What the prospective weight loss surgery patient has to take a psychological exam

One of the most often-asked questions a prospect for weight loss surgery poses revolves around the issue of the psychological evaluation.

I am often asked “What can I say to pass it?” In truth, there are no right or wrong answers. The examination is designed to determine the existence of any problems that might sabotage the individuals’ chances of success.

There are a few areas of the evaluation that are critical to the success of the candidates or their chances of failure. Probably the one major area that we psychologists examine very closely is that of the presence of a mental health issue such as the presence or indication of addictions or addictive traits such as eating disorders.

It’s important to deal with these problems, to be aware of them because there is a great tendency in humans to substitute one addiction for another. For instance, I’ve seen the chemically dependent person become free of drugs and/or alcohol to become addicted to foods, particularly sweets.

This occurs because of the way addictions are established, and how they work. We become addicted to something that gives us reward or feeling we desire to have. In our brain we have a family of neurotransmitters called endorphins. Most notable among this group of chemicals is dopamine. This is the chemical that acts as a pleasure giver in our brain. When we engage in something that results in our being rewarded in some manner, it is the release of dopamine whenever we engage in that behavior that rewards us or makes us feel good. And because we feel good, we return to that behavior to feel the same way again.

An example of how this primary process works can be seen in our food intake. It is not what we eat as much as how, when, and why we ate that food. When I was a young boy, I had my tonsils out. To soothe my throat, my mother gave me bowls of ice cream. It tasted good, and made my throat hurt less. Thus the connection between feeling bad and eating ice cream to feel better is made. Let’s say I am feeling bad and I eat some ice cream and it makes me feel better again. Now that connection can become an addiction to food if we have low self-esteem and psychic pain and pull out that tub of ice cream, which we now have a connection between feeling better when we eat ice cream. The more often we follow this circular route, the stronger that addiction becomes and we gain weight.

This is one of the things we are looking for, because it can sabotage our journey.

We also look for any evidence of the lack of a support group. If we don’t have a good support group, other people such as friends or family can work to sabotage our progress by “feeding us.” Or, they will seek other ways to hinder the weight loss. If we lack a good support group, it will be extremely difficult to cope with many of the events that occur during our journey. Often one’s spouse or mate couple with us because of our larger size. When we link to them, a quasi-contract is formed that states we will not change. An equilibrium is achieved. By losing the weight and changing the contract unilaterally the balance is upset, and interferes with a successful life restructuring program.

We also look for other conditions or states of mind that would interfere with your journey. For instance, why do you want to become healthier? Are you being coerced into the surgery, or do you have unhealthy expectations of the surgery?

The psych evaluation is a tool to assist both us and the surgeons create a new you.

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