Psychological Factors in Bariatric (Weight Loss) Surgery

Obesity has reached epidemic proportions in the United States, and is becoming a major health problem in much of the rest of the world as well. Tragically, many around the world are starving and have trouble finding enough food to sustain themselves while others are struggling with the health complications and risks of eating too much. Unfortunately, in addition to dealing with the difficulties and risks of their excess weight, obese people bear the brunt of social and cultural misunderstanding, discrimination, and prejudice. They are frequently portrayed as weak, lacking control or self-respect, and being self-destructive. In reality, weight and obesity are extremely complex and multi-faceted issues with health and mental health implications. Being overweight is rarely a simple matter.

In recent years, bariatric (weight loss) surgery has become a viable option for many patients for whom weight is a significant health issue. Bariatric surgery has been available for decades, but surgical and medical improvements in recent years have made this surgery appropriate for more patients. In addition, the surgery is now minimally invasive, so the post-surgical discomfort and recovery time are significantly less than in the past.

Another reason bariatric surgery is becoming more common is that many health insurance and managed care organizations are approving this surgery for more patients. These healthcare companies have realized that bariatric surgery is less expensive than paying to treat the medical problems that result from continued obesity. However, no patient is approved for surgery unless there is clear documentation of serious attempts at weight loss in the past, and for whom there is obvious “medical necessity” for the procedure.

Obesity is a complex phenomenon, and there are many psychological factors involved with gaining excess weight and living with obesity. For most people with weight problems, there are relevant psychological factors that may need attention, including depression and anxiety. In fact, in determining whether or not a patient is appropriate for bariatric surgery, most insurance/managed care companies as well as most surgeons require that a patient be evaluated psychologically or psychiatrically to determine if they are mentally and emotionally prepared for surgery. Further, many patients face challenging post-surgery approaches to eating and changing life styles associated with weight loss. Post-bariatric surgery patients should consider seeking psychological services to help them move forward in a positive, healthy manner.

For any person dealing with significant weight issues, it is important that they pay attention to the full range of health and mental health issues. Psychologists have much to contribute to patients struggling with these issues. Working in collaboration with primary care physicians, medical specialists, bariatric surgeons, and nutritionists, psychologists can provide the full range of services to help patients attain and sustain a healthier, more productive, and more fulfilling lives.


Rudy Nydegger, PhD, ABPP

Chief of the Division of Psychology at Ellis Hospital
Clinical and Consulting Psychologist in practice over 30 years
Former President of the New York Psychological Association, and current Chair of the Legal and Legislative Committee.