WLS is not brain surgery

WLS Is Not Brain Surgery: A Mental Health Professional’s Perspective

November 1, 2017

Weight loss surgery is so much more than a typical surgery. One thing that patients need to remember is that WLS is not brain surgery. Many people ask why they have to see a psychologist prior to getting bariatric surgery. I tend to first explain it by comparing WLS to other types of surgery. For instance, I explain that if you have a broken wrist, you need to get your wrist repaired and, of course, there is a recovery time and perhaps even some physical therapy involved, but then that is it. It is done, you had the physical surgery, and you move on with your life.

Now, let’s think about WLS. This is not a surgery where you are just simply getting something repaired, nothing is broken, BUT you are being provided with a tool that will assist you in living a healthier life.

The Key Is What You Do With WLS Afterward

The surgeon will do her/his job and do the physical surgery, but the key is what you do with that surgery afterward. The key is IF you use the tool that the surgeon gave you, and IF you use it properly. Similarly to a prescription, the doctor can write a prescription but then it is up to you and is YOUR choice to fill it, be compliant, and take the medication.

So, you may still be asking why a pre-operative psychosocial evaluation is necessary or why one has to see a mental health provider prior to surgery (and strongly encouraged after surgery). I remember years ago when I first started getting involved in bariatrics that a colleague of mine said the role of the bariatric mental health provider “is NOT to be the gatekeeper” and this is very true. It is NOT our job to simply say yes someone should have bariatric surgery or no someone should not.

Rather, our job during the pre-operative process is more complicated than that. It is the mental health provider’s job to make recommendations to the patient AND the bariatric surgery team by identifying the patient’s strengths, potential barriers or challenges, and using this information to help develop interventions to assist the patient in being successful.

For example, if the patient is participating in any disordered eating behaviors (i.e. skipping meals, emotional eating, binge eating or night eating), we could problem solve together and come up with a plan to assist with this and improve their health behaviors PRIOR to having surgery.

A Mental Health Professional's Role Is To Assist You

What makes the appointment with the mental health professional unique is our ability to globally assist the patient in coming up with a plan so they will not only be able to follow through with the recommendations, but also to assist them in anticipating difficulties that may arise as their lifestyle changes, both before and after surgery.

This is different from the pragmatic approach of other surgical team members, including the surgeon and nutritionist whose roles are a bit more limited. Because of the uniqueness of each individual, their different lifestyles, backgrounds, and continued stressors we, the mental health provider specializing in bariatric care, can assist the patient in coming up with a plan that will specifically work for them and help them be successful.

Since bariatric surgery requires a lifestyle change, other changes may occur that an individual may not necessarily be prepared for that may impact a patient’s daily life or relationships.

Therefore, another important part of the psychosocial evaluation for bariatric surgery is not just assessing and gathering information, but also providing education regarding these potential changes, as well as assisting the patient in coming up with a plan to deal with them. There are so many changes that could possibly occur after an individual loses a lot of weight and/or has bariatric surgery.

For instance, an individual’s eating habits are going to change, and the question of how they will continue to socialize and go to events where food will be present is a question or problem that tends to arise. It is something that needs to be thought about and planned for in order for the patient to remain on track and successful.

Further, as an individual loses weight their body image changes, as well as their self-confidence which can change relationships. The more we can work on prior to surgery the easier, and less overwhelming, it will be for the patient after surgery.

It Is Important To Remember That WLS Is Not Brain Surgery

Similarly, WLS is not like any other surgery. WLS is a tool, as well as a treatment for obesity. The surgeon is NOT changing your brain, your thoughts, or your emotions (although there are some interesting research and evidence that there are some changes in the brain that occur after surgery), but at the end of the day, individuals who choose to have bariatric surgery need to work on their behaviors in order to maximize the benefits of the surgery. The surgeon will do her/his job, but now it is time for you to do your job.

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Rachel Goldman, PhD, FTOS is a licensed psychologist in NYC. Dr. Rachel is the Clinical Assistant Professor, Department of Psychiatry at NYU School of Medicine. She completed her Pre-Doctoral Clinical Internship in Behavioral Medicine and Post-Doctoral Fellowship in Obesity and Bariatric Surgery. She is on many professional committees & speaks at national conferences on the behavioral aspects of obesity and weight management.

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