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Psychological Evaluation of Bariatric Surgery Applicants: Procedures and Reasons for Delay or Denial of Surgery

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Psychologists play an important role as members of the bariatric surgery team. The current investigation examined the frequency with which psychologists recommend delay or denial of surgery for psychological reasons, the procedures they use in making their clinical decisions, and the reasons for such conclusions.


A sample of 103 psychologists with experience in conducting pre-surgical psychological evaluations responded to a brief survey.


There was significant variability in the number of evaluations psychologists complete and the instruments they use to make their clinical decisions. For most candidates, the evaluation results in psychological clearance for surgery. However, approximately 15%, on average, are delayed or denied for psychological reasons. The most common reasons for delaying or denying surgery were significant psychopathology (including psychosis or bipolar disorder), untreated or undertreated depression, and lack of understanding about the risks and postoperative requirements of surgery, which were reported by 51, 39, and 30% of respondents, respectively. Several other reasons were reported less frequently and many appeared to be idiosyncratic.


Psychologists differ in their preoperative evaluation practices. Further research is needed to determine the reasons for the variability in clinical decision making and the long-term medical and psychosocial outcomes associated with the recommendation to delay or deny surgery for psychosocial reasons. When patients receive such a recommendation, they can be encouraged to seek a second opinion from a mental health professional with bariatric expertise.

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Correspondence to Steven Walfish.

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Walfish, S., Vance, D. & Fabricatore, A.N. Psychological Evaluation of Bariatric Surgery Applicants: Procedures and Reasons for Delay or Denial of Surgery. OBES SURG 17, 1578–1583 (2007).

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