Advertisement

Obesity Surgery

, Volume 18, Issue 10, pp 1330–1337 | Cite as

Preoperative Psychological Testing—Another Form of Prejudice

  • David AshtonEmail author
  • Franco Favretti
  • Gianni Segato
Review

Abstract

Preoperative psychological screening of bariatric surgery candidates has become routine, and a significant proportion of patients have their surgery deferred as a consequence. If psychological testing is being used as a form of preoperative triage, both patients and surgeons are entitled to know whether there is sufficient evidence to justify its use in this way. We define the argument for psychological screening as consisting of four premises (p1–p4) and a conclusion (C) as follows: (p1) A significant minority of obese patients will not be successful in losing weight following bariatric surgery—the “failure” group; (p2) A significant minority of patients will exhibit abnormal psychological profiles during preoperative testing; (p3) The majority of individuals referred to in (p2) will be found in group (p1) i.e., abnormal psychological profiles identified preoperatively predict less favorable weight loss outcomes postoperatively; (p4) Identifying patients with adverse psychological profiles preoperatively would allow either exclusion of those at high risk of failure or provide a more secure rationale for targeted pre- and postoperative support; (C) Psychological screening should be part of the routine preoperative assessment for patients undergoing obesity surgery. We reviewed the literature to find evidence to support the premises and show that (p1) can be justified but that (p2) is problematic and can only be accepted in a heavily qualified version. We find no evidence for (p3) and since (p4) and (C) are predicated on (p3), the argument clearly fails. There is no evidence to suggest that preoperative psychological screening can predict postoperative outcomes and no justification for using such testing as a means of discriminating between candidates presenting themselves for bariatric surgery.

Keywords

Predictors of success Psychological screening Bariatric surgery Psychopathology Psychological profile Psychosocial factors 

Notes

Acknowledgment

The authors would like to thank Mr Nick Everitt for his helpful comments on a first draft of this paper.

