| Psychiatric Evaluation for Gastric ByPass Surgeries |
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General information about Gastric Bypass (from Medline Plus)
The Center for Brief Therapy offers psychiatric evaluations for bariatric surgery. Dr. Sharon Morgillo Freeman will conduct your evaluation
and forward it to your surgeon.
Bariatric surgery - gastric bypass
Gastric bypass surgery is one type of procedure that can be used to cause significant weight loss if you are very obese. The surgery reduces
your body's intake of calories. Calorie reduction is accomplished in two ways:
After the surgery, your stomach is smaller. You feel full faster and learn to reduce the amount that you eat at any given time.
Part of your stomach and small intestines are literally bypassed (skipped over) so that fewer calories are absorbed. Unfortunately,
sometimes nutrients are lost as well.
The surgery is only right for you if you meet certain strict criteria described later in this article.
Description
Prior to any weight loss operation, your doctor will give you a complete medical examination and evaluate your overall health.
A psychological evaluation will be given to you. The Center for Brief Therapy offers psychiatric evaluation for bariatric surgery. Dr. Sharon
Morgillo Freeman will conduct your evaluation and forward it to your surgeon. This will determine whether you are ready to adhere to a
healthier lifestyle. If you are not ready to make lifestyle changes (and have not tried hard to do so already), you will not be considered eligible
for the procedure. Without changing your lifestyle, the surgery will not be a success.
You will also receive extensive nutritional counseling before (and after) your surgery.
The surgery is performed under anesthesia. There are two basic steps:
STEP 1 -- The first step in the surgical procedure makes your stomach smaller. The surgeon divides the stomach into a small upper section
and a larger bottom section using staples that are similar to stitches. The top section of the stomach (called the pouch) will hold your food.
STEP 2 -- After the stomach has been divided, the surgeon connects a section of the small intestine to the pouch. When you eat, the food will
now travel from the pouch through this new connection ("Roux limb"), bypassing the lower portion of the stomach. The surgeon will then
reconnect the base of the Roux limb with the remaining portion of the small intestines from the bottom of the stomach, forming a y-shape.
This "y-connection" allows food to mix with pancreatic fluid and bile, aiding the absorption of important vitamins and minerals. You still may
experience poor absorption of certain nutrients.
The risk of malabsorption is of greater concern in gastric surgeries that skip over a larger portion of the small intestines. These are
performed much less commonly than the Roux-en-Y gastric bypass as described.
LAPAROSCOPY
Gastric bypass can be performed using a laparoscope. This less-invasive technique allows the surgeon to make smaller incisions, which
lowers the risk of large scars and hernias after the procedure.
First, small incisions are made in your abdomen. The surgeon passes slender surgical instruments through these narrow openings. The
surgeon also passes a camera (laparoscope) through one of these small openings and watches through a lens and video monitor to do the
surgery.
TYPES OF WEIGHT LOSS SURGERIES
Weight loss surgery can be divided into three types:
Restrictive procedures reduce the size of your stomach.
Malabsorptive procedures alter the flow from your stomach to your intestine, causing poor absorption of calories, vitamins, and minerals in
the intestine.
Combination procedures involve characteristics of both restrictive and malabsorptive procedures.
Gastric bypass surgeries are combination procedures that use both restriction and malabsorption to achieve weight loss.
Because it is a combination approach, it tends to be more successful for weight loss than purely restrictive surgeries. However, your body
may not absorb vitamins and minerals properly.
Restrictive-only procedures are not as successful. It is easy to "cheat" and eat too much food, over-stretching the newly created stomach
pouch.
Lap-Band Surgery
A newer procedure, called the Lap-Band, uses a band around the upper part of the stomach, creating a small pouch to hold food. The band
limits the amount of food you can eat, and increases the time it takes the intestines to digest the food. Your doctor can later adjust the band
to allow food to pass more slowly or quickly through your digestive system. Possible complications include nausea, vomiting and
gastroesophageal reflux.
Indications
Gastric bypass surgery may be an option if you are significantly obese and have tried unsuccessfully to lose weight on diet and exercise
programs and are unlikely to lose weight successfully with non-surgical methods.
Gastric bypass surgery is not a "quick fix" for obesity. The surgery can take several hours and has risks and possible complications. For
example, vomiting following the surgery is not uncommon because of eating more than the new, small stomach can accommodate.
Your commitment to diet and exercise must be very strong because even after the surgery, you must adhere to these lifestyle changes.
Otherwise, complications from the surgery are likely to develop.
