Psychological Considerations Before Bariatric Surgery
Psychological Considerations Before Bariatric Surgery Gretchen E. Ames, PhD, ABPP ASMBS Fellow Series 2018 MFMER 3697160-1 Bariatric Team Patient Relations Specialist RN Coordinator Surgeons Bariatric Medicine Physician Psychologist Bariatric Surgery Board Physician Assistant Dietitians 2018 MFMER 3697160-2 Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D. Provided to ASMBS for distribution as part of The FELLOW Project
Bari Board—Shared Decisions Primary Surgery Revisions (15%) Psychological issues Adherence issues Medically complex Sleeve to RYGB Sleeve to SADI TORe American Society for Metabolic and Bariatric Surgery. Estimate of bariatric surgery numbers, 2011-2018. Accessed November 30, 2020. https:// asmbs.org/resources/estimate-of-bariatric-surgery numbers 2018 MFMER 3697160-3 Learning Objectives Purpose Components Content areas Clinical pearls 2018 MFMER 3697160-4 Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D. Provided to ASMBS for distribution as part of The FELLOW Project
Purpose “Did I pass?” Help patients access treatment of medical necessity Does lifestyle change fit for you? How can we help optimize your outcome? Required by insurance 2018 MFMER 3697160-5 Patient Misperceptions: Obesity is a choice Obesity is my fault Obesity is temporary Achieve normal weight/BMI Hard work and self-discipline Right way is diet and exercise Surgery is cheating Ames et al., Mayo Clinic Proceedings. 2020. 95 (3); 527-540 2018 MFMER 3697160-6 Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D. Provided to ASMBS for distribution as part of The FELLOW Project
Language Matters—Consider Alternatives Words to be avoided: Obese Weight loss surgery Failure (15% revisions) Last resort Morbid obesity Permanent Exercise Cure/resolution Non-compliance Clearance Recidivism Gold standard . Sogg et al., Bad words: Why language counts in our work with bariatric patients. SOARD, 2018;14:682–692 2018 MFMER 3697160-7 Components Screening Measures Clinical Interview Group Education Individual Treatment (EPIC) (PRN) 2018 MFMER 3697160-8 Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D. Provided to ASMBS for distribution as part of The FELLOW Project
Screening Measures Eating behavior Questionnaire of Eating and Weight Patterns-5 (QEWP-5) Alcohol use Modified Yale Food Addiction Scale (mYFAS) Mood Alcohol Use Disorders Identification Test (AUDIT) Abuse Hx Patient Health Questionnaire-9 (PHQ-9) Not for diagnosis Generalized Anxiety Disorder-7 (GAD-7) Mood Disorders Questionnaire (MDQ) Adverse Childhood Events (ACE) Perceived Stress Scale (PSS) Brief Resilience Scale (BRS) LASA Quality of Life 2018 MFMER 3697160-9 Interview Content— Weight History “I know you’re not going to believe me” Listen with curiosity Empathy—I understand why you feel . Kushner et al., JAMA. 2014;312(9):943-952. doi:10.1001/jama.2014.10432 2018 MFMER 3697160-10 Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D. Provided to ASMBS for distribution as part of The FELLOW Project
Interview Content— Problematic Eating Behaviors Binge Eating Disorder (10%) Night eating (31% with BED) Loss of control eating Grazing (33%) Food addiction (14%) Hx of Anorexia Nervosa Emotional eating Hx of Bulimia Nervosa Mitchell et al., Surg Obes Relat Dis. 2012 ; 8(5): 533–541. Ivezaj et al., Obes Rev. 2017 18(12): 1386-1397. Goodpaster et al., Surg Obes Relat Dis. 2016 Jun;12(5):1091-1097 2018 MFMER 3697160-11 Eating Behaviors—Keep It Simple Eat too much Eat too fast Eat at the wrong times Eat poor quality foods Eat for the wrong reasons Mitchell et al., Int J Eat Disord 2015 Mar;48(2):215-22 2018 MFMER 3697160-12 Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D. Provided to ASMBS for distribution as part of The FELLOW Project
Eating Behaviors—Clinical Pearls Lack prognostic significance for surgical outcome Significantly improved 1-2 years after surgery BED, LOC eating, food addiction associated with mood disturbance Follow-up care is critical Brode, C.S. and J.E. Mitchell, Psychiatr Clin North Am, 2019. 42(2): p. 287-297 2018 MFMER 3697160-13 Interview Content— Psychosocial History (Lifetime prevalence) Mood Disorders (44%) Tobacco Use Alcohol Use Disorder (33%) Childhood Trauma (42;24%) Drug Abuse/Dependence (7.5%) Cognitive Function Personality Disorders (20%) Current Stressors Knowledge/expectations Quality of Life Social Support Physical Activity Mitchell et al., Surg Obes Relat Dis. 2012 8(5): 533–541 Kalarchian et al., Am J Psychiatry. 2007 Feb;164(2):328-34 Orcutt et al., Surg Obes Relat Dis. 2019 15: 295-304 Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D. Provided to ASMBS for distribution as part of The FELLOW Project 2018 MFMER 3697160-14
