Bariatric Psychological Evaluation Report: Template & Guide
What Is a Bariatric Psychological Evaluation?
A bariatric psychological evaluation is a pre-surgical assessment conducted by a licensed psychologist or other qualified mental health professional to determine a patient's psychological readiness for weight loss surgery. This evaluation is required by virtually all insurance companies and most bariatric surgery programs, originating from the 1991 NIH Consensus Development Conference statement recommending psychological assessment as part of the multidisciplinary pre-surgical workup for patients with severe obesity.
The evaluation covers domains specific to bariatric surgical success: weight and dieting history, current and past eating behaviors (binge eating, emotional eating, night eating, grazing), psychiatric history and current functioning, substance use history and risk, coping skills and emotional regulation, social support and living environment, understanding of the surgical procedure, and realistic expectations about outcomes. The psychologist integrates these findings to formulate a recommendation regarding surgical readiness and to identify pre-operative and post-operative treatment needs.
This is a specialty evaluation requiring familiarity with the bariatric surgery literature, the behavioral demands of specific surgical procedures, the psychological predictors of post-surgical outcomes, and complications with psychological components such as transfer addiction, dumping syndrome, and body image dissatisfaction despite significant weight loss. A psychologist conducting bariatric evaluations without adequate background in health psychology or behavioral medicine risks producing reports that fail to address the clinically relevant issues.
When You Need It
- When a patient has been medically approved for bariatric surgery (BMI greater than or equal to 40, or BMI greater than or equal to 35 with obesity-related comorbidities) and requires psychological clearance as part of the pre-surgical protocol
- When an insurance company mandates a psychological evaluation as a condition for surgery pre-authorization
- When a bariatric program's multidisciplinary team includes psychological assessment in its standard pre-surgical pathway
- When a patient was previously not cleared and is returning for re-evaluation after completing recommended treatment
- When a patient's psychiatric history, substance use history, or behavioral presentation raises concerns that warrant formal evaluation
- When a patient is seeking revision surgery and the surgical team wants updated psychological assessment
Key Components / Required Sections
Referral Information and Medical Context
Document the referring surgeon or program, the planned surgical procedure (Roux-en-Y gastric bypass, sleeve gastrectomy, duodenal switch, adjustable gastric banding), the patient's current BMI, weight, and height, and obesity-related medical comorbidities (type 2 diabetes, hypertension, obstructive sleep apnea, osteoarthritis, GERD, fatty liver disease). Note whether this is a primary or revision procedure.
Weight and Dieting History
- Age of onset of overweight and obesity
- Maximum and minimum adult body weights
- Perceived causes and contributors to weight gain
- History of all significant weight loss attempts: commercial programs, medically supervised diets, pharmacotherapy, behavioral programs, prior bariatric procedures
- Pattern of weight cycling and factors associated with weight regain
- Family history of obesity and bariatric surgery
Eating Behavior Assessment
This is one of the most critical sections. Assess:
- Binge eating: frequency, duration, triggers, loss of control, volume, associated distress. Use the Binge Eating Scale (BES) or Eating Disorder Examination Questionnaire (EDE-Q).