The procedure may be considered for obese individuals who have:
A Body Mass Index (BMI) of 40 or more. BMI is a calculation based on height and weight that is used to determine whether you are of normal
weight or are overweight. Someone with a BMI of 40 or more is at least 100 pounds over their recommended weight. A normal BMI is
between 18.5 and 25.
A BMI of 35 or more along with a life-threatening illness that can be made better with weight loss, such as sleep apnea, type 2 diabetes, and
heart disease.
LAPAROSCOPY
Not everyone is a candidate for the laparoscopic (minimally invasive) approach. You are probably NOT a good candidate for laparoscopy if
you weigh more than 350 pounds. Others who have had past abdominal surgery may also not be candidates, due to scar tissue. Your
surgeon will determine the best and safest approach for you.
Risks
The risks of gastric bypass surgery include:
Bleeding
Infections
Follow-up surgeries to correct complications, or to remove excess skin
Gallstones due to significant weight loss in a short amount of time
Gastritis (inflammation of the lining of the stomach)
Vomiting from eating more than the stomach pouch can hold
Iron or vitamin B12 deficiencies (if they occur) can lead to anemia
Calcium deficiency (if it occurs) can contribute to the development of early osteoporosis or other bone disorders
Follow up surgeries may be less likely if gastric bypass is performed with a laparoscope.
Another common complication from gastric bypass is "dumping syndrome." The symptoms often include:
Nausea and vomiting
Diarrhea
Bloated feeling
Dizziness
Sweating
You can lessen these symptoms by following your dietitian's guidelines very carefully, especially during the first two months after surgery.
Expectations after surgery
The weight loss results of gastric bypass surgery are generally good. Most patients lose an average of 10 pounds per month and reach a
stable weight between 18 and 24 months after surgery. Often, the greatest rate of weight loss occurs in the very beginning (that is, just
following the surgery when you are still on a liquid diet).
After the surgery, you will need to follow up with your doctor fairly often during the first year. During those visits, your physician will be
evaluating your physical and mental health status, including any change in weight and your nutritional needs. You will likely see a dietitian
during those visits as well.
The surgery is not a solution in and of itself. While it can train you to eat smaller quantities and feel full more quickly, you still have to do
much of the work. To achieve weight loss and avoid complications from the procedure, you must exercise and eat properly -- according to
important, healthy guidelines that your doctor and nutritionist will teach you.
Recovery
Most people typically stay in the hospital for a few days or less after gastric bypass surgery. Some may need to stay 4 to 5 days. Your doctor
will approve your discharge to home once you can do the following:
Move without too much discomfort
Eat liquid and/or pureed food without vomiting
No longer require pain medication given by injection
You will remain on liquid or pureed food for several weeks after the surgery. Even after that time, you will feel full very quickly, sometimes only
being able to take a few bites of solid food. This is because the new stomach pouch initially only holds a tablespoonful of food. The pouch
eventually expands. However, it will hold no more than about one cup of thoroughly chewed food (a normal stomach can hold up to one
quart).
Upon follow up, your doctor will determine if you need replacement of iron, calcium, vitamin B12, or other nutrients. Supplements, such as a
multivitamin with minerals, will be prescribed to provide any nutrients that you may not be getting from your diet. This lack of nutrients can
occur because you are eating less and because the food moves through your digestive system more quickly.
Once your diet begins to consist of more solid food, remember to chew each bite very slowly and thoroughly.
You will be instructed on eating small meals frequently throughout the day, rather than large meals that your stomach cannot accommodate.
Your new stomach probably won’t be able to handle both solid food and fluids at the same time. So, you should separate fluid and food
intake by at least 30 minutes and only sip what you are drinking.
You won’t be able to tolerate large amounts of fat, alcohol, or sugar. You should reduce your fat intake, especially fast food meals, deep-fried
foods, and high-fat foods, as well as high-sugar foods like cakes, cookies, and candy.
Exercise and the support of others (for example, joining a support group with people who have undergone weight loss surgery) are
extremely important to help you lose weight and maintain that loss following gastric bypass. You can generally resume exercise 6 weeks
after the operation. Even sooner than that, you will be able to take short walks at a comfortable pace, with the approval and guidance of your
doctor. Exercise improves your metabolism, while both exercise and attending a group support can boost your self-esteem and help you
stay motivated
The Center for Brief Therapy offers psychiatric evaluations for bariatric surgery. Dr. Sharon Morgillo Freeman will conduct your evaluation
and forward it to your surgeon.
