Psychological and psychiatric standardized procedures for metabolic bariatric surgery: a clinical practice model for mental health providers.

Introduction: Obesity is a multifactorial and chronic disease, constantly growing in prevalence. Metabolic and Bariatric Surgery (MBS) is among the most effective therapies for obesity, determining consistent long-term weight loss and maintenance. Increasing evidence suggests a relevant mental health contribution to obesity pathogenesis. European and International Guidelines for MBS emphasize the importance of a pre-surgical psychological/psychiatric assessment and a post-surgical follow-up to improve MBS outcomes. Yet, no standard psychological/psychiatric procedures currently exist.

Methods: This paper overviews the psychological/psychiatric procedures which Italian mental health providers currently perform on MBS candidates to provide psychological support through every step of the MBS, from the assessment to the postsurgical follow-up, to evaluate eligibility, prevent mental health flare-ups and weight regain, as endorsed by the Board of the Italian Society of Surgery for Obesity and Metabolic Diseases (SICOB).

Results: The psychological/psychiatric procedures should encompass two phases: pre-surgical assessment and post-surgical follow-up. Pre-surgical assessment should investigate every condition that might reduce the MBS effectiveness or contraindicate the surgical process. It must include a mental state evaluation, weight history, eating behavior, body image, psychosocial conditions, and motivation. The post-surgical follow-up should offer psychological support to patients in achieving weight loss and maintenance. It should also prevent the onset or recurrence of psychiatric disorders that may affect clinical outcomes.

Discussion: This paper is the first to introduce a standardized protocol for psychological/psychiatric procedures for each phase of the surgical process, to allow MBS candidates to receive similar care despite geographical differences. It also serves as a potential clinical model for assessing mental eligibility or contraindications prior to MBS, and subsequently support the individual behavioral and lifestyle changes to achieve and maintain weight loss.