I had a video call this week with a mental health counselor. She asked me about my medical history, my mental health history, my weight loss history, whether I was an emotional eater or a habitual eater, and what I prefer to eat and drink. I answered everything. She typed. At the end of the appointment, after confirming that my payment had cleared, she told me everything looked good and that she’d send a report to my surgical team.
No advice. No techniques. No discussion of strategies for the road ahead. Just questions, answers, and a payment confirmation.
I am now officially sane enough to have someone remove 70% of my stomach and re-route my small intestine. The paperwork will reflect this.
Why This Actually Exists
Here’s the thing – the psychological evaluation isn’t just bureaucratic theater, even if it can feel that way from the inside of a ten-minute video call.
The requirement traces back to a 1991 National Institutes of Health consensus statement recommending that bariatric surgery candidates be evaluated by a multidisciplinary team – medical, surgical, nutritional, and psychiatric. The reasoning was sound: people seeking bariatric surgery show higher rates of depression, anxiety, and disordered eating than the general population, and those factors can meaningfully affect outcomes after surgery. The surgery changes your body; it doesn’t automatically change the relationship with food that got you here.
The Obesity Action Coalition has a good overview of what these evaluations are designed to identify. The goal, broadly, is to flag anyone who might benefit from psychological support before surgery, identify anyone who might need ongoing support after, and – in rare cases – identify the small percentage of candidates (studies put it around 4%) who aren’t good candidates at the moment and might do better with some pre-surgery work first.
It’s a real screen for real reasons. The surgery is a tool, not a solution. Someone needs to make sure you understand the difference.
What It Felt Like From My End
The questions were thorough. Emotional eating, habitual eating – yes, I have opinions on both of those (I covered some of this in my last post). Weight loss history – yes, plenty of that too, none of it permanent. Mental health history – nothing dramatic to report. What do I prefer to eat and drink – well, I prefer chips and Diet Coke, which is probably why we’re here.
What there wasn’t, at least in my appointment, was any discussion of what comes next. No tools, no techniques, no “here’s how to think about your relationship with food differently.” Just intake. Just documentation. The report goes to my surgical team, gets filed somewhere, and somewhere a box gets ticked.
I don’t say that as a complaint about the counselor – she was perfectly pleasant and clearly knew what she was doing. I say it because the experience highlighted something about this whole process: most of these pre-surgery appointments are about the system confirming that I meet the criteria, not about preparing me for what’s coming. The preparation, apparently, is my job.
Which is fine. I’m a smart guy. I know how to read the documentation.
Another box ticked. The checklist marches on.