JourneyLite Physicians · PDF text · 03/2023

Guidelines for Psychological Evaluation for Bariatric Surgery

Our patient is considering surgical weight loss surgery and requires an evaluation by a psychologist or psychiatrist. Most insurance companies will not authorize the surgery without a letter of support. It would be helpful if you provide documentation on the following issues.

1. Obesity history, how long has obesity been a problem? Attempts to lose weight?
2. How does the patient think the surgery will help? What are the benefits and risks?
3. Please list details of the patient’s personal history such as where they are from, where they live now, education, marital status, physical and sexual abuse, home situation and family interactions.
4. Please describe sources of stress in the patient’s life.
5. Details of tobacco, alcohol and recreational drug use.
6. History of addictions or substance abuse.
7. Does the patient have any untreated or incompletely treated psychiatric illness?
8. Please describe details of depression, suicidal tendencies, eating disorders and compliance issues.
9. Please describe patients' comprehension of the surgery and their ability to make lifestyle changes.
10. Please describe patients' understanding of compliance in diet, exercise and the lifelong vitamin and follow-up care at this office. (Surgical follow-up, nutritional counseling and support group meetings.)
11. Will the patient be compliant with post operative instructions?
12. Is the patient reliable?
13. Does the patient have adequate support?
14. Does the patient have realistic expectations and understand complications that can occur?
15. Is the patient capable of giving informed consent?
16. Psychological testing results that were used.