Bariatric surgery - gastric bypass
Gastric bypass surgery is one type of procedure that can be used to cause significant weight loss if you are very obese. The surgery reduces
your body's intake of calories. Calorie reduction is accomplished in two ways:
After the surgery, your stomach is smaller. You feel full faster and learn to reduce the amount that you eat at any given time.
Part of your stomach and small intestines are literally bypassed (skipped over) so that fewer calories are absorbed. Unfortunately,
sometimes nutrients are lost as well.
The surgery is only right for you if you meet certain strict criteria described later in this article.
Description
Prior to any weight loss operation, your doctor will give you a complete medical examination and evaluate your overall health.
A psychological evaluation will be given to you. The Center for Brief Therapy offers psychiatric evaluation for bariatric surgery. Dr. Sharon
Morgillo Freeman will conduct your evaluation and forward it to your surgeon. This will determine whether you are ready to adhere to a
healthier lifestyle. If you are not ready to make lifestyle changes (and have not tried hard to do so already), you will not be considered eligible
for the procedure. Without changing your lifestyle, the surgery will not be a success.
You will also receive extensive nutritional counseling before (and after) your surgery.
The surgery is performed under anesthesia. There are two basic steps:
STEP 1 -- The first step in the surgical procedure makes your stomach smaller. The surgeon divides the stomach into a small upper section
and a larger bottom section using staples that are similar to stitches. The top section of the stomach (called the pouch) will hold your food.
STEP 2 -- After the stomach has been divided, the surgeon connects a section of the small intestine to the pouch. When you eat, the food will
now travel from the pouch through this new connection ("Roux limb"), bypassing the lower portion of the stomach. The surgeon will then
reconnect the base of the Roux limb with the remaining portion of the small intestines from the bottom of the stomach, forming a y-shape.
This "y-connection" allows food to mix with pancreatic fluid and bile, aiding the absorption of important vitamins and minerals. You still may
experience poor absorption of certain nutrients.
The risk of malabsorption is of greater concern in gastric surgeries that skip over a larger portion of the small intestines. These are
performed much less commonly than the Roux-en-Y gastric bypass as described.
LAPAROSCOPY
Gastric bypass can be performed using a laparoscope. This less-invasive technique allows the surgeon to make smaller incisions, which
lowers the risk of large scars and hernias after the procedure.
First, small incisions are made in your abdomen. The surgeon passes slender surgical instruments through these narrow openings. The
surgeon also passes a camera (laparoscope) through one of these small openings and watches through a lens and video monitor to do the
surgery.
TYPES OF WEIGHT LOSS SURGERIES
Weight loss surgery can be divided into three types:
Restrictive procedures reduce the size of your stomach.
Malabsorptive procedures alter the flow from your stomach to your intestine, causing poor absorption of calories, vitamins, and minerals in
the intestine.
Combination procedures involve characteristics of both restrictive and malabsorptive procedures.
Gastric bypass surgeries are combination procedures that use both restriction and malabsorption to achieve weight loss.
Because it is a combination approach, it tends to be more successful for weight loss than purely restrictive surgeries. However, your body
may not absorb vitamins and minerals properly.
Restrictive-only procedures are not as successful. It is easy to "cheat" and eat too much food, over-stretching the newly created stomach
pouch.
Lap-Band Surgery
A newer procedure, called the Lap-Band, uses a band around the upper part of the stomach, creating a small pouch to hold food. The band
limits the amount of food you can eat, and increases the time it takes the intestines to digest the food. Your doctor can later adjust the band
to allow food to pass more slowly or quickly through your digestive system. Possible complications include nausea, vomiting and
gastroesophageal reflux.
Indications
Gastric bypass surgery may be an option if you are significantly obese and have tried unsuccessfully to lose weight on diet and exercise
programs and are unlikely to lose weight successfully with non-surgical methods.
Gastric bypass surgery is not a "quick fix" for obesity. The surgery can take several hours and has risks and possible complications. For
example, vomiting following the surgery is not uncommon because of eating more than the new, small stomach can accommodate.
Your commitment to diet and exercise must be very strong because even after the surgery, you must adhere to these lifestyle changes.
Otherwise, complications from the surgery are likely to develop.
The procedure may be considered for obese individuals who have:
A Body Mass Index (BMI) of 40 or more. BMI is a calculation based on height and weight that is used to determine whether you are of normal
weight or are overweight. Someone with a BMI of 40 or more is at least 100 pounds over their recommended weight. A normal BMI is
between 18.5 and 25.
A BMI of 35 or more along with a life-threatening illness that can be made better with weight loss, such as sleep apnea, type 2 diabetes, and
heart disease.
