The Role of the Psychologist in the Management of the Bariatric Patient

  • Ninoska D. Peterson


Multidisciplinary teams are utilized to assess and treat morbid obesity and are considered standard of care for patients seeking bariatric surgery. In addition to the medical comorbidities associated with morbid obesity, there are negative psychological consequences. Research on predictive psychosocial factors is inconsistent, but common findings suggest that psychiatric disorders, cognitive functioning, personality factors, and eating pathology can affect both short- and long-term outcomes of weight loss surgery. While practice standards have not been defined for psychological evaluations, this chapter aims to describe general domains that have been agreed upon by clinicians. Information obtained during the clinical interview is key for assessing a patient’s readiness for surgery and for improving postsurgical outcomes. Thus, in addition to reviewing the role of a psychologist in conducting presurgical evaluations, this chapter will describe the role of a psychologist in facilitating psychosocial interventions in the preoperative phase as well as providing long-term care for patients with postoperative issues.


Psychologist Mental health Behavioral health Psychosocial evaluation Bariatric surgery Weight loss surgery Psychosocial factors 


  1. 1.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMedCrossRefGoogle Scholar
  2. 2.
    Courcoulas AP, Christian NJ, Belle SH, Berk PD, Flum DR, Garcia L, et al. Weight change and health outcomes at 3 years after bariatric surgery among individual with severe obesity. JAMA. 2013;310(22):2416–25.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial- a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.PubMedCrossRefGoogle Scholar
  4. 4.
    Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, et al. Bariatric surgery versus intensive medical therapy for diabetes- 5-year outcomes. N Engl J Med. 2017;376(7):641–51.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.PubMedCrossRefGoogle Scholar
  6. 6.
    Hsu LKG, Benotti PN, Dwyer J, Roberts SB, Saltzman E, Shikora S, et al. Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med. 1998;60(3):338–46.PubMedCrossRefGoogle Scholar
  7. 7.
    Sarwar DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13(4):639–48.CrossRefGoogle Scholar
  8. 8.
    NIH Consensus Development Conference Panel. Gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115:956–61.CrossRefGoogle Scholar
  9. 9.
    Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21:S1–27.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Bauchowitz AU, Gonder-Frederick LA, Olbrisch ME, Azarbad L, Ryee MY, Woodson M, et al. Psychosocial evaluation of bariatric surgery candidates: a survey of present practices. Psychosom Med. 2005;67(5):825–32.PubMedCrossRefGoogle Scholar
  11. 11.
    Greenberg I, Sogg S, Perna FM. Behavioral and psychological care in weight loss surgery: best practice update. Obesity. 2009;17(5):880–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Sogg S, Lauretti J, West-Smith L. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis. 2016;12:731–49.PubMedCrossRefGoogle Scholar
  13. 13.
    American Psychological Association (APA). What is APA’s definition of a ‘psychologist’? [Internet]. 2017. [cited 2017 May 1]. Available from:
  14. 14.
    American Psychological Association Practice Organization (APAPO). Prescriptive Authority. [Internet]. 2017. [cited 2017 May 1].Available from:
  15. 15.
    West-Smith L, Sogg S. Creating a credential for bariatric behavioral health professionals: potential benefits, pitfalls, and provider opinion. Surg Obes Relat Dis. 2010;6(6):695–701.PubMedCrossRefGoogle Scholar
  16. 16.
    Fabricatore AN, Crerand CE, Wadden TA, Sarwer DB, et al. How do mental health professionals evaluate candidates for bariatric surgery? Survey results Obes Surg. 2006;16:567–73.PubMedCrossRefGoogle Scholar
  17. 17.
    Sogg S, Mori DL. The Boston Interview for gastric bypass: determining the psychological suitability of surgical candidates. Obes Surg. 2004;14(3):370–80.PubMedCrossRefGoogle Scholar
  18. 18.
    de Zwaan M, Mitchell JE. Eating disorders and eating behavior pre- and post-bariatric surgery. In: Still C, Sarwar DB, Blankenship J, editors. The ASMBS textbook of bariatric surgery. vol. 2: Integrated health; New York: Springer Science; 2014. Chapter 4, p. 25–32.Google Scholar
  19. 19.
