The Role of Psychology in Bariatric Surgery at Aurora Health Care


Betsy Blair, PsyD

Psychology is an important element in Bariatric Surgery Programs.  Prospective patients attend an information seminar as their first step in the process.  The seminar reviews the process and preparation for surgery, including segments on psychological and nutritional preparation, as well as insurance requirements.  One or both of our surgeons speak as well, describing the various available procedures. Finally, a number of successful bariatric surgery patients talk and share their own experiences.

The prospective patient then makes initial appointments with one of our Registered Dieticians and the Psychologist.  The psychological evaluation consists of a depression and eating disorder screening and an in-depth clinical interview.

The three main components of the psychological evaluation are:

  1. Active versus passive sense of control.  If a patient presents saying “I have no self-control, I need surgery to make me stop eating the wrong foods,” they have a lot of preparation ahead of them. They will need to implement active strategies prior to being approved for surgery.  Motivation and confidence are also assessed.
  2. Emotional eating.  When some describes food as “my friend,” “my reward,” or “my comfort or distraction”, a referral for psychotherapy is usually warranted.
  3. Social support.  Unfortunately, many people will describe partners and families as being threatened by the person’s attempts to improve their physical health. We often discuss food from a family-systems perspective, as well as the role of envy or insecurity in relationships.

Levels of readiness:  The majority of patients evaluated are seen only once by the psychologist. Progress is monitored as they work with the Registered Dietician (RD), typically over a six month period.  There is a segment of patients that return for follow-up visits with the program psychologist, most often to help integrate and implement goals developed with the RD.  People who are resistant to a referral to psychotherapy are often followed in this manner.  Patients with a significant psychiatric history, untreated symptoms, those with chaotic and unstable support systems, emotional eating, or history of eating disorders are referred to psychotherapy. The psychological evaluation outlines goals for treatment when a patient is referred.

Case Conference:  The entire team (RD’s, psychologist, RN manager, insurance specialist and surgeon) meet weekly.  Every patient is reviewed and progress is evaluated.  When a patient has met all goals with their RD and psychologist (often based upon feedback from outside providers) then they are considered “cleared” and move on to meet with the surgeon, and have surgery scheduled.

Post-op follow-up

Follow-up with the Registered Dietician and psychologist are standard elements of the program. The patient meets with the RD frequently during the first 12 months following surgery. All postop patients meet with the psychologist six months following surgery. For many patients, this is a time when they are at risk of resuming old habits. For some patients, the 6 month mark is the moment to point out to the patient they are not yet successful with weight loss (eg someone may lose only 10# in the first six months.) In that case the psychologist will try to explore and enhance motivation, identify barriers to weight loss, or recommend more focused treatment.

Support group

ASMC Bariatric Surgery program has operated a monthly support group for close to ten years. A typical group has a scheduled speaker for 45 minutes. The large group breaks into smaller groups by surgery type, or dates of surgery. The group is very well attended, often including up to 30 participants, both pre and postop. The group is facilitated by trained support group facilitators, an RN and an RD. Feedback from the group indicates a high level of engagement and meaningful benefit to all participants.

The Bariatric Surgery Program, a Center of Excellence, has been active at Aurora Sinai Medical Center since 2002. Elizabeth Blair, PsyD is a clinical psychologist at Aurora Behavioral Health Services, and provides psychological evaluation for the ASMC Bariatric Program.


Has the media affected your own body image?

Does the media’s portrayal of body image affect how the average person feels about themselves? Sandra Blaies, a Licensed Clinical Social Worker and  Eating Disorder Program Supervisor at Aurora Psychiatric Hospital shares her thoughts on the relationship between the media and body image.

Media images help form cultural definitions of beauty and attractiveness. Media messages screaming “thin is in” may not directly cause eating disorders, but they cause us to place a value on the size and shape of our bodies. Media helps our culture define what is beautiful, and therefore the media’s power over our development of self-esteem and body image can be incredibly strong.

Media’s representation of body image is often in conflict with reality.  For example, the average American woman is 5’4” tall and weighs 140 pounds. The average American model is 5’11” tall and weighs 117 pounds. Most fashion models are thinner than 98% of American women.

This representation of “beauty” as defined by media drives many individuals to diet. Consider these statistics from the National Eating Disorder Association.

  • Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.
  • 25% of American men and 45% of American women are on a diet on any given day
  • 42% of 1st-3rd grade girls want to be thinner
  • 81% of 10 year olds are afraid of being fat
  • 46% of 9-11 year-olds are “sometimes” or “very often” on diets, and 82% of their families are “sometimes” or “very often” on diets
  • 91% of women recently surveyed on a college campus had attempted to control their weight through dieting, 22% dieted “often” or “always”.
  • Americans spend over $40 billion on dieting and diet-related products each year.
  • 35% of “normal dieters” progress to pathological dieting. Of those, 20-25% progress to partial or full syndrome eating disorders.

National Eating Disorders Awareness Week kicks off on Sunday, February 26. Let’s all remember that size and shape is not as important as health, and that media images of beauty are often not realistic. We need more diverse and real images of people with more positive messages about health and self-esteem. We need to reduce the pressures many people feel to make their bodies conform to one ideal, and in the process, reduce feelings of body dissatisfaction and ultimately decrease the potential for eating disorders.

If you or someone you know may be struggling with an eating disorder, please contact Aurora Behavioral Health Services at 877-666-7223 or visit our web site at Aurora Behavioral Health Services