LAPAROSCOPY
Not everyone is a candidate for the laparoscopic (minimally invasive) approach. You are probably NOT a good candidate for laparoscopy if
you weigh more than 350 pounds. Others who have had past abdominal surgery may also not be candidates, due to scar tissue. Your
surgeon will determine the best and safest approach for you.
Risks
The risks of gastric bypass surgery include:
Bleeding
Infections
Follow-up surgeries to correct complications, or to remove excess skin
Gallstones due to significant weight loss in a short amount of time
Gastritis (inflammation of the lining of the stomach)
Vomiting from eating more than the stomach pouch can hold
Iron or vitamin B12 deficiencies (if they occur) can lead to anemia
Calcium deficiency (if it occurs) can contribute to the development of early osteoporosis or other bone disorders
Follow up surgeries may be less likely if gastric bypass is performed with a laparoscope.
Another common complication from gastric bypass is "dumping syndrome." The symptoms often include:
Nausea and vomiting
Diarrhea
Bloated feeling
Dizziness
Sweating
You can lessen these symptoms by following your dietitian's guidelines very carefully, especially during the first two months after surgery.
Expectations after surgery
The weight loss results of gastric bypass surgery are generally good. Most patients lose an average of 10 pounds per month and reach a
stable weight between 18 and 24 months after surgery. Often, the greatest rate of weight loss occurs in the very beginning (that is, just
following the surgery when you are still on a liquid diet).
After the surgery, you will need to follow up with your doctor fairly often during the first year. During those visits, your physician will be
evaluating your physical and mental health status, including any change in weight and your nutritional needs. You will likely see a dietitian
during those visits as well.
The surgery is not a solution in and of itself. While it can train you to eat smaller quantities and feel full more quickly, you still have to do
much of the work. To achieve weight loss and avoid complications from the procedure, you must exercise and eat properly -- according to
important, healthy guidelines that your doctor and nutritionist will teach you.
Recovery
Most people typically stay in the hospital for a few days or less after gastric bypass surgery. Some may need to stay 4 to 5 days. Your doctor
will approve your discharge to home once you can do the following:
Move without too much discomfort
Eat liquid and/or pureed food without vomiting
No longer require pain medication given by injection
You will remain on liquid or pureed food for several weeks after the surgery. Even after that time, you will feel full very quickly, sometimes only
being able to take a few bites of solid food. This is because the new stomach pouch initially only holds a tablespoonful of food. The pouch
eventually expands. However, it will hold no more than about one cup of thoroughly chewed food (a normal stomach can hold up to one
quart).
Upon follow up, your doctor will determine if you need replacement of iron, calcium, vitamin B12, or other nutrients. Supplements, such as a
multivitamin with minerals, will be prescribed to provide any nutrients that you may not be getting from your diet. This lack of nutrients can
occur because you are eating less and because the food moves through your digestive system more quickly.
Once your diet begins to consist of more solid food, remember to chew each bite very slowly and thoroughly.
You will be instructed on eating small meals frequently throughout the day, rather than large meals that your stomach cannot accommodate.
Your new stomach probably won’t be able to handle both solid food and fluids at the same time. So, you should separate fluid and food
intake by at least 30 minutes and only sip what you are drinking.
You won’t be able to tolerate large amounts of fat, alcohol, or sugar. You should reduce your fat intake, especially fast food meals, deep-fried
foods, and high-fat foods, as well as high-sugar foods like cakes, cookies, and candy.
Exercise and the support of others (for example, joining a support group with people who have undergone weight loss surgery) are
extremely important to help you lose weight and maintain that loss following gastric bypass. You can generally resume exercise 6 weeks
after the operation. Even sooner than that, you will be able to take short walks at a comfortable pace, with the approval and guidance of your
doctor. Exercise improves your metabolism, while both exercise and attending a group support can boost your self-esteem and help you
stay motivated
General Information About Your Psychiatric Evaluation for Bariatric Surgery
The Center for Brief Therapy offers psychiatric evaluation for bariatric surgery. Dr. Sharon Morgillo Freeman will conduct
your evaluation and forward it to your surgeon. The operation serves as a powerful support for alteration in eating
behavior, but is a tool, not a cure for obesity. Patients need to make lifelong lifestyle changes, with a focus on a healthy
diet and regular exercise. If they follow the recommended diet, and exercise regularly, patients typically lose 50-65% of
their excess body weight, and rarely achieve their ideal body weight. After gastric bypass, some patients will experience
dumping syndrome, which can consist of nausea, dizziness, nausea, vomiting, abdominal cramping and diarrhea after
eating foods high in fat and concentrated sweets. Patients can undo the work of the surgery by continually snacking,
eating soft foods or drinking high calorie liquids. There is no guarantee for successful weight loss after gastric bypass.