- Emotional eating: eating in response to stress, anxiety, sadness, boredom, loneliness, anger, or celebration
- Grazing: continuous or repetitive unplanned eating of small amounts throughout the day, with or without a sense of loss of control
- Night eating: evening hyperphagia (consuming more than 25% of daily intake after the evening meal) and/or nocturnal ingestion (waking to eat)
- Food preferences and diet quality: types of foods consumed, sugar-sweetened beverage intake, meal regularity, portion awareness
- Purging behaviors: self-induced vomiting, laxative use, diuretic misuse, excessive exercise
- History of diagnosed eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder
Psychiatric History and Current Mental Health
- Current and lifetime psychiatric diagnoses, listed by onset and course
- Current and past psychotropic medications (names, dosages, prescribers, effectiveness, side effects, adherence)
- Psychiatric hospitalizations, emergency department visits for psychiatric reasons
- Current depressive symptoms: screen with PHQ-9 or BDI-II
- Current anxiety symptoms: screen with GAD-7 or BAI
- Suicidal ideation and self-harm history (current and lifetime)
- Trauma history (physical, sexual, emotional abuse; domestic violence; combat; accidents)
- Psychotic symptoms (hallucinations, delusions) — screen and rule out
- Current psychotherapy or counseling engagement
Substance Use History and Risk Assessment
- Current alcohol use: frequency, quantity, type, pattern, AUDIT score
- Current and past illicit drug use
- Tobacco and nicotine use (many surgical programs require tobacco cessation before surgery)
- History of prescription medication misuse
- Family history of substance use disorders
- Prior substance use treatment
- Patient's understanding of altered alcohol metabolism after gastric bypass
Coping Skills and Emotional Regulation
- Current strategies for managing stress, negative emotions, and interpersonal conflict
- Degree to which food serves as a primary emotional regulation strategy
- History and current use of non-food coping strategies (exercise, social support, relaxation, hobbies)
- Capacity for behavioral self-monitoring (food tracking, appointment adherence)
- Frustration tolerance and distress tolerance
Social Support and Environmental Factors
- Household composition and primary relationships
- Partner/family attitudes toward the surgery and willingness to support dietary changes
- Social isolation and its relationship to eating behavior
- Employment status and capacity for post-surgical medical leave
- Financial stability and insurance coverage for post-surgical follow-up
Surgical Knowledge, Motivation, and Expectations
- Patient's understanding of the specific procedure being planned
- Knowledge of risks and potential complications
- Understanding of the dietary progression (liquid, pureed, soft, regular) and lifelong dietary modifications
- Understanding of required vitamin and mineral supplementation
- Expected weight loss amount and timeline (compare with realistic norms)
- Motivation for surgery: internally driven versus externally pressured
- What the patient expects will change in their life beyond weight loss
Mental Status Examination
Document appearance, behavior, psychomotor activity, speech, mood, affect, thought process, thought content, perceptual disturbances, cognition, insight, and judgment.
Clinical Formulation and Recommendation
Synthesize findings into an integrated clinical formulation. Provide DSM-5-TR diagnoses if applicable. Issue a clear recommendation:
- Approved without reservations — no significant psychological risk factors identified
- Approved with recommendations — psychological risk factors identified that can be managed concurrently with surgical preparation; specify pre-operative and post-operative recommendations
- Delay recommended — significant risk factors that should be addressed before surgery; specify treatment goals, timeline, and criteria for re-evaluation
- Not recommended at this time — rare; reserved for cases with absolute contraindications
Bariatric Psychological Evaluation — 42-Year-Old Pre-Sleeve Gastrectomy
CONFIDENTIAL PSYCHOLOGICAL EVALUATION Pre-Surgical Bariatric Assessment
Patient: Angela Torres Date of Birth: 07/03/1983 Age: 42 Date of Evaluation: 02/24/2026 Date of Report: 03/02/2026 Referring Surgeon: Robert Chen, M.D., Bariatric Surgery Associates Planned Procedure: Laparoscopic Sleeve Gastrectomy Evaluator: Lisa Hartfield, Ph.D., Licensed Psychologist
Referral Information
Ms. Torres was referred by Dr. Robert Chen for pre-surgical psychological evaluation as part of the standard protocol for laparoscopic sleeve gastrectomy at Bariatric Surgery Associates. Current BMI: 44.2 (height 5'4", weight 258 lbs). Obesity-related comorbidities include type 2 diabetes mellitus (HbA1c 8.1), hypertension (managed with lisinopril 20mg), obstructive sleep apnea (uses CPAP nightly), and bilateral knee osteoarthritis. Ms. Torres has completed the required nutrition education classes and medical workup.
Weight and Dieting History
Ms. Torres reports being overweight since approximately age 10, following her parents' divorce, which she identifies as the beginning of emotional eating patterns. Her lowest adult weight was 168 lbs at age 22, achieved through a commercial liquid meal replacement program. Her highest weight was 274 lbs at age 39. She has attempted 8-10 structured weight loss programs over the past 20 years, including Weight Watchers (three separate attempts with 15-30 lbs lost each time), Jenny Craig, self-directed low-carbohydrate diets, a physician-supervised VLCD (very low calorie diet), and phentermine prescribed by her primary care physician for 3 months. Each attempt produced initial weight loss of 20-45 lbs followed by complete regain within 12-24 months, often exceeding the starting weight. She has not had prior bariatric surgery.