    Heinberg LJ, Ashton K, Windover A. Moving beyond dichotomous psychological evaluation: the Cleveland Clinic behavioral rating system for weight loss surgery. Surg Obes Relat Dis. 2010;6(2):185–90.PubMedCrossRefGoogle Scholar
  20. 20.
    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
  21. 21.
    Heinberg LJ, Coughlin JW. The role of behavioral health in bariatric surgery. In: Brethauer SA, Schauer PR, Schirmer BD, editors. Minimally Invasive Bariatric Surgery. 2nd ed. New York: Springer; 2015; Chapter 8. p. 83–92.Google Scholar
  22. 22.
    Gonder-Frederick L, Bauchowitz A, Azarbad L, Bender S, Ryee M, Miller A, et al. Assessment of Patient Knowledge. In: Rosenthal RJ, Jones DB, editors. Weight loss surgery: a multidisciplinary approach. Edgemont: Matric Medical Communications; 2008.Google Scholar
  23. 23.
    Bauchowitz A, Azarbad L, Day K, Gonder-Frederick L. Evaluation of expectations and knowledge in bariatric surgery patients. Surg Obes Relat Dis. 2007;3(5):554–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Price HI, Gregory DM, Twells LK. Weight loss expectations of laparoscopic sleeve gastrectomy candidates compared to clinically expected weight loss outcomes 1-year post-surgery. Obes Surg. 2013;23(12):1987–93.PubMedCrossRefGoogle Scholar
  25. 25.
    Kaly P, Orellana S, Torrella T, Takagishi C, Saff-Koche L, Murr MM. Unrealistic weight loss expectations in candidates for bariatric surgery. Surg Obes Relat Dis. 2008;4(1):6–10.PubMedCrossRefGoogle Scholar
  26. 26.
    Heinberg LJ, Keating K, Simonelli L. Discrepancy between ideal and realistic goal weights in three bariatric surgery procedures: who is likely to be unrealistic? Obes Surg. 2010;20(2):148–53.PubMedCrossRefGoogle Scholar
  27. 27.
    Foster GD, Wadden TA, Vogt RA, Brewer G. What is a reasonable weight loss? Patients' expectations and evaluations of obesity treatment outcomes. J Consult Clin Psychol. 1997;65(1):79–85.PubMedCrossRefGoogle Scholar
  28. 28.
    Cash TF. The psychology of physical appearance: aesthetics, attributes, and image. In: Cash TF, Pruzinsky T, editors. Body images: development, deviance, and change. New York: Guilford Press; 1990. p. 51–79.Google Scholar
  29. 29.
    Huberman WL. The importance of pursuing the patient’s definition of success following weight loss surgery: strategies and considerations for the bariatric team. Bariatric Times. 2013;10(10):1. 14–21Google Scholar
  30. 30.
    Gibbons LM, Sarwer DB, Crerand CE, Fabricatore AN, Kuehnel RH, Lipchutz PE, et al. Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery? Obesity. 2006;14(Suppl 2):70S–6S.PubMedCrossRefGoogle Scholar
  31. 31.
    Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: A systematic review of the literature. J Am Diet Assoc. 2011;111:92–102.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Wadden TA, Osei S. The treatment of obesity: An overview. In: Wadden TA, Stunkard AJ, editors. Handbook of obesity treatment. New York: Guilford Press; 2002. p. 229–48.Google Scholar
  33. 33.
    Peterson ND, Middleton KR, Nackers LM, Medina KE, Milsom VA, Perri MG. Dietary self-monitoring and long-term success with weight management. Obesity. 2014;22(9):1962–7.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  35. 35.
    Mitchell JE, Selzer F, Kalarchian MA, Devlin MJ, Strain G, Elder KA, et al. Psychopathology prior to surgery in the Longitudinal Assessment of Bariatric Surgery-3 (LABS-3) Psychosocial Study. Surg Obes Relat Dis. 2012;8(5):533–41.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Kalarchian MA, Marcus MD, Levine MD, Soulakova JN, Courcoulas AP, Wisinski MS. Relationship of psychiatric disorders to 6-month outcomes after gastric bypass. Surg Obes Relat Dis. 2008;4:544–9.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Mühlhans B, Horbach T, de Zwaan M. Psychiatric disorders in bariatric surgery candidates: a review of the literature and results of a German prebariatric surgery sample. Gen Hosp Psychiatry. 2009;31:414–21.PubMedCrossRefGoogle Scholar
  38. 38.
