Photo by Boliston
Last week I wrote a post discussing whether or not candidates for obesity surgery should be required to undergo a psychological exam prior to treatment. My post was in response to a recent editorial in The Guardian by Dr David Ashton which can be found here, which described the psychological exam for obesity surgery candidates as prejudiced and unjust. A few days later I received a detailed response from our friend and colleague Danielle Gabert, who works in obesity research and management at the University of Alberta, and who is much more familiar with this type of treatment than either Peter or I. I found her email so informative that I have posted excerpts below (with her permission), in the hopes that others will find it as useful as I did.
“I don’t feel that a mental health evaluation needs to act as “gate-keeper” for Bariatric surgery, but given the number of candidates for surgery, it seems quite reasonable to determine if a pre-operative psychiatric status has any impact on post-operative success. Dr Ashton made it seem that these psychological evaluations are pass/fail, and that if you “fail”, you get no medical help. The reality is that even if a patient has a psychiatric diagnosis, they can still undergo surgery at the discretion of a health professional, as was demonstrated in a study by Sarwer et al. in 2004:
“[out of 90 total patients]Almost two-thirds of patients received a psychiatric diagnosis, the most common of which was major depressive disorder. Nearly two-fifths of all participants, and more than half of those given a psychiatric diagnosis, were engaged in some form of psychiatric treatment at the time of the evaluation. Nevertheless, 64% of patients were unconditionally approved for [bariatric] surgery; 31% were recommended for additional psychiatric or nutritional counselling prior to surgery [note: still eligible]. Three patients [out of 90] were not recommended for surgery.”
Thus I would never imagine that if someone does have a mental health concern or illness that they should be deprived of any obesity treatment, including Bariatric surgery. However, I would say that if someone is diagnosed with a psychiatric condition, that this could be seen as a barrier that must be addressed prior to placing any expectations of program adherence on that individual (Especially given the often rigorous post-op guidelines). Rather than give the patient bariatric surgery and then hope to address the mental health issue, it would make more sense to address the mental health issue and then approve the surgery. And to know if there are any mental health issues, it seems rather appropriate to administer psychological testing (which sounds more daunting that it is, since this can be anything from the MMPI – Minesota multiphasic personality inventory – or even patient interviewing by trained professionals).
That being said, I believe that guidelines, as useful as they are, are only that – guidelines. “Research is useful and Instructive, but it is not a substitute for clinical sensitivity to the unique situation of each individual patient.” -Alejandro R Jadad.
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