Background

Psychological evaluation is a requirement before bariatric surgery that identifies patients who have psychologic contraindications which may contribute to poor post-operative outcomes. The benefits of psychological evaluation are not well reported. The aim of this study is to compare weight loss in patients approved without psychological restriction to patients who required a psychological delay, treatment, and re-evaluation prior to bariatric surgery.

Methods

We performed a retrospective review of patients referred for standardized pre-bariatric surgery psychological assessment (clinical interview with validated questionnaires pertaining to eating habits and mental health status). The medical record was reviewed for anthropometric data at surgical consult, pre-operative, and post-operative through 24-month follow-up. Comparisons were made using chi-square and Wilcoxon rank-sum tests. Multivariable mixed modeling was used to assess differences in weight loss between groups.

Results

Of 108 patients included, 25 (23.1%) were delayed due to untreated psychopathology or current emotional/binge eating. Delayed patients underwent psychological therapy (averaging 5 sessions over 5 months) and then “passed” psychological re-evaluation and underwent bariatric surgery. The groups had similar pre-operative BMI (delay 43.2±6.3 vs no delay 42.8±6.8, p=0.790). The delay group had significantly greater percent total body weight loss (%TBWL) at 1-year post-operative compared to the no delay group (34.6±8.8 vs 28.4±10.7, p=0.020).

Conclusions

Patients who are delayed by pre-surgical psychological evaluation, and complete psychotherapy can achieve similar or slightly greater weight loss as those who do not require a delay prior to bariatric surgery. Future work is encouraged to identify therapeutic components which contribute to post-surgical success.