Obesity Surgery

, Volume 19, Issue 3, pp 369–377 | Cite as

Psychosocial Evaluation for Bariatric Surgery: The Boston Interview and Opportunities for Intervention

  • Stephanie SoggEmail author
  • DeAnna L. Mori


The process of psychosocial evaluation for weight loss surgery (WLS) is one that goes beyond serving the function of information-gathering (Bauchowitz et al. in Surg Obes Relat Dis 3:554–558, 2007; Friedman et al. in Surg Obes Relat Dis 3:376–382, 2007; Lanyon and Maxwell in Obes Surg 17:321–328, 2007; Sogg and Mori in Obes Surg 14:370–380, 2004; Sogg and Mori in Surg Obes Relat Dis 4:455–463, 2008). This process offers myriad opportunities for delivering significant and powerful interventions that can enhance the patient’s success in the WLS process. A discussion of the unique opportunities for psychosocial intervention afforded by the pre-surgical evaluation process is presented, using The Boston Interview for Bariatric Surgery (Sogg and Mori in Surg Obes Relat Dis 4:455–463, 2008) as the organizing framework.


Bariatric surgery/psychology Behavior Humans Obesity Morbid/psychology/surgery 


  1. 1.
    Bauchowitz A, Azarbad L, Day K, et al. Evaluation of expectations and knowledge in bariatric surgery patients. Surg Obes Relat Dis. 2007;3:554–8.CrossRefGoogle Scholar
  2. 2.
    Friedman KE, Applegate KL, Grant J. Who is adherent with preoperative psychological treatment recommendations among weight loss surgery candidates? Surg Obes Relat Dis. 2007;3:376–82.CrossRefGoogle Scholar
  3. 3.
    Lanyon R, Maxwell B. Predictors of outcome after gastric bypass surgery. Obes Surg. 2007;17:321–8.CrossRefGoogle Scholar
  4. 4.
    Sogg S, Mori DL. The Boston Interview for Gastric Bypass: Determining the psychological suitability of surgical candidates. Obes Surg. 2004;14:370–80.CrossRefGoogle Scholar
  5. 5.
    Sogg S, Mori DL. Revising the Boston Interview: Incorporating new knowledge and experience. Surg Obes Relat Dis. 2008;4:455–63.CrossRefGoogle Scholar
  6. 6.
    NIH Consensus Development Conference Panel. Gastrointestinal surgery for severe obesity. Consensus development conference panel. Ann Intern Med. 1991;115:956–61.CrossRefGoogle Scholar
  7. 7.
    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.CrossRefGoogle Scholar
  8. 8.
    Devlin MJ, Goldfein JA, Flancbaum L, et al. Surgical management of obese patients with eating disorders: A survey of current practice. Obes Surg. 2004;14:1252–7.CrossRefGoogle Scholar
  9. 9.
    Kalarchian MA, Marcus MD, Levine MD, et al. Psychiatric disorders among bariatric surgery candidates: Relationship to obesity and functional health status. Am J Psychiatry. 2007;164:328–34.CrossRefGoogle Scholar
  10. 10.
    Pawlow LA, O'Neil PM, White MA, et al. Findings and outcomes of psychological evaluations of gastric bypass applicants. Surg Obes Relat Dis. 2005;1:523–7. discussion 528–529.CrossRefGoogle Scholar
  11. 11.
    Wadden TA, Butryn ML, Sarwer DB, et al. Comparison of psychosocial status in treatment-seeking women with class III vs. Class I-II obesity. Obesity 2006;14:90S–98S.PubMedGoogle Scholar
  12. 12.
    Greenberg I, Sogg S, Perna F. Behavioral and psychological care in weight loss surgery—best practice update. Obesity; In Press (2008).Google Scholar
  13. 13.
    Wadden TA, Sarwer DB. Behavioral assessment of candidates for bariatric surgery: A patient-oriented approach. Obesity 2006;14(Suppl 2):53S–62S.PubMedGoogle Scholar
  14. 14.
    Hebl MR, Xu J. Weighing the care: Physicians' reactions to the size of a patient. Int J Obes. 2001;25:1246–52.CrossRefGoogle Scholar
  15. 15.
    Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001;9:788–805.CrossRefGoogle Scholar
  16. 16.