    Ashton K, Heinberg L, Windover A, Merrell J. Positive response to binge eating intervention enhances postoperative weight loss. Surg Obes Relat Dis. 2011;7(3):315–20.PubMedCrossRefGoogle Scholar
  39. 39.
    Mauri M, Rucci P, Calderone A, Santini F, Oppo A, Romano A. e al. Axis I and II disorders and quality of life in bariatric surgery candidates. J Clin Psychiatry. 2008;69(2):295–301.PubMedCrossRefGoogle Scholar
  40. 40.
    Rosenberger PH, Henderson KE, Grilo CM. Psychiatric disorder comorbidity and association with eating disorders in bariatric surgery patients: A cross-sectional study using structured interview-based diagnosis. J Clin Psychiatry. 2006;67(7):1080–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Stunkard AJ, Grace WJ, Wolf HG. The night-eating syndrome: a pattern of food intake among certain obese patients. Am J Med. 1955;19(1):78–86.PubMedCrossRefGoogle Scholar
  42. 42.
    Allison KC, Wadden TA, Sarwer DB, Fabricatore AN, Crerand CE, Gibbons LM, et al. Night eating syndrome and binge eating disorder among persons seeking bariatric surgery: prevalence and related features. Obesity. 2006;14:77S–81S.PubMedCrossRefGoogle Scholar
  43. 43.
    Allison KC, Lundgren JD, O'Reardon JP, Martino NS, Sarwer DB, Wadden TA, et al. The night eating questionnaire (NEQ): psychometric properties of a measure of severity of the night eating syndrome. Eat Behav. 2008;9(1):62–72.PubMedCrossRefGoogle Scholar
  44. 44.
    Goodpaster KP, Marek RJ, Lavery ME, Ashton K, Merrell Rish J, Heinberg LJ. Graze eating among bariatric surgery candidates: prevalence and psychosocial correlates. Surg Obes Relat Dis. 2016;12(5):1091–7.PubMedCrossRefGoogle Scholar
  45. 45.
    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(3):615–22.PubMedCrossRefGoogle Scholar
  46. 46.
    Smith M, Segal J, Segal R. Emotional eating: how to recognize and stop emotional eating [Internet]. 2017 [updated 2017 May; cited 2017 May 14]. Available from:
  47. 47.
    Dawes AJ, Maggard-Gibbons M, Maher AR, Booth MJ, Miake-Lye I, Beroes JM, et al. Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. JAMA. 2016;315:150–63.PubMedCrossRefGoogle Scholar
  48. 48.
    Kalarchian MA, Marcus MD, Levine MD, Courcoulas AP, Pilkonis PA, Ringham RM, et al. Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry. 2007;164(2):328–34.PubMedCrossRefGoogle Scholar
  49. 49.
    van Hout GC, Verschure SK, van Heck GL. Psychosocial predictors of success following bariatric surgery. Obes Surg. 2005;15(4):552–60. ReviewPubMedCrossRefGoogle Scholar
  50. 50.
    Wimmerlmann CL, Dela F, Mortensen FL. Psychological predictors of weight loss after bariatric surgery: a review of recent research. Obes Res Clin Pract. 2014;8(4):e299–e313. Epub 2013 Oct 13.
  51. 51.
    Fisher D, Coleman KJ, Artervburn DE, Fisher H, Yamamoto A, Young DR, et al. Mental illness in bariatric surgery: a cohort study from the PORTAL network. Obesity. 2017;25(5):850–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Padwal R, Brocks D, Sharma AM. A systematic review of drug absorption following bariatric surgery and its theoretical implications. Obes Rev Off J Int Assoc Study Obes. 2010;11:41–50.CrossRefGoogle Scholar
  53. 53.
    Bland CM, Quidley AM, Love BL, Yeager C, McMichael B, Bookstaver PB. Long-term pharmacotherapy considerations in the bariatric surgery patient. Am J Health-Syst Pharm. 2016;73:e469–81.CrossRefGoogle Scholar
  54. 54.