Family history is significant for obesity in both parents (mother with BMI estimated over 40, father with BMI over 35), type 2 diabetes in her mother and maternal grandmother, and a sister who underwent Roux-en-Y gastric bypass in 2023 with good results.
Eating Behavior Assessment
Ms. Torres reports eating 2-3 structured meals per day during the workweek, with reasonably controlled portions at breakfast and lunch. Evening and weekend eating is significantly less structured. She describes a pattern of continuous grazing from approximately 7:00 PM until bedtime, typically consuming chips, crackers, cheese, ice cream, and cookies while watching television. She estimates this grazing adds 600-1,000 calories to her daily intake.
She endorsed binge eating episodes occurring 2-3 times per month. During these episodes, she consumes large quantities of food (a full pizza, a pint of ice cream, and multiple servings of bread) within a 1-2 hour period, experiences a sense of loss of control ("once I start I can't stop"), eats more rapidly than normal, eats until physically uncomfortable, and feels distressed, guilty, and self-critical afterward. Common triggers include work stress, arguments with her husband, loneliness on weekends when her children are with friends, and premenstrual mood changes.
Binge Eating Scale (BES) score: 24 (moderate range; 18-26 indicates moderate binge eating severity).
She denied self-induced vomiting, laxative or diuretic misuse, and excessive compensatory exercise. She denied a history of anorexia nervosa or bulimia nervosa. She has never been treated for an eating disorder.
She described her relationship with food as "my main comfort — I celebrate with food, I cope with food, I socialize over food, and I numb out with food." She acknowledged this as a core issue that will need to change post-surgery.
Psychiatric History and Current Functioning
Ms. Torres has a history of major depressive disorder, with her first episode at age 25 following a miscarriage. She experienced a second depressive episode at age 34 following the loss of her mother. She has been prescribed sertraline 100mg by her primary care physician for the past 6 years. She reports the medication is "helpful but not enough" — she continues to experience low mood, poor self-esteem (primarily weight-related), and periodic feelings of hopelessness. She has never been psychiatrically hospitalized. She has never attempted suicide and denied current or past suicidal ideation. She denied psychotic symptoms, manic episodes, and trauma beyond the emotional impact of her parents' divorce in childhood.
She endorsed generalized worry about her health, her children's futures, and finances, but this did not meet full GAD-7 criteria for generalized anxiety disorder.
She has never engaged in individual psychotherapy. Her only mental health treatment has been medication management through her PCP.
Screening Measure Results:
| Measure | Score | Interpretation |
|---|---|---|
| PHQ-9 | 11 | Moderate depressive symptoms |
| GAD-7 | 7 | Mild anxiety symptoms |
| BES | 24 | Moderate binge eating |
| AUDIT | 3 | Low-risk alcohol use |
| DAST-10 | 0 | No drug use concerns |
Substance Use History
Ms. Torres reports consuming 1-2 glasses of wine per week in social settings. She denied any history of alcohol-related problems, blackouts, legal consequences, or concern from others about her drinking. AUDIT score of 3 is consistent with low-risk use. She denied current or past illicit drug use. She smoked cigarettes from ages 18-28 and has been tobacco-free for 14 years. She denied misuse of prescription medications.
She was educated about the elevated risk of developing alcohol use disorder following bariatric surgery, particularly with gastric bypass, and acknowledged understanding this risk.
Coping Skills and Emotional Regulation
Ms. Torres identified food as her primary coping mechanism for managing stress, negative emotions, boredom, and loneliness. She stated: "When I've had a terrible day, the first thing I think about is what I'm going to eat when I get home." She recognized that surgery will remove her ability to use food for emotional regulation in the same way and expressed both understanding and anxiety about this transition.
Non-food coping strategies she identified include talking to her sister (her closest confidant), listening to music, and reading. She does not currently exercise regularly due to knee pain and fatigue, though she expressed interest in beginning a water aerobics program after surgery. She has no meditation, yoga, or structured relaxation practice. She described limited frustration tolerance and a tendency to avoid conflict in her marriage, which she connected to her evening emotional eating pattern.