References

  1. 1.
    McTigue KM, Harris R, Hemphill B, et al. Screening and intervention for obesity in adults: summary of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2003;139:933–49.PubMedGoogle Scholar
  2. 2.
    O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006;144:625–33.PubMedGoogle Scholar
  3. 3.
    O’Brien PE, McPhail T, Chaston TB, Dixon JB. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–40.PubMedCrossRefGoogle Scholar
  4. 4.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  5. 5.
    Dixon JB, O’Brien PE. Changes in co-morbidities and improvements in quality of life after LAP-BAND placement. Am J Surg. 2002;184:51S–4S.PubMedCrossRefGoogle Scholar
  6. 6.
    Dixon JB, O’Brien PE. Lipid profile in the severely obese; changes with weight after lap-band surgery. Obes Res. 2002;10:903–10.PubMedCrossRefGoogle Scholar
  7. 7.
    Busetto L, Sergi G, Enzi G, et al. Short-term effects of weight loss on the cardiovascular risk factors in morbidly obese patients. Obes Res. 2004;12:1256–63.PubMedCrossRefGoogle Scholar
  8. 8.
    Dixon JB, O’Brien PE. Bariatric surgery provides unparalleled metabolic benefits. Obes Surg. 2007;17:193.PubMedCrossRefGoogle Scholar
  9. 9.
    Phelan S, Wadden TA, Berkowitz RI, et al. Impact of weight loss on the metabolic syndrome. Int J Obes. 2007;31:1442–8.CrossRefGoogle Scholar
  10. 10.
    Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;23:741–52.CrossRefGoogle Scholar
  11. 11.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after bypass surgery. N Engl J Med. 2007;357:753–61.PubMedCrossRefGoogle Scholar
  12. 12.
    Favretti F, Segato G, Ashton WD, et al. Laparoscopic adjustable gastric banding in 1,791 consecutive patients; 12-year results. Obes Surg. 2007;17:168–75.PubMedCrossRefGoogle Scholar
  13. 13.
    Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity and health care use in morbidly obese patients. Ann Surg. 2004;240:416–24.PubMedCrossRefGoogle Scholar
  14. 14.
    Sugerman HJ, Londrey GL, Kellum JM. Weight loss with vertical banded gastroplasty and Roux-y gastric bypass with selective vs random assignment. Am J Surg. 1989;157:93–102.PubMedCrossRefGoogle Scholar
  15. 15.
    Brolin RE, Kenler HA, Gorman RC, Cody RP. The dilemma of outcome assessment after operations for morbid obesity. Surgery. 1989;105:337–46.PubMedGoogle Scholar
  16. 16.
    Hsu LKG, Benotti PN, Dwyer J, et al. Nonsurgical factors that influence the outcome of bariatric surgery; a review. Psychosom Med. 1998;60:338–46.PubMedGoogle Scholar
  17. 17.
    Lanyon RI, Maxwell BM. Predictors of outcome after gastric bypass surgery. Obes Surg. 2007;17:321–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Devlin MJ, Goldfein JA, Flanebaum L, et al. Surgical management of obese patients with eating disorders: a survey of current practice. Obes Surg. 2004;14:1252–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Hubbard VS, Hall WH. Gastrointestinal surgery for severe obesity. Obes Surg. 1991;1:257–65.PubMedCrossRefGoogle Scholar
  20. 20.
    LeMont D, Moorehead MK, Parish MS, et al. Suggestions for the pre-surgical psychological assessment of bariatric surgery candidates. Allied Health sciences section ad hoc Behavioural Health Committee 2004. American Society for Metabolic and Bariatric Surgery.Google Scholar
  21. 21.
    Fabricatore AN, Crerand CE, Wadden T, et al. How do mental health professionals evaluate candidates for bariatric surgery? Survey results. Obes Surg. 2006;16:567–73.PubMedCrossRefGoogle Scholar
  22. 22.
    Van Hout GC, Leibbrandt AJ, Jakimowicz JJ, et al. Bariatric surgery and bariatric psychology: general overview and the Dutch approach. Obes Surg. 2003;13:926–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Bauchowitz AU, Gonder-Frederick LA, Olbrisch ME, et al. Psychosocial evaluation of bariatric surgery candidates; a survey of present practices. Psychosom Med. 2005;67:825-32.PubMedCrossRefGoogle Scholar
  24. 24.
    Sarwer DB, Cohn NI, Gibbons LM, et al. Psychiatric diagnosis and psychiatric treatment among bariatric surgery candidates. Obes Surg. 2004;14:1148–56.CrossRefGoogle Scholar
  25. 25.
    Pawlow LA, O’Neil PM, White MA, et al. Findings and outcomes of psychological evaluations of gastric bypass applications. Surg Obes Relat Dis. 2005;1:523–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Mason EE, Maher JW, Scott DH, et al. Ten years of vertical banded gastroplasty for severe obesity. Probl Gen Surg. 1992;9:280–9.Google Scholar
  27. 27.
    Halverson JD, Zuckerman GR, Koehler RE, et al. Gastric bypass for morbid obesity: a medical-surgical assessment. Ann Surg. 1981;194:152–60.PubMedCrossRefGoogle Scholar
  28. 28.