    Schneider B, Lukaschek K, Baumert J, Meisinger C, Erazo N, Ladwig KH. Living alone, obesity, and smoking increase risk for suicide independently of depressive mood findings from the population-based MONICA/KORA Augsburg cohort study. J Affect Disord. 2014;152–154:416–21.PubMedCrossRefGoogle Scholar
  55. 55.
    Wagner B, Klinitzke G, Brähler E, Kersting A. Extreme obesity is associated with suicidal behavior and suicide attempts in adults: results of a population-based representative sample. Depress Anxiety. 2013;30(10):975–81.PubMedGoogle Scholar
  56. 56.
    Lagerros YT, Brandt L, Hedberg J, Sundbom M, Bodén R. Suicide, self-harm, and depression after gastric bypass surgery: a nationwide cohort study. Ann Surg. 2017;265(2):235–43.PubMedCrossRefGoogle Scholar
  57. 57.
    Alvarez J, Pavao J, Baumrind N, Kimerling R. The relationship between child abuse and adult obesity among California women. Am J Prev Med. 2007;33(1):28–33.PubMedCrossRefGoogle Scholar
  58. 58.
    Williamson DF, Thompson TJ, Anda RF, Dietz WH, Felitti V. Body weight and obesity in adults and self-reported abuse in childhood. Int J Obes Relat Metab Disord. 2002;26:1075–82.PubMedCrossRefGoogle Scholar
  59. 59.
    Felitti VJ. Long-term medical consequences of incest, rape, and molestation. South Med J. 1991;84:328–31.PubMedCrossRefGoogle Scholar
  60. 60.
    Gustafson TB, Gibbons LM, Sarwer DB, Crerand CE, Fabricatore AN, Wadden TA, et al. History of sexual abuse among bariatric surgery candidates. Surg Obes Relat Dis. 2006;2(3):369–76.PubMedCrossRefGoogle Scholar
  61. 61.
    Gustafson TB, Sarwer DB. Childhood sexual abuse and obesity. Obes Rev. 2004;5(3):129–35.PubMedCrossRefGoogle Scholar
  62. 62.
    NIH National Institute on Alcohol Abuse and Alcoholism. Alcohol facts and statistics. Statistics. 2017 [Updated 2017 Feb; cited 2017 May 20] Available from:
  63. 63.
    Blackburn AN, Hajnal A, Leggio L. The gut in the brain: the effects of bariatric surgery on alcohol consumption. Addict Biol. 2016;31. [Epub ahead of print].Google Scholar
  64. 64.
    King WC, Chen JY, Mitchell JE, Kalarchian MA, Steffen KJ, Engel SG, et al. Prevalence of alcohol use disorders before and after bariatric surgery. JAMA. 2012;307(23):2516–25.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Heinberg LJ, Ashton K, Coughlin J. Alcohol and bariatric surgery: review and suggested recommendations for assessment and management. Surg Obes Relat Dis. 2012;8(3):357–63.PubMedCrossRefGoogle Scholar
  66. 66.
    Sarwar DB, Allison KC, Bailer BA, Faulconbridge LF. Psychosocial characteristics of bariatric surgery candidates. In Still C, Sarwar DB, Blankenship J, editors. The ASMBS textbook of bariatric surgery. vol. 2: Integrated health; New York: Springer; 2014. Chapter 1. p. 3–9.Google Scholar
  67. 67.
    Romo LK, Dailey RM. Weighty dynamics: Exploring couples’ perceptions of post-weight-loss interaction. Health Commun. 2014;29(2):193–204.PubMedCrossRefGoogle Scholar
  68. 68.
    Klos LA, Sobal J. Marital status and body weight, weight perception, and weight management among U.S. adults. Eat Behav. 2013;14(4):500–7.PubMedCrossRefGoogle Scholar
  69. 69.
    Bocchieri LE, Meana M, Fisher BL. Perceived psychosocial outcomes of gastric bypass surgery: a qualitative study. Obes Surg. 2002;12(6):781–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Le Mont D, Moorehead MK, Parish MS, Reto CS, Ritz SJ. Suggestions for the pre-surgical psychological assessment of bariatric surgery candidates. [updated 2017 May; cited 2017]. Available from: Accessed 5 April 2010.
  71. 71.
    Heinberg LJ. The role of psychological testing for bariatric/metabolic surgery candidates. Bariatric Times [Internet]. 2013 21[updated 2017 May; cited 2017 May 14]. Available from
  72. 72.
