1 in 5 Bariatric Surgery Candidates Not Psychologically Cleared For Surgery

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Source: Lifespan

Date: Oct 15, 2007

One In Five Bariatric Surgery Candidates Not

Psychologically Cleared For Surgery

Science Daily — A new study by Rhode Island Hospital

and Brown University researchers reported that 18% of

500 candidates for bariatric surgery did not receive

the initial psychiatric clearance for the surgery. The

study is the first to examine the reliability of

decisions to clear candidates for surgery, and the

largest to determine the percentage of candidates who

are not cleared and detail the reasons for exclusion.

Findings indicate the most common reasons for not

receiving psychiatric clearance were frequent

overeating to cope with stress/emotional distress, a

current eating disorder and uncontrolled psychiatric

disorders. Researchers also found that the decision to

clear candidates for bariatric surgery is made with

high reliability, meaning independent reviews of

available information by independent psychiatrists

will result in the same decision.

Most bariatric surgery programs include psychiatric

evaluations as part of the pre-operative screening

procedure. Some of the psychological factors

considered important in determining appropriate

surgical candidates include the presence of eating,

mood psychotic, personality and substance abuse

disorders; eating to regulate negative affect (using

food as a method to cope with psychological stress);

history of noncompliance with treatment; and

inappropriate expectations of life change due to

surgery.

Lead author Mark Zimmerman, MD, director of outpatient

psychiatry at Rhode Island Hospital and associate

professor of psychiatry and human behavior at The

Warren Alpert Medical School of Brown University,

emphasized, " The goal of the psychiatric evaluation is

not to keep patients from having the surgery. Rather,

the goal is to determine if there are any problems

that might interfere with the success of surgery, and

have the patient get treatment for these problems. "

Zimmerman continues, " In so doing, the patient is more

likely to have a positive outcome from surgery that is

delayed to allow time to address the problems. "

Caren Francione, a post-doctoral fellow and co-author

of the report, noted that they have conducted a

follow-up study of the patients who were initially

screened out from having the surgery. Preliminary

analysis of the data found that most of these patients

followed the psychiatrists' recommendation to have

counseling before surgery and subsequently went on to

have surgery.

The report is from the Rhode Island Methods to Improve

Diagnostic Assessment and Services (MIDAS) Project,

for which Zimmerman is the principal investigator.

Zimmerman said, " The MIDAS project is unique in its

integration of research quality diagnostic methods

into a community-based outpatient practice affiliated

with an academic medical center. "

This research was published in the October 2007

edition of the Journal of Clinical Psychiatry.

Note: This story has been adapted from material

provided by Lifespan.

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