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.


Athletes and Eating Disorders; what parents and coaches need to know…

Elizabeth Hunkins is a therapist at Aurora Behavioral Health Center in Summit

Elizabeth Hunkins is a therapist at Aurora Behavioral Health Center in Summit

Sport activities offer such an array of benefits for individuals from improved confidence, self-esteem, social skills and healthy activity.  But when does having “fun” cross the line that places an individual at risk for possible eating disorder?

Competition in athletics can be a factor that leads to psychological stress, which increases risk factors for disordered eating patterns in males and females.  A study in 1992 found that 62 percent of females in sports suffered from eating disorders (  It is believed that since that study was completed that eating disorders among athletes continue to be on the rise.  Many parents, coaches and even physicians fail to recognize the signs of eating disorders in these individuals.  Athletes are at a greater risk of medical complication due to the demands they place on their body.

There are too many stories of athletes that have suffered from this disease. In July of 1994, top US gymnast, Christy Henrich died of multiple organ failure after a US judge told her she was “too fat and needed to lose weight to make the team”, and subsequently dropped to 47 pounds. She resorted to anorexia and bulimia, which eventually took her life.  Cathy Rigby, another Olympian suffered with this disease for 12 years and went into cardiac arrest two different times (  Not only is this happening on the elite level, it is happening on every level of competition in sports.

What are some early warning signs of an eating disorder in an athlete?

  • Rapid weight loss
  • Going to bathroom after meals
  • No breaks in weekly training (should have 1-2 days off per week)
  • Increased concern about body fat/calorie intake
  • Rigid behavior around food (refuses food groups, eating fat free/eating in isolation)
  • Social withdrawal from family and peers
  • Preoccupied with training/exercise and becomes upset if unable to workout
  • Will continue to workout even when ill/sick
  • Other areas in life becomes unmanageable (relationships, work, school)
  • Loss or irregular menses

Coaches need to educate themselves on the dangers of eating disorders and recognize early warning signs and intervene.  Education needs to be provided on healthy nutrition, and proper refueling.  Coaches need to be positive, encouraging and motivating; not harsh, negative and critical to athletes.  Parents should attend a training session to observe their child and the coach’s training.  A parent should not witness a coach pressuring their child to “WIN at any cost”.

Coaches should encourage athletes to develop a healthy routine with adequate emphasis on eating, hydration and life balance. Coaches should praise their efforts and their achievements.  If there are negative comments about an athlete’s appearance/weight and performance, then it is time to change coaches/programs for the well-being of the individual and seek assistance from a professional.

Liz Hunkins, LCSW is a therapist at Aurora Behavioral Health Center in Summit

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

Want to lose holiday weight? Lose the diet first!

The Twelve Days of Christmas, or “How to have your plum pudding and eat it too!”

anne sprenger

Anne Sprenger is a registered dietician working in the eating disorders program at Aurora Psychiatric Hospital.

Right after the holidays there is a noticeable increase in advertising for weight loss programs. This is no doubt an effort to take advantage of the fact that many people will gain an average of seven pounds over the holidays!

Current research shows the whole concept of “dieting” doesn’t really work for anyone to lose weight or even stay at a healthy weight.

According to Psychology Today, about 95% of people who lose weight by dieting will regain it in 1-5 years. The temporary nature of dieting means it won’t work in the long run. One reason is that cutting out calories changes your metabolism and brain, so your body hoards fat and your mind magnifies food cravings into an obsession.

Dieting raises levels of hormones that stimulate appetite — and lowers levels of hormones that suppress it. For more information about why diets don’t work, click here.

In the true non-diet spirit, follow these recommendations from Anne Sprenger, registered dietician at Aurora Psychiatric Hospital.

Day 1 (Christmas Day): Throw out every calorie-counting book on the shelf. We know dieting doesn’t work.

Day 2: There is not one food you cannot have today. It is human nature telling ourselves we can’t have something makes us want more. If we eat a forbidden food, we feel guilty. Permission allows us to eat without guilt and to eat less in the long run.