    Marek RJ, Heinberg LJ, Lavery M, Merrell Rish J, Ashton K. A review of psychological assessment instruments for use in bariatric surgery evaluations. Psychol Assess. 2016;28(9):1142–57.PubMedCrossRefGoogle Scholar
  73. 73.
    Beck AT, Steer RA, Brown GK. Manual for the Beck depression inventory-II. San Antonio: Psychological Corporation; 1996.Google Scholar
  74. 74.
    Kroenke K, Spitzer RL. The PHQ-9: A new depression diagnostic and severity measure. Psychiatr Ann. 2002;32(9):509–15.CrossRefGoogle Scholar
  75. 75.
    Beck AT, Steer RA. Beck anxiety inventory manual. San Antonio: Psychological Corporation; 1993.Google Scholar
  76. 76.
    Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med. 2006;166:1092–7.PubMedCrossRefGoogle Scholar
  77. 77.
    Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, Keck PE Jr, Lewis L, McElroy SL, Post RM, Rapport DJ, Russell JM. Development and validation of a screening instrument for bipolar spectrum disorder: the mood disorder questionnaire. Am J Psychiatr. 2000;157(11):1873–5.PubMedCrossRefGoogle Scholar
  78. 78.
    Gormally J, Black S, Daston S, Rardin D. The assessment of binge eating severity among obese persons. Addict Behav. 1982;7(1):47–55.PubMedCrossRefGoogle Scholar
  79. 79.
    Fairburn CG, Beglin S. Eating disorder examination questionnaire. In: Fairburn CG, editor. Cognitive behavior therapy and eating disorders. New York: Guilford Press; 2008. p. 309–14.Google Scholar
  80. 80.
    Corsica JA, Hood MM, Azarbad L, Ivan I. Revisiting the revised master questionnaire for the psychological evaluation of bariatric surgery candidates. Obes Surg. 2012;22(3):381–8.PubMedCrossRefGoogle Scholar
  81. 81.
    Allison KC, Lundgren JD, O'Reardon JP, Martino NS, Sarwer DB, Wadden TA, Crosby RD, Engel SG, Stunkard AJ. The night eating questionnaire (NEQ): psychometric properties of a measure of severity of the night eating syndrome. Eat Behav. 2008;9(1):62–72.PubMedCrossRefGoogle Scholar
  82. 82.
    Spitzer RL, Yanovski SZ, Marcus MD. The questionnaire on eating and weight patterns-revised (QEWP-R). New York: New York State Psychiatric Institute; 1993.Google Scholar
  83. 83.
    Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res. 1985;29(1):71–83.PubMedCrossRefGoogle Scholar
  84. 84.
    Gearhardt AN, Corbin WR, Brownell KD. Development of the Yale Food Addiction Scale Version 2.0. Psychol Addict Behav. 2016;30(1):113.PubMedCrossRefGoogle Scholar
  85. 85.
    Derogatis LR. BSI, Brief Symptom Inventory: administration, scoring & procedures manual. 4th ed. Minneapolis, MN: National Computer Systems; 1993.Google Scholar
  86. 86.
    Millon T, Antoni M, Millon C, Minor S, Grossman G. MBMD manual supplement: bariatric report. Minneapolis: NCS Pearson; 2007.Google Scholar
  87. 87.
    Butcher JN, Dahlstrom WG, Graham JR, et al. The Minnesota Multiphasic Personality Inventory-2 (MMPI-2): manual for administration and scoring. Minneapolis: University of Minnesota Press; 1989.Google Scholar
  88. 88.
    Ben-Porath YS, Tellegen A. The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF): Manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press; 2008.Google Scholar
  89. 89.
    Morey LC. Personality assessment inventory professional manual. 2nd ed. Odessa: Psychological Assessment Resources; 2007.Google Scholar
  90. 90.
    Derogatis LR. SCL-90-R symptom checklist-90-R administration, scoring and procedures manual. Minneapolis: National Computer Systems; 1994.Google Scholar
  91. 91.
    Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.PubMedCrossRefGoogle Scholar
  92. 92.
    Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.PubMedCrossRefGoogle Scholar
  93. 93.
    Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. Manual for the alcohol use disorders identification test (AUDIT). 2nd ed. Geneva: World Health Organization; 2001. p. 1–40.Google Scholar
  94. 94.
    Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 1998;158(16):1789–95.PubMedCrossRefGoogle Scholar
  95. 95.
    Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992:473–83.Google Scholar
  96. 96.
    Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245–58.PubMedCrossRefGoogle Scholar
  97. 97.
    Kolotkin RL, Crosby RD. Manual for the impact of weight on quality of life measure (IWQOL and IWQOL-Lite). Durham: Obesity and Quality of Life Consulting; 2008.Google Scholar
  98. 98.
    Crowne DP, Marlowe D. A new scale of social desirability independent of psychopathology. J Consult Psychol. 1960;24(4):349.PubMedCrossRefGoogle Scholar
  99. 99.
    Moorehead MK, Ardelt-Gattinger E, Lechner H, Oria HE. The validation of the Moorehead-Ardelt quality of life questionnaire II. Obes Surg. 2003;13(5):684–92.PubMedCrossRefGoogle Scholar
  100. 100.
    Cash TF. Multidimensional body-self relations questionnaire (MBSRQ). Norfolk: Author; 2000.Google Scholar
  101. 101.
    Walfish S, Vance D, Fabricatore AN. Psychological evaluation of bariatric surgery applicants: procedures and reasons for delay or denial of surgery. Obes Surg. 2007;17(12):1578–83.PubMedCrossRefGoogle Scholar
  102. 102.
    Tsuda S, Barrios L, Schneider B, Jones DB. Factors affecting rejection of bariatric patients from an academic weight loss program. Surg Obes Relat Dis. 2009;5(2):199–202.PubMedCrossRefGoogle Scholar
  103. 103.
    Sadhasivam S, Larson CJ, Lambert PJ, Mathiason MA, Kothari SN. Refusals, denials, and patient choice: reasons prospective patients do not undergo bariatric surgery. Surg Obes Relat Dis. 2007;3(5):531–5.PubMedCrossRefGoogle Scholar
  104. 104.
    Ashton K, Drerup M, Windover A, Heinberg L. Brief, four-session group CBT reduces binge eating behaviors among bariatric surgery candidates. Surg Obes Relat Dis. 2009;5(2):257–62.PubMedCrossRefGoogle Scholar
  105. 105.
    Lavery M, Heinberg H, Goodpaster K, Rish JM, Ashton K. Brief four session CBT group increases knowledge and coping skills in a high-risk bariatric surgery population. Surg Obes Relat Dis/Preconference: Master Course in Behavioral Health. 2015;11:s49.Google Scholar
  106. 106.
    Ashton K, Heinberg L, Merrell J, Lavery M, Windover A, Alcorn K. Pilot evaluation of a substance abuse prevention group intervention for at-risk bariatric surgery candidates. Surg Obes Relat Dis. 2013;9(3):462–7.PubMedCrossRefGoogle Scholar
  107. 107.
    Paul L, van Rongen S, van Hoeken D, Deen M, Klaassen R, Biter LU, et al. Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study. Contemp Clin Trials. 2015;42:252–6.PubMedCrossRefGoogle Scholar
  108. 108.
    Alami RS, Morton JM, Schuster R, Lie J, Sanchez BR, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis. 2007;3(2):141–5; discussion 145-6.PubMedCrossRefGoogle Scholar
  109. 109.
    Benotti PN, Still CD, Wood GC, Akmal Y, King H, El Arousy H, et al. Preoperative weight loss before bariatric surgery. Archives of Surgery, 144, 1150–1155. Arch Surg. 2009;144(12):1150–5.PubMedPubMedCentralCrossRefGoogle Scholar
  110. 110.
    Compher CW, Hanlon A, Kang Y, Elkin L, Williams NN. Attendance at clinical visits predicts weight loss after gastric bypass surgery. Obes Surg. 2012;22(6):927–34.PubMedCrossRefGoogle Scholar
  111. 111.
    Kaiser KA, Franks SF, Smith AB. Positive relationship between support group attendance and one-year postoperative weight loss in gastric banding patients. Surg Obes Relat Dis. 2011;7(1):89–93.PubMedCrossRefGoogle Scholar
  112. 112.
    Karmali S, Brar B, Shi X, Sharma AM, de Gara C, Birch DW. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23(11):1922–33.PubMedCrossRefGoogle Scholar
  113. 113.