    Dixon JB, McPhail T, O’Brien PE. Minimal reporting requirements for weight loss: current methods not ideal. Obes Surg. 2005;15:1034–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Sarwer DB, Cohn NI, Gibbons LM, et al. Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates. Obes Surg. 2004;14:1148–56.PubMedCrossRefGoogle Scholar
  30. 30.
    Gertler R, Ramsey-Stewart G. Pre-operative psychiatric assessment of patients presenting for gastric bariatric surgery (surgical control of morbid obesity). Aust N Z J Surg. 1986;56:157–61.PubMedCrossRefGoogle Scholar
  31. 31.
    Onyike CU, Crum RM, Lee HB, et al. Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey. Am J Epidemiol. 2003;158:1139–47.PubMedCrossRefGoogle Scholar
  32. 32.
    Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioural aspects of bariatric surgery. Obes Res. 2005;12:639–48.CrossRefGoogle Scholar
  33. 33.
    American Psychiatric Association. Diagnosis and statistical manual of mental disorders: revision, DSM-III. 3rd ed. Washington, DC: American Psychiatric Association; 1980.Google Scholar
  34. 34.
    American Psychiatric Association. Diagnosis and statistical manual of mental disorders: revision, DSM-III-R. 3rd ed. Washington, DC: American Psychiatric Association; 1987.Google Scholar
  35. 35.
    Glinksi J, Wetzler S, Goodman E. The psychology of gastric bypass surgery. Obes Surg. 2001;11:581–8.CrossRefGoogle Scholar
  36. 36.
    Herpertz S, Kielmann R, Wolf AM, et al. Does obesity surgery improve psychosocial functioning? Int J Obes. 2003;27:1300–14.CrossRefGoogle Scholar
  37. 37.
    Gentry K, Halverson JD, Heisler S. Psychological assessment of morbidly obese patients undergoing bypass: a comparison of pre-operative and post-operative adjustment. Surgery. 1984;94:215–20.Google Scholar
  38. 38.
    Gertler R, Ramsay-Stewart G. Pre-operative psychiatric assessment of patients presenting for gastric bariatric surgery (surgical control of morbid obesity). Aust N Z J Surg. 1986;56:157–61.PubMedCrossRefGoogle Scholar
  39. 39.
    Powers PS, Rosemurgy A, Boyd F, Perez A. Outcome of gastric restriction procedures; weight, psychiatric diagnoses, and satisfaction. Obes Surg. 1997;7:471–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Powers PS, Boyd F, Blair CR, et al. Psychiatric issues in bariatric surgery. Obes Surg. 1992;2:315–25.PubMedCrossRefGoogle Scholar
  41. 41.
    Larsen F. Psychosocial function before and after gastric banding surgery for morbid obesity: a prospective psychiatric study. Acta Psychiatr Scand Suppl. 1990;359:1–57.PubMedGoogle Scholar
  42. 42.
    Rosik CH. Psychiatric symptoms among prospective bariatric surgery patients: rates of prevalence and their relation to social desirability, pursuit of surgery and follow-up attendance. Obes Surg. 2005;15:677–83.PubMedCrossRefGoogle Scholar
  43. 43.
    Kalarchian MA, Marcus MD, Levine MD, et al. Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatr. 2007;164:328–34.PubMedCrossRefGoogle Scholar
  44. 44.
    Adami GF, Gandolfo P, Bauer B, Scopinaro N. Binge eating in massively obese patients undergoing bariatric surgery. Int J Eat Disord. 1995;17:45–50.PubMedCrossRefGoogle Scholar
  45. 45.
    Kalarchian MA, Wilson GT, Brolin RE, Bradley L. Binge eating in bariatric surgery patients. Int J Eat Disord. 1998;23:89–92.PubMedCrossRefGoogle Scholar
  46. 46.
    Kalarchian MA, Wilson GT, Brolin RE, Bradley L. Assessment of eating disorders in bariatric surgery candidates: self-report questionnaire versus interview. Int J Eat Disord. 2000;28:465–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Powers PS, Perez A, Boyd F, Rosemurgy A. Eating pathology before and after bariatric surgery: a prospective study. Int J Eat Disord. 1999;25:293–300.PubMedCrossRefGoogle Scholar
  48. 48.
    deZwaan M, Mitchell JE, Howell LM, et al. Characteristics of morbidly obese patients before gastric bypass surgery. Compr Psychiatry. 2003;44:428–34.CrossRefGoogle Scholar
  49. 49.
    Hsu LK, Mulliken B, McDonagh B, et al. Binge eating disorder in extreme obesity. Int J Obes Relat Metab Disord 2002;26:1398–403.PubMedCrossRefGoogle Scholar
  50. 50.
    Wadden TA, Sarwer DB, Womble LG, Foster GD, McGuckin BG, Schimmel A. Psychosocial aspects of obesity and obesity surgery. Surg Clin North Am. 2001;81:1001–24.PubMedCrossRefGoogle Scholar
  51. 51.
    Maddi SR, Khoshaba DM, Persico M, et al. Psychosocial correlates of psychopathology in a national sample of the morbidly obese. Obes Surg. 1997;7:397–404.PubMedCrossRefGoogle Scholar
  52. 52.
    Black DW, Goldstein RB, Mason EE. Prevalence of mental disorder in 88 morbidly obese bariatric clinic patients. Am J Psychiatry. 1992;149:227–34.PubMedGoogle Scholar
  53. 53.
    Widiger TA, Clark LA. Towards DSM-V and the classification of psychopathology. Psychol Bull. 2000;126:946–63.PubMedCrossRefGoogle Scholar
  54. 54.
    Kutchins H, Kirk SA. DSM-III: the conflict over new psychiatric diagnoses. Health Soc Work. 1989;14:91–101.PubMedGoogle Scholar
