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1 in 5 bariatric surgery candidates not psychologically cleared for surgery

October 15, 2007

Largest study of its kind to determine reliability and reasons for psychological exclusions

Providence, RI - A new study by Rhode Island Hospital and Brown University researchers reported that 18 percent of 500 candidates for bariatric surgery did not receive the initial psychiatric clearance for the surgery. The study is the first to examine the reliability of decisions to clear candidates for surgery, and the largest to determine the percentage of candidates who are not cleared and detail the reasons for exclusion. It was published in the October edition of the Journal of Clinical Psychiatry.

Findings indicate the most common reasons for not receiving psychiatric clearance were frequent overeating to cope with stress/emotional distress, a current eating disorder and uncontrolled psychiatric disorders. Researchers also found that the decision to clear candidates for bariatric surgery is made with high reliability, meaning independent reviews of available information by independent psychiatrists will result in the same decision.

Most bariatric surgery programs include psychiatric evaluations as part of the pre-operative screening procedure. Some of the psychological factors considered important in determining appropriate surgical candidates include the presence of eating, mood psychotic, personality and substance abuse disorders; eating to regulate negative affect (using food as a method to cope with psychological stress); history of noncompliance with treatment; and inappropriate expectations of life change due to surgery.

Lead author Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital and associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, emphasized, "The goal of the psychiatric evaluation is not to keep patients from having the surgery. Rather, the goal is to determine if there are any problems that might interfere with the success of surgery, and have the patient get treatment for these problems." Zimmerman continues, "In so doing, the patient is more likely to have a positive outcome from surgery that is delayed to allow time to address the problems."

Caren Francione, a post-doctoral fellow and co-author of the report, noted that they have conducted a follow-up study of the patients who were initially screened out from having the surgery. Preliminary analysis of the data found that most of these patients followed the psychiatrists' recommendation to have counseling before surgery and subsequently went on to have surgery.

The report is from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project, for which Zimmerman is the principal investigator. Zimmerman said, "The MIDAS project is unique in its integration of research quality diagnostic methods into a community-based outpatient practice affiliated with an academic medical center."

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