    Schwartz MB, Chambliss HO, Brownell KD, et al. Weight bias among health professionals specializing in obesity. Obes Res. 2003;11:1033–9.CrossRefGoogle Scholar
  17. 17.
    Teachman BA, Brownell KD. Implicit anti-fat bias among health professionals: Is anyone immune? Int J Obes Relat Metab Disord. 2001;25:1525–31.CrossRefGoogle Scholar
  18. 18.
    van Hout GC, Boekestein P, Fortuin FA, et al. Psychosocial functioning following bariatric surgery. Obes Surg. 2006;16:787–94.CrossRefGoogle Scholar
  19. 19.
    O'Neil PM. Editorial: Lessons from, and on, the psychological assessment of bariatric surgery patients. Surg Obes Relat Dis. 2006;2:133–5.CrossRefGoogle Scholar
  20. 20.
    Kushner RF, Roth JL. Medical evaluation of the obese individual. Psychiatr Clin North Am. 2005;28:89–103. viii.CrossRefGoogle Scholar
  21. 21.
    Ma Y, Pagoto SL, Olendzki BC, et al. Predictors of weight status following laparoscopic gastric bypass. Obes Surg. 2006;16:1227–31.CrossRefGoogle Scholar
  22. 22.
    Fabricatore AN, Crerand CE, Wadden TA, et al. How do mental health professionals evaluate candidates for bariatric surgery? Survey results. Obes Surg. 2006;16:567–73.CrossRefGoogle Scholar
  23. 23.
    Boan J, Kolotkin RL, Westman EC, et al. Binge eating, quality of life and physical activity improve after Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2004;14:341–8.CrossRefGoogle Scholar
  24. 24.
    Colles SL, Dixon JB, O'Brien PE. Grazing and loss of control related to eating: Two high-risk factors following bariatric surgery. Obesity 2008;16:615–22.CrossRefGoogle Scholar
  25. 25.
    Green AE, Dymek-Valentine M, Pytluk S, et al. Psychosocial outcome of gastric bypass surgery for patients with and without binge eating. Obes Surg. 2004;14:975–85.CrossRefGoogle Scholar
  26. 26.
    Malone M, Alger-Mayer S. Binge status and quality of life after gastric bypass surgery: A one-year study. Obes Res. 2004;12:473–81.CrossRefGoogle Scholar
  27. 27.
    White MA, Masheb RM, Rothschild BS, et al. The prognostic significance of regular binge eating in extremely obese gastric bypass patients: 12-month postoperative outcomes. J Clin Psychiatry. 2006;67:1928–35.CrossRefGoogle Scholar
  28. 28.
    Bocchieri-Ricciardi LE, Chen EY, Munoz D, et al. Pre-surgery binge eating status: Effect on eating behavior and weight outcome after gastric bypass. Obes Surg. 2006;16:1198–204.CrossRefGoogle Scholar
  29. 29.
    Burgmer R, Grigutsch K, Zipfel S, et al. The influence of eating behavior and eating pathology on weight loss after gastric restriction operations. Obes Surg. 2005;15:684–91.CrossRefGoogle Scholar
  30. 30.
    Fujioka K, Yan E, Wang HJ, et al. Evaluating preoperative weight loss, binge eating disorder, and sexual abuse history on roux-en-y gastric bypass outcome. Surg Obes Relat Dis. 2008;4:137–43.CrossRefGoogle Scholar
  31. 31.
    Hsu LK, Sullivan SP, Benotti PN. Eating disturbances and outcome of gastric bypass surgery: A pilot study. Int J Eat Disord. 1997;21:385–90.CrossRefGoogle Scholar
  32. 32.
    Kalarchian MA, Wilson GT, Brolin RE, et al. Effects of bariatric surgery on binge eating and related psychopathology. Eat Weight Disord. 1999;4:1–5.CrossRefGoogle Scholar
  33. 33.
    Kalarchian MA, Marcus MD, Wilson GT, et al. Binge eating among gastric bypass patients at long-term follow-up. Obes Surg. 2002;12:270–5.CrossRefGoogle Scholar
  34. 34.
    Latner JD, Wetzler S, Goodman ER, et al. Gastric bypass in a low-income, inner-city population: Eating disturbances and weight loss. Obes Res. 2004;12:956–61.CrossRefGoogle Scholar
  35. 35.
    Mitchell JE, Lancaster KL, Burgard MA, et al. Long-term follow-up of patients' status after gastric bypass. Obes Surg. 2001;11:464–8.CrossRefGoogle Scholar