Mood Disorders (Lifetime prevalence) Depression (39%) Anxiety Disorders (32%) Bipolar Disorder Suicidal ideation/attempt Tx history—medication Mitchell et al., Surg Obes Relat Dis. 2012 ; 8(5): 533–541 Hawkins, M., et al., Psychosomatics, 2019. 60(5): p. 449-457. 2018 MFMER 3697160-15 Potential Contraindications—Pearls Schizophrenia/psychosis/dementia Untreated severe depression Untreated Bipolar Disorder No psychiatry support Psychiatric hospitalization ( 12 mo) Substance use treatment ( 12 mo) Active substance use 2018 MFMER 3697160-16 Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D. Provided to ASMBS for distribution as part of The FELLOW Project
Knowledge/Expectations Understanding of desired procedure Understanding of tool vs. cure Importance of lifestyle change—values Level of confidence to make change—ability Expectations for weight loss/BMI 2018 MFMER 3697160-17 Expectations—BMI After Surgery Classification BMI outcome Normal 25 2% after surgery Overweight/Obesity 35 BMI 50 before surgery Obesity 40 BMI 50 before surgery Biron, et al., Obesity Surgery. 2004; 14: 160-164 2018 MFMER 3697160-18 Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D. Provided to ASMBS for distribution as part of The FELLOW Project
Expectations—Chronic Disease Management 1. Educate yourself 2. Self-monitoring 3. Follow-up care 2018 MFMER 3697160-19 Social Support Immediate family Convenience eating Partner’s weight Surgery not a change agent Wallwork et al., Obesity Surgery (2017) 27:1973-1981. Bruze, G., et al. JAMA Surgery (2018): E1-E8. 2018 MFMER 3697160-20 Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D. Provided to ASMBS for distribution as part of The FELLOW Project
PT Consult Resistance training What can they do now? What would they like to get back to doing? 2018 MFMER 3697160-21 Follow-up Care Weight Loss Physical Activity Eating Behavior Alcohol Use Mood Suicide Opioid Use 2018 MFMER 3697160-22 Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D. Provided to ASMBS for distribution as part of The FELLOW Project
Thank You Stay Tuned! 2018 MFMER 3697160-23 Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D. Provided to ASMBS for distribution as part of The FELLOW Project
Psychological Considerations Before Bariatric Surgery (2020) Dr. Gretchen E. Ames, Ph.D . Provided to ASMBS for distribution as part of The FELLOW Project 2018 MFMER 3697160 -1 Psychological Considerations Before Bariatric Surgery Gretchen E. Ames, PhD, ABPP ASMBS Fellow Series 2018 MFMER 3697160 -2 Bariatric Team Patient Relations .
rates after bariatric surgery have fallen by 80% in the past decade. Data involving nearly 60,000 bariatric pa-tients from American Society for Metabolic and Bariatric Surgery (ASMBS) Bariatric Centers of Excellence data-base show that the risk of death within the 30 days fol-lowing bariatric surgery av-erages 0.13%, or approxi-
1. Bariatric Clear Liquids: starts the day after surgery. 2. Bariatric Full Liquids: starts the day you go home from the hospital. 3. Bariatric Pureed Food: starts at your 2-week post-op clinic visit. 4. Bariatric Soft Foods: lasts about 2 weeks for Bypass and 4 weeks for the Sleeve. 5. Bariatric Regular diet: Begins at your 2-month post-op .
Post-bariatric surgery health behaviour changes. Post-bariatric surgery diet. Centres that perform bariatric surgery will typically provide pa-tients with a dietary protocol to follow. Initially, over several weeks, patients transition from liquid, to soft and then to a sol-id diet. Over the long term, patients are encouraged to follow
Bariatric Surgery Patient Binder Weight Loss Surgery Bariatric surgery, or weight loss surgery, is a tool to help people lose weight. When accompanied by permanent lifestyle changes, it can help individuals achieve lasting health benefits. Baptist Health Bariatric Center offers the lat-est and safest weight loss surgery options:
Improvement in mortality after bariatric surgery 72 1.21 Resolution of co - morbidities after bariatric surgery 73 1.22 Bariatric surgery leads to an improv ement in glucose homeostasis 74 1.23 The economic costs of obesity can be counteracted by obesity surgery 75 1.24 Our hypoth
Bellevue Bariatric Program February 2019 Lactose Intolerance and Sensitivity after Bariatric Surgery by Kat Cozza , PA-C Patients who have had bariatric surgery may experience a varie-ty of gastrointestinal changes. In particular, some bariatric by- pass patients may experience GI symptoms due to an intoler-ance or sensitivity to lactose found .
This Coverage Policy addresses bariatric surgery and procedures for the treatment of morbid obesity. Coverage Policy . Coverage for bariatric surgery or revision of a bariatric surgery procedure varies across plans and may be governed by state mandates. Refer to t
Elastomeric bumpers (ASME A17.1 year 2013 & prior) or buffer springs (ASME A17.1 year 2016) Platform Sizes 48"W x 54"D standard 42"W x 60"D optional 42"W x 54"D standard 51"W x 51"D 90 optional Specifications Power supply: 208/230 VAC, 1 ph, 30 amp, 60 hz Capacity: 1400 lb. (635 kg) Speed: 30 fpm (.15 m/s) Travel: up to 25'0" standard Three-year .
