Factors That Predict Preoperative Psychological Evaluation Recommendations For Bariatric Surgery Candidates

Approximately 36% of adults in the United States population are obese. Obese patients have an increased risk of mortality and morbidity, particularly related to hypertension, dyslipidemia, Type 2 diabetes, asthma, sleep apnea, and impaired psychosocial functioning. The popularity of bariatric surgery has seen significant increases in recent years as a cost-effective way to manage weight. Determining candidates' psychological suitability for bariatric surgery is complicated by the fact that research on psychosocial predictors of success and/or poor outcomes is lacking and results are inconsistent. Psychologists often develop their own guidelines to assist in deciding whether a candidate should be cleared for surgery; thus evaluation procedures and cited contraindications to surgery vary greatly among programs. This study investigated predictors of psychological evaluation recommendation status in a sample of 100 bariatric surgery candidates. The variables that were examined included demographics, Axis I and Axis II psychopathology, and data from the Millon Behavioral Medicine Diagnostic (MBMD) (i.e., coping styles, stress moderators such as social isolation, and treatment prognostics such as interventional fragility, utilization excess, and problematic compliance). Number of Axis I diagnoses, social isolation, and educational level emerged as the strongest predictors of recommendation status. Multivariate logistic regression results suggest that for every additional Axis I diagnosis, the odds of being in the delayed group are approximately 5 times higher after controlling for the other factors in the model. Participants who reported greater social isolation on the MBMD have the odds of being delayed 6% times higher than those with higher social support. For those participants whose highest level of education is grade school, the odds of being delayed were 55 times higher than those participants who completed college or beyond. Additional research into predictors of success following bariatric surgery using large-scale, prospective, longitudinal studies is needed to better inform psychological evaluations. Efforts should also be made to review one's own bariatric psychological evaluation procedure to uncover which factors are most influential in the decision-making process.