  36. 36.
    Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13:639–48.CrossRefGoogle Scholar
  37. 37.
    Saunders R. "grazing": A high-risk behavior. Obes Surg. 2004;14:98–102.CrossRefGoogle Scholar
  38. 38.
    Hsu LK, Betancourt S, Sullivan SP. Eating disturbances before and after vertical banded gastroplasty: A pilot study. Int J Eat Disord. 1996;19:23–34.CrossRefGoogle Scholar
  39. 39.
    Larsen JK, van Ramshorst B, Geenen R, et al. Binge eating and its relationship to outcome after laparoscopic adjustable gastric banding. Obes Surg. 2004;14:1111–7.CrossRefGoogle Scholar
  40. 40.
    Bocchieri LE, Meana M, Fisher BL. A review of psychosocial outcomes of surgery for morbid obesity. J Psychosom Res. 2002;52:155–65.CrossRefGoogle Scholar
  41. 41.
    Fischer S, Chen E, Katterman S, et al. Emotional eating in a morbidly obese bariatric surgery-seeking population. Obes Surg. 2007;17:782–8.CrossRefGoogle Scholar
  42. 42.
    Guerdjikova A, West-Smith L, McElroy S, et al. Emotional eating and emotional eating alternatives in subjects undergoing bariatric surgery. Obes Surg. 2007;17:1091–6.CrossRefGoogle Scholar
  43. 43.
    Friedman JM. Modern science versus the stigma of obesity. Nat Med. 2004;10:563–9.CrossRefGoogle Scholar
  44. 44.
    Teachman BA, Gapinski KD, Brownell KD, et al. Demonstrations of implicit anti-fat bias: The impact of providing causal information and evoking empathy. Health Psychol. 2003;22:68–78.CrossRefGoogle Scholar
  45. 45.
    Wang SS, Brownell KD, Wadden TA. The influence of the stigma of obesity on overweight individuals. Int J Obes Relat Metab Disord. 2004;28:1333–7.CrossRefGoogle Scholar
  46. 46.
    Farooqi IS, O'Rahilly S. Genetic factors in human obesity. Obes Rev. 2007;8(Suppl 1):37–40.CrossRefGoogle Scholar
  47. 47.
    Miller AD, Smith KM. Medication and nutrient administration considerations after bariatric surgery. Am J Health Syst Pharm. 2006;63:1852–7.CrossRefGoogle Scholar
  48. 48.
    Raper SE, Sarwer DB. Informed consent issues in the conduct of bariatric surgery. Surg Obes Relat Dis. 2008;4:60–8.CrossRefGoogle Scholar
  49. 49.
    Giusti V, De Lucia A, Di Vetta V, et al. Impact of preoperative teaching on surgical option of patients qualifying for bariatric surgery. Obes Surg. 2004;14:1241–6.CrossRefGoogle Scholar
  50. 50.
    Suter M, Calmes JM, Paroz A, et al. A 10-year experience with laparoscopic gastric banding for morbid obesity: High long-term complication and failure rates. Obes Surg. 2006;16:829–35.CrossRefGoogle Scholar
  51. 51.
    Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus roux-en-y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis. 2007;3:127–32.CrossRefGoogle Scholar
  52. 52.
    Elder KA, Wolfe BM. Bariatric surgery: A review of procedures and outcomes. Gastroenterology 2007;132:2253–71.CrossRefGoogle Scholar
  53. 53.
    Delin CR, Watts JM, Saebel JL, et al. Eating behavior and the experience of hunger following gastric bypass surgery for morbid obesity. Obes Surg. 1997;7:405–13.CrossRefGoogle Scholar
  54. 54.
    Delin CR, Anderson PG. A preliminary comparison of the psychological impact of laparoscopic gastric banding and gastric bypass surgery for morbid obesity. Obes Surg. 1999;9:155–60.CrossRefGoogle Scholar
  55. 55.
    Taddeucci RJ, Madan AK, Tichansky DS. Band versus bypass: Influence of an educational seminar and surgeon visit on patient preference. Surg Obes Relat Dis. 2007;3:452–5.CrossRefGoogle Scholar
  56. 56.
    Dalle Grave R, Calugi S, Molinari E, et al. Weight loss expectations in obese patients and treatment attrition: An observational multicenter study. Obes Res. 2005;13:1961–9.CrossRefGoogle Scholar
  57. 57.