    Odom J, Zalesin KC, Washington TL, Miller WW, Hakmeh B, Zaremba DL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20(3):349–56.PubMedCrossRefGoogle Scholar
  114. 114.
    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
  115. 115.
    Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244:734–40.PubMedPubMedCentralCrossRefGoogle Scholar
  116. 116.
    Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.PubMedCrossRefGoogle Scholar
  117. 117.
    Sjöström L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008;32(Suppl 7):S93–7.CrossRefGoogle Scholar
  118. 118.
    Pagoto SL, Appelhans BM. A call for an end to the diet debates. JAMA. 2013;310(7):687–8.PubMedCrossRefGoogle Scholar
  119. 119.
    Sarwer DB, Wadden TA, Moore RH, Baker AW, Gibbons LM, Raper SE, et al. Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2008;4(5):640–6.PubMedPubMedCentralCrossRefGoogle Scholar
  120. 120.
    Kofman MD, Lent MR, Swencionis C. Maladaptive eating patterns, quality of life, and weight outcomes following gastric bypass: results of an Internet survey. Obesity. 2010;18(10):1938–43.PubMedCrossRefGoogle Scholar
  121. 121.
    Burgmer R, Grigutsch K, Zipfel S, Wolf AM, de Zwaan M, Husemann B, et al. The influence of eating behavior and eating pathology on weight loss after gastric restriction operations. Obes Surg. 2005;15(5):684–91.PubMedCrossRefGoogle Scholar
  122. 122.
    Elkins G, Whitfield P, Marcus J, Symmonds R, Rodriguez J, Cook T. Noncompliance with behavioral recommendations following bariatric surgery. Obes Surg. 2005;15(4):546–51.PubMedCrossRefGoogle Scholar
  123. 123.
    Faria SL, de Oliveira Kelly E, Faria OP, Ito KM. Snack-eating patients experience lesser weight loss after Roux-En-Y gastric bypass surgery. Obes Surg. 2009;19(9):1293–6.CrossRefGoogle Scholar
  124. 124.
    Ernst B, Thurnheer M, Wilms B, Schultes B. Differential changes in dietary habits after gastric bypass versus gastric banding operations. Obes Surg. 2009;19(3):274–80.PubMedCrossRefGoogle Scholar
  125. 125.
    Suter M, Calmes JM, Paroz A, Giusti V. A new questionnaire for quick assessment of food tolerance after bariatric surgery. Obes Surg. 2007;17:2–8.PubMedCrossRefGoogle Scholar
  126. 126.
    Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005;6(1):67–85.PubMedCrossRefGoogle Scholar
  127. 127.
    Jakicic JM, Marcus BH, Lang W, Janney C. Effect of exercise on 24-month weight loss maintenance in overweight women. Arch Intern Med. 2008;168(14):1550–9; discussion 1559-60PubMedPubMedCentralCrossRefGoogle Scholar
  128. 128.
    Coen PM, Goodpaster BH. A role for exercise after bariatric surgery? Diabetes Obes Metab. 2016;18(1):16–23.PubMedCrossRefGoogle Scholar
  129. 129.
    KA K, Franks SF, Smith AB. Positive relationship between support group attendance and one-year postoperative weight loss in gastric banding patients. Surg Obes Relat Dis. 2011;7(1):89–93.CrossRefGoogle Scholar
  130. 130.
    Livhits M, Mercado C, Yemilov I, Parikh JH, Dutson E, Mehran A, et al. Is social support associated with greater weight loss after bariatric surgery? A systemtic review. Obe Rev. 2011;12:142–8.CrossRefGoogle Scholar
  131. 131.
    Pontiroli AE, Fossati A, Vedani P, Fiorilli M, Folli F, Paganelli M, et al. Post-surgery adherence to scheduled visits and compliance, more than personality disorders, predict outcome of bariatric restrictive surgery in morbidly obese patients. Obes Surg. 2007;17(11):1492–7.PubMedCrossRefGoogle Scholar
  132. 132.
    Davidson, P. Behavioral health—when to refer the postop. Paper presented at: Integrated Health: AACE/TOS/ASMBS Postoperative Recommendations Scientific Session; 2014.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryCleveland Clinic, Bariatric and Metabolic Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandUSA

Personalised recommendations