  55. 55.
    Sadler JZ, Hulgus YF, Agich GJ. On values in recent American psychiatric classification. J Med Philos. 1994;19:261–77.PubMedGoogle Scholar
  56. 56.
    Goodwin D, Guze S. Psychiatric diagnosis. 4th ed. New York: Oxford University Press; 1989.Google Scholar
  57. 57.
    Clark L, Livesley J, Morley L. Personality disorder assessment: the challenge of construct validity. J Pers Disord. 1997;11:205–31.PubMedGoogle Scholar
  58. 58.
    Kendell R, Jablensky A. Distinguishing between the vaidity and utility of psychiatric diagnoses. Am J Psychiatry. 2003;160:4–12.PubMedCrossRefGoogle Scholar
  59. 59.
    Buchanan A. Georges Canguilhem and the diagnosis of personality disorder. J Am Acad Psychiatry Law. 2007;35:148–51.PubMedGoogle Scholar
  60. 60.
    Powers PS, Rosemurgy A, Boyd F, et al. Outcome of gastric restriction procedures: weight, psychiatric diagnoses and satisfaction. Obes Surg. 1997;7:471–7.PubMedCrossRefGoogle Scholar
  61. 61.
    Vallis TM, Butler GS, Perey B, et al. The role of psychological functioning in morbid obesity and its treatment with gastroplasty. Obes Surg. 2001;11:716–25.PubMedCrossRefGoogle Scholar
  62. 62.
    Black DW, Goldstein RB, Mason EE. Psychiatric diagnosis and weight loss following gastric surgery for obesity. Obes Surg. 2003;13:746–51.PubMedCrossRefGoogle Scholar
  63. 63.
    Averbukh Y, Heshka S, El-Shoreya H, et al. Depression score predicts weight loss following Roux-en-Y gastric bypass. Obes Surg. 2003;13:833–6.PubMedCrossRefGoogle Scholar
  64. 64.
    Clark MM, Balsiger BM, Sletten CD, et al. Psychosocial factors and 2-year outcome following bariatric surgery for weight loss. Obes Surg. 2003;13:739–45.PubMedCrossRefGoogle Scholar
  65. 65.
    Herpertz S, Kielmann R, Wolf AM, Hebebrand J, Senf W. Do psychosocial variables predict weight loss or mental health after obesity surgery? A systematic review. Obes Res. 2004;12:1554–69.PubMedCrossRefGoogle Scholar
  66. 66.
    van Hout GCM, Verschure SKM, van Heck GL. Psychosocial predictors of success following bariatric surgery. Obes Surg. 2005;15:552–60.PubMedCrossRefGoogle Scholar
  67. 67.
    Wadden TA, Sarwer DB, Fabricatore AN, et al. Psychosocial and behavioural status of patients undergoing bariatric surgery: what to expect before and after surgery. Med Clin N Am. 2007;91:451–69.PubMedCrossRefGoogle Scholar
  68. 68.
    Ryden O, Hedenbro JL, Frederiksen SG. Weight loss after vertical banded gastroplasty can be predicted: a prospective psychological study. Obes Surg. 1996;6:237–43.CrossRefGoogle Scholar
  69. 69.
    Leombruni P, Piero A, Dosio D, et al. Psychological predictors of outcome in vertical banded gastroplasty: a 6-month prospective pilot study. Obes Surg. 2007;17:941–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Sallet PC, Sallet JA, Dixon JB, et al. Eating behaviour as a prognostic factor for weight loss after gastric bypass. Obes Surg. 2007;17:445–51.PubMedCrossRefGoogle Scholar
  71. 71.
    Burgmer R, Grigutsch K, Zipfel S, et al. The influence of eating behaviour and eating pathology on weight loss after gastric resection operations. Obes Surg. 2005;15:684–91.PubMedCrossRefGoogle Scholar
  72. 72.
    Powers PS, Perez A, Boyd F, et al. Eating pathology before and after bariatric surgery. A prospective study. Int J Eat Disord. 1999;25:293–300.PubMedCrossRefGoogle Scholar
  73. 73.
    Bocchieri-Ricciardi LE, Chen EY, Munoz D. Pre-surgery binge eating status: effect on eating behaviour and weight outcome after gastric bypass. Obes Surg. 2006;16:1198–204.PubMedCrossRefGoogle Scholar
  74. 74.
    Busetto l, Segato G, De Marchi F, et al. Outcome predictors in morbidly obese recipients of an adjustable gastric band. Obes Surg. 2002;12:83–92.PubMedCrossRefGoogle Scholar
  75. 75.
    Dziurowicz-Kozlowska AH, Wierzbicki Z, Lisik W, et al. The objective of psychological evaluation in the process of qualifying candidates for bariatric surgery. Obes Surg. 2006;16:196–202.PubMedCrossRefGoogle Scholar
  76. 76.
    Sobal J, Stunkard AJ. Socioeconomic status and obesity: a review of the literature. Psychol Bull. 1989;105:260–7.PubMedCrossRefGoogle Scholar
  77. 77.
    National Institute of Health. The practical guide: identification, evaluation and treatment of overweight and obesity in adults. Publication number 00-4084. National Institute of Health, October 2000.Google Scholar
  78. 78.
    van Gemert WG, Severijns RM, Greve JWM, et al. Psychological functioning of morbidly obese patients after surgical treatment. Int J Obes. 1998;22:393–8.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  1. 1.Imperial College School of MedicineLondonUK
  2. 2.Healthier Weight CentreBirminghamUK
  3. 3.Department of SurgeryRegional HospitalVicenzaItaly

Personalised recommendations