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Bariatric surgery psychology is a specialty area of psychology, requiring specialized training for mental health experts. This training would have a parallel to what would be required of general surgeons obtaining the specialized training to enable them to perform safe and effective bariatric surgery. In numerous bariatric surgery forums, such as The American Society for Bariatric Surgery (ASBS), the International Federation for the Surgery of Obesity (IFSO), and the American College of Surgeons (ACS), the bariatric surgery healthcare field has demonstrated recognition of the valued role of the bariatric mental health provider.

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The discussions in this chapter focus on both theoretical and applied aspects for psychological assessment and care of the morbidly/super obese patient presenting for surgery. The primary purpose of this chapter is to briefly highlight and elucidate the “Who, What, Where, When, and Why” regarding the role and benefits of bariatric surgery psychology. The clinical data and observations presented are gleaned from a biomedical literature review and 20 plus years of clinical experience in the design and implementation of the psychological standardized protocol presented at both the ASBS and IFSO. The chapter is designed to be a user-friendly document that can help sensitize any interested party to obtain a better understanding of the strengths and challenges faced by the bariatric surgery patient. Another goal is to support the consideration, awareness, and decision to integrate the bariatric surgery mental health specialist into the multidisciplinary team.

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The clinical cases supporting the data reviewed in the following sections have been compiled from hundreds of vertical band gastroplasty patients, thousands of Roux-en-Y gastric bypass cases, an ever growing number of adjustable gastric band patients, and a clinical trial of gastric stimulator cases. Considerations of the psychological sequelae of depression, anxiety, and addictions are discussed with specific reference to the impact of psychosocial stress, coping skills, and specific behaviors common to the severe/super obese archetype.

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In furtherance of the learning goals outlined above, the literature review and psychological impressions presented are gathered heuristically from direct practice and are clinical in nature rather than anecdotal. As consideration is given to the often underserved and misconceived needs of this patient population, it is anticipated that a comprehensive multidisciplinary program that incorporates psychological service will be seen, not only of critical benefit in enhancing patient compliance, but also in securing patients’ dramatic improvement in longer-term quality of life. A standardized psychological care model is outlined for a bariatric surgery program and thoughts offered regarding future research possibilities will conclude the discussion section of the chapter.

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While the psychologist is well-suited for the advanced specialty training and delivery of services to the bariatric surgery patient population, psychiatry, psychiatric nursing, and social workers have also proved to be invaluable in meeting the needs of a comprehensive program. Key ingredients to consider in determining the efficacy of mental health specialists include empathy, authenticity, passion, and willingness to learn and better understand the maturational needs ...

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