The evaluation should include the following information:
1. Dates of visits for evaluation (minimum of two visits)
2. Past psychiatric history
3. Alcohol/drug/addictions/ substance use history
4. Psychosocial history
5. Family psychological history
6. Education/employment history
7. Supports
8. Mental status exam
9. Provisional diagnosis
10. Treatment plan/ summary
Also, comments regarding the following are helpful:
• Patient’s insight into eating triggers.
• Adverse psychiatric conditions: binge eating, night-eating syndrome, bulimia, self-induced vomiting, diuretic or
laxative use to lose weight, psychosis, severe neurosis, schizophrenia, uncontrolled depression, borderline personality,
and active suicidal ideation.
• Severe behavioral disorder, which might contraindicate surgery
• Unrealistic expectations, or goals of gastric bypass
• Understanding of the risks and discomforts of surgery
• Ability to handle the stress of the period that follows surgery and the counselor’s willingness to follow and treat the
patient in the post-operative period if needed.
• Ability to understand and comply with instructions and recommendations for daily vitamin and mineral supplements
for life, and regular follow-up with the Bariatric Surgery Program.
• Ability to make lifestyle changes, comply with a restricted diet and get regular exercise.
• Understanding that non-compliance may put the patient at risk.
• Recommendations regarding daily psychiatric medications (if any) during the early post-operative period.
The results of your evaluation will assist in determining the patient’s suitability for surgery from a mental health
perspective, as well as planning post-operative care and follow-up. This information may be made available to an
insurance carrier as part of our Bariatric Surgery Program evaluation criteria.
The Center for Brief Therapy offers psychiatric evaluation for bariatric surgery. Dr. Sharon Morgillo Freeman will conduct
your evaluation and forward it to your surgeon. The operation serves as a powerful support for alteration in eating
behavior, but is a tool, not a cure for obesity. Patients need to make lifelong lifestyle changes, with a focus on a healthy
diet and regular exercise. If they follow the recommended diet, and exercise regularly, patients typically lose 50-65% of
their excess body weight, and rarely achieve their ideal body weight. After gastric bypass, some patients will experience
dumping syndrome, which can consist of nausea, dizziness, nausea, vomiting, abdominal cramping and diarrhea after
eating foods high in fat and concentrated sweets. Patients can undo the work of the surgery by continually snacking,
eating soft foods or drinking high calorie liquids. There is no guarantee for successful weight loss after gastric bypass.
The evaluation should include the following information:
1. Dates of visits for evaluation (minimum of two visits)
2. Past psychiatric history
3. Alcohol/drug/addictions/ substance use history
4. Psychosocial history
5. Family psychological history
6. Education/employment history
7. Supports
8. Mental status exam
9. Provisional diagnosis
10. Treatment plan/ summary
Also, comments regarding the following are helpful:
• Patient’s insight into eating triggers.
• Adverse psychiatric conditions: binge eating, night-eating syndrome, bulimia, self-induced vomiting, diuretic or
laxative use to lose weight, psychosis, severe neurosis, schizophrenia, uncontrolled depression, borderline personality,
and active suicidal ideation.
• Severe behavioral disorder, which might contraindicate surgery
• Unrealistic expectations, or goals of gastric bypass
• Understanding of the risks and discomforts of surgery
• Ability to handle the stress of the period that follows surgery and the counselor’s willingness to follow and treat the
patient in the post-operative period if needed.
• Ability to understand and comply with instructions and recommendations for daily vitamin and mineral supplements
for life, and regular follow-up with the Bariatric Surgery Program.
• Ability to make lifestyle changes, comply with a restricted diet and get regular exercise.
• Understanding that non-compliance may put the patient at risk.
• Recommendations regarding daily psychiatric medications (if any) during the early post-operative period.
The results of your evaluation will assist in determining the patient’s suitability for surgery from a mental health
perspective, as well as planning post-operative care and follow-up. This information may be made available to an
insurance carrier as part of our Bariatric Surgery Program evaluation criteria.
| CBT The Center for Brief Therapy, PC, 10319 Dawson's Creek Blvd, Suite J, Fort Wayne, Indiana, USA 46825 260-969-5583; fax 260-969-5584; email: freemancbt@aol.com |
