I’m writing this piece wearing two hats. Yes, I am a card-carrying anthropologist with all that entails. I’m also a licensed clinical psychologist. In the latter role, I’ve been doing psychological assessments for gastric bypass and laparoscopy. These surgeries are increasing in number. Furthermore, they are being given to teenagers and contemplated for younger children. For many years, a patient who was going to get these surgeries had to go through a psych assessment before proceeding. I wanted to tell you what I do in these assessments. My questions involve food and the person’s relationship to food.
First, the intake questions focus on the person’s family history. How does the patient view food culturally? How does it fit into their social life? What specifically do they eat that we can see as “culturally-based eating?” Is the person’s family of origin prone to obesity? (BTW, the politically correct term is severe, not morbid, obesity.)
Is there a psychiatric history of the person and family members? At times I’ve given a test to assess stability. Then I’ve asked what medications the person is taking. This last point is crucial, because many medications, such as anti-depressants put on weight. Is there a family history of Type II diabetes? Has the person gone to the primary care physician and been tested for any kind of thyroid abnormalities? What natural supplements are the person taking (and have they told their physician), since these supplements, too, can have side effects affecting weight, diet, and other medical conditions?
Second, the questions focus on the success or failure of different kinds of diets. For the most part, the person has gone through many diets, none of which has worked. The question is why. Yes, the patient has told the doctor this. But I ask them about their present eating habits. I review their daily meals. Despite the fact that they are preparing for surgery, many of them are still eating “badly” too much fat, salt, and random and inadequate meals. Many people tend to drink caffeinated drinks. Even though they don’t have sugar, caffeine can stimulate a sugar response as well as a cycle of highs and lows.
Third, the questions focus on whether the person has had a significant psychiatric and substance abuse history. Quite often, for example, the person has been sexually abused. The purpose of these questions is to find out whether the person will follow instructions post-surgery, since violating instructions, i.e., eating too much and the wrong kinds of food can put the surgery at risk.
Fourth, the questions focus on how the person chooses to get medical information. Does the person want it in written form, orally, and/or visually? Does the patient want a friend to come to the doctor’s office to help them with information?
Fifth, the questions focus on who is going to help the person post-surgery. This is particularly important since the person may be incapacitated for a while. Equally important, the patient is queried on family dynamics. One often finds that a patient’s partner “enables” the obesity by wanting the person to be overweight. There are lots of reasons for this. The partner may want a larger person as their significant other. The partner and the patient may be avoiding having sex because of the weight issue and other factors. I also ask the patient how s/he will deal with their new body at work and in their social life. As is often the case, obese people are ignored, and changing one’s weight makes a person visible. My impression after doing these assessments for over ten years is that this is a more sensitive issue for women than men. Men tend to be seen as more visible, women, less so. Again, this gender difference worsens as people get older, more so for women.
I follow up several months later to see how the person is doing. The follow-up reviews both weight and food compliance and family dynamics. The purpose of the follow-up is to help the person maintain compliance and achieve success.
I’ve tried to be general here. I look forward to specific comments and questions, because there are more physical and psychological concerns that are involved. I’ve noticed that they can affect each gender differently.
Comments by Richard Zimmer