Day 3: Don’t skip breakfast and lunch because you are going out for dinner tonight. You will just set yourself up to overeat the entire evening. If dinner is late, have a snack before you go. Once you are full at dinner, set aside the reset of the food and ask for a “doggie bag” to take home.

Day 4: Take time for yourself by taking a walk. If you don’t have an hour, then 15 minutes will do.

Day 5: Don’t eat those cookies sitting around at work for lunch. Eat a well-balanced lunch containing all the food groups and then see how many of those cookies you really want.

Day 6: While planning that special dinner menu, think of colorful low-fat choices to put with that prime rib you want to serve. Fresh steamed asparagus could replace broccoli with cheese sauce. Other festive options are cauliflower with red & green peppers or lime & raspberry sherbet in schaum torte cups.

Day 7: Pamper yourself with a bubble bath, a long shower or a nap. Often we turn to food as a stress-reliever, when what our body really needs is time to relax and unwind.

Day 8: Happy New Year! Make a resolution this year to take time to take care of yourself-enough time for exercise, enough time for relaxation, and enough time to enjoy food.

Day 9: Don’t suffer with your special once-a-year recipe made with fat-free sour cream. Use the tastier low-fat version that you will enjoy, and don’t fall into the trap of thinking “fat-free is calorie free”. This simply is not true.

Day 10: Go sledding with the kids

Day 11: Go buy some fresh watermelon, fresh berries, or any other non-winter fruit you can find. What a treat!

Day 12: You don’t have to finish all your plum pudding. It will save until tomorrow; you can eat it for breakfast if you like. Once it is gone, cherish the memories of a delightful treat. Or better yet, plan to make it again in July!

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

Would you recognize if your friend or family member had an eating disorder?

I first showed signs of anorexia when I was a sophomore in high school. I began limiting food. I was a synchronized swimmer and wanted to lose weight to look better in a bathing suit. Rather than eating lunch, I’d study or talk to friends. I stayed late at school and skipped dinner. I exercised compulsively, sometimes working out all night. I didn’t want to sleep, because I wouldn’t be burning any calories. Keeping up the self-starvation became more difficult when I started going to Sweet 16 parties. I’d eat a salad or soup, a binge for me at that time. To compensate, I began purging and taking pills—laxatives, diet pills, water pills—25 or 30 a day. I lost weight. I always felt cold and often lightheaded. I fainted. I was very moody and temperamental. Toward the end, I developed fine baby hair on my tummy (a symptom of anorexia). The enamel on my teeth eroded from the stomach acid coming back up when I vomited. I needed many fillings.

Read more about Joan’s Story

Eating Disorders are serious, life-threatening illnesses – not choices – and it’s important to recognize the pressures, attitudes and behaviors that shape the disorder. Would you recognize if your friend or family member had an eating disorder? Parents, siblings and close friends play a significant role in guiding and supporting someone with an eating disorder. In many cases, individuals with eating disorders cannot recognize a need for help in themselves, and it takes a strong, caring individual to reach out. Most importantly, you need to know that there is hope. For those seeking recovery for a loved one, eating disorder treatment is available.

Some of the warning signs that may indicate an Eating disorder include:

  • Excessive weight loss – losing 15% or more of ideal body weight
  • Obsession with food calories and fat content
  • Dieting even when thin
  • Intense fear of gaining weight, even when underweight
  • Distorted self-image of excess weight even though not overweight.
  • preoccupation with size, body weight or shape
  • preoccupied with food, calories, nutrition, or cooking
  • Being secretive about food
  • Social isolation / avoid situations where food is served
  • Uses the bathroom frequently after meals.
  • Experiences frequent fluctuations in weight.
  • Loss of menstrual periods (secondary amenorrhea ) or delay in onset of period (menarche)
  • Excessive or increase in exercise
  • Feeling cold, especially in the hands and feet
  • Hair loss and/or growth of fine hair on the body
  • Over-use of laxatives or other weight loss products
  • Fainting or severe lightheadedness
  • Depression and/or anxiety
  • Heart palpitations

February 26 – March 3, 2012 is National Eating Disorders Awareness week. Access an Eating Disorders Screening Tool, or get information about Eating Disorder Treatment.

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.

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