional eating, an over reliance on inappropriate foods for self-soothing
Periods of excessive eating or binge eating (undiagnosed)
Other areas are also explored:Relationship to food
History of weight
Current psycho-social situation
Coping strategies and support network
Understanding of surgical procedures and anticipated weight-loss
Understanding of excess skin and ability to tolerate unsightly skin-folds
Inter-personnel relationships and the impact that surgery will have on these
Bariatric surgery is not a miracle cure for weight-loss, it is a tool that needs to be worked with.
Important factors to remember:-
Surgery can cause serious problems with inter-personal relationships; friends and partners sometimes struggle with the changes it can engender in a loved one.
Any procedure can be sabotaged unless fundamental changes are made. The band is particularly easy to sabotage. The band works best if patients can also commit to regular exercise. Skin fold removal is costly and VERY painful.
This service is available as a standalone clinic service or can be incorporated into existing pathways and multi-disciplinary teams.