Presurgical Psychiatric Evaluations of Candidates for Bariatric Surgery, Part 1: Reliability and Reasons for and Frequency of Exclusion

Objective: Many bariatric surgery programs include psychiatric evaluations as part of the preoperative screening procedure. Surveys of surgeons and mental health professionals have found variability in opinion regarding what psychosocial problems warrant denial of clearance for surgery. Few studies have reported the number of patients who are not cleared for surgery due to psychiatric reasons, and no study has reported the reliability of decision making. The goals of the present study were to examine the reliability of decisions to clear candidates for surgery, determine the percentage of candidates who were not cleared for surgery, and detail the reasons candidates were not cleared for surgery.

Method: Five hundred candidates for bariatric surgery were evaluated from July 2004 until July 2006 with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders supplemented by a module specific to this population. Reliability for determining clearance was evaluated in 73 patients. Reasons for not clearing patients were recorded on the Surgery Clearance Form.

Results: Eighteen percent (N = 92) of the patients were not cleared for surgery. The kappa coefficient of reliability of determining surgical clearance was 0.83. The most common reasons for the negative recommendation were overeating to cope with stress or emotional distress, current eating disorder, uncontrolled psychopathology, and the presence of significant life stressors. Only 1 patient was excluded for a lack of understanding of the potential risks of surgery.

Conclusions: The decision whether to clear candidates for bariatric surgery can be made reliably. Approximately 1 in 5 surgical candidates did not pass the initial psychiatric screening, usually because of current eating pathology, other forms of uncontrolled psychopathology, or difficulty coping with current life stressors.