    Fabricatore AN, Wadden TA, Womble LG, et al. The role of patients' expectations and goals in the behavioral and pharmacological treatment of obesity. Int J Obes. 2007;31:1739–45.CrossRefGoogle Scholar
  58. 58.
    Foster GD, Kendall PC. The realistic treatment of obesity: Changing the scales of success. Clin Psychol Rev. 1994;14:701–36.CrossRefGoogle Scholar
  59. 59.
    Linde JA, Jeffery RW, Levy RL, et al. Weight loss goals and treatment outcomes among overweight men and women enrolled in a weight loss trial. Int J Obes. 2005;29:1002–5.CrossRefGoogle Scholar
  60. 60.
    Wadden TA, Womble LG, Sarwer DB, et al. Great expectations: "i'm losing 25% of my weight no matter what you say". J Consult Clin Psychol. 2003;71:1084–9.CrossRefGoogle Scholar
  61. 61.
    Kaly P, Orellana S, Torrella T, et al. Unrealistic weight loss expectations in candidates for bariatric surgery. Surg Obes Relat Dis. 2008;4:6–10.CrossRefGoogle Scholar
  62. 62.
    Wee CC, Jones DB, Davis RB, et al. Understanding patients' value of weight loss and expectations for bariatric surgery. Obes Surg. 2006;16:496–500.CrossRefGoogle Scholar
  63. 63.
    White M, Masheb R, Rothschild B, et al. Do patients' unrealistic weight goals have prognostic significance for bariatric surgery? Obes Surg. 2007;17:74–81.CrossRefGoogle Scholar
  64. 64.
    Foster GD, Wadden TA, Vogt RA, et al. What is a reasonable weight loss? Patients' expectations and evaluations of obesity treatment outcomes. J Consult Clin Psychol. 1997;65:79–85.CrossRefGoogle Scholar
  65. 65.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.CrossRefGoogle Scholar
  66. 66.
    Ray EC, Nickels MW, Sayeed S, et al. Predicting success after gastric bypass: The role of psychosocial and behavioral factors. Surgery 2003;134:555–63.CrossRefGoogle Scholar
  67. 67.
    Wadden TA, Sarwer DB, Fabricatore AN, et al. Psychosocial and behavioral status of patients undergoing bariatric surgery: What to expect before and after surgery. Med Clin N Am. 2007;91:451–69.CrossRefGoogle Scholar
  68. 68.
    Bocchieri LE, Meana M, Fisher BL. Perceived psychosocial outcomes of gastric bypass surgery: A qualitative study. Obes Surg. 2002;12:781–8.CrossRefGoogle Scholar
  69. 69.
    Higgs ML, Wade T, Cescato M, et al. Differences between treatment seekers in an obese population: Medical intervention vs. Dietary restriction. J Behav Med. 1997;20:391–405.CrossRefGoogle Scholar
  70. 70.
    Larsen JK, Geenen R. Childhood sexual abuse is not associated with a poor outcome after gastric banding for severe obesity. Obes Surg. 2005;15:534–7.CrossRefGoogle Scholar
  71. 71.
    Oppong BA, Nickels MW, Sax HC. The impact of a history of sexual abuse on weight loss in gastric bypass patients. Psychosomatics 2006;47:108–11.CrossRefGoogle Scholar
  72. 72.
    Kalarchian M, Courcoulas A, Levine M, et al. Presurgery psychiatric disorders are associated with smaller reductions in bmi at 6 months after gastric bypass. Surg Obes Relat Dis. 2007;3:280.CrossRefGoogle Scholar
  73. 73.
    Kinzl JF, Schrattenecker M, Traweger C, et al. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;16:1609–14.CrossRefGoogle Scholar
  74. 74.
    Sogg S. Is major mental illness a clear contraindication for weight loss surgery? Bariatric Nursing and Surgical Patient Care. 2006;1:293–4.CrossRefGoogle Scholar
  75. 75.
    Sarwer D, Wadden TA. Editorial comment: Findings and outcomes of psychological evaluations of gastric bypass applicants. Surg Obes Relat Dis. 2005;1:528–9.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  1. 1.Massachusetts General Hospital Weight CenterHarvard Medical SchoolBostonUSA
  2. 2.VA Boston Healthcare SystemBoston University School of MedicineBostonUSA

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