Social Support and Living Situation
Ms. Torres lives with her husband Marco (age 45) and their two children (ages 14 and 11) in their own home. She described her marriage as "mostly good but strained" — she noted that Marco has been ambivalent about surgery, expressing concern about surgical risks and changes to their shared food culture. He has agreed to attend one pre-surgical education session. Her sister, who had gastric bypass 3 years ago with successful outcomes, is a strong supporter and practical resource.
Ms. Torres has worked as an elementary school vice principal for 8 years. She has adequate health insurance through her employer and plans to take 3 weeks of medical leave for surgery and initial recovery. She has no concerns about job security.
Surgical Knowledge and Expectations
Ms. Torres demonstrated good knowledge of the sleeve gastrectomy procedure, accurately describing the permanent reduction in stomach size to approximately 15-20% of its original capacity, the need for small frequent meals, the dietary progression from liquids to solid foods over 4-6 weeks, and the lifelong requirement for vitamin and mineral supplementation (particularly B12, iron, calcium, and multivitamins). She stated that her sister's experience has helped her understand what to expect.
When asked about weight loss expectations, she stated she hopes to reach 160-170 lbs, which represents approximately 60-65% excess weight loss — consistent with established norms for sleeve gastrectomy. Her motivation is primarily health-driven: reducing or eliminating diabetes medication, lowering blood pressure, reducing knee pain, and improving energy and sleep quality. She also acknowledged wanting to "feel comfortable in my own body." Her expectations appear realistic and appropriately health-focused.
She was asked what she thinks will not change after surgery. She responded thoughtfully, noting that she will still need to deal with stress, marital issues, and emotional triggers without using food, and that surgery is "a tool, not a cure."
Mental Status Examination
Ms. Torres presented as a cooperative, warmly engaged, obese woman who appeared her stated age. She was neatly groomed and casually dressed. Psychomotor activity was normal. Speech was normal in rate, rhythm, and volume. She described her mood as "hopeful but nervous." Affect was full range, congruent with stated mood, and appropriate to content. Thought process was logical, organized, and goal-directed. Thought content was focused on the evaluation and surgery preparation; she denied suicidal ideation, homicidal ideation, and paranoid ideation. No perceptual disturbances were observed or reported. She was oriented to person, place, time, and situation. Memory and concentration appeared grossly intact. Insight was good — she demonstrated accurate understanding of her eating patterns, their emotional drivers, and the challenges she will face post-surgery. Judgment was adequate.
Diagnostic Impressions
- Binge Eating Disorder, Moderate (F50.81) — Recurrent binge eating episodes (2-3x/month) with loss of control, marked distress, and three or more DSM-5-TR associated features. No compensatory behaviors. Duration exceeds 3 months.
- Major Depressive Disorder, Recurrent, in Partial Remission (F33.41) — History of at least two major depressive episodes; currently managed on sertraline with residual symptoms (PHQ-9 = 11).
- Obesity, BMI 44.2 (E66.01) — With type 2 diabetes, hypertension, OSA, and osteoarthritis.
Recommendation: APPROVED FOR SURGERY WITH RECOMMENDATIONS
Ms. Torres is psychologically appropriate for sleeve gastrectomy. She demonstrates realistic expectations, health-driven motivation, adequate knowledge of the procedure and its requirements, stable psychiatric functioning on current medication, intact cognitive abilities, and sufficient psychological resources to participate in post-surgical care. She has identifiable risk factors (binge eating disorder, emotional eating as primary coping, residual depressive symptoms, limited non-food coping repertoire) that are modifiable and should be addressed with targeted intervention.
Pre-Surgical Recommendations:
- Begin individual cognitive-behavioral therapy (CBT) for binge eating disorder. Minimum 6-8 sessions prior to surgery, focusing on: identifying binge eating triggers, developing non-food emotional regulation strategies, establishing structured eating patterns, and building a post-surgical coping plan.
- Develop a written "coping without food" plan that identifies the patient's top 5 emotional triggers and at least 2 specific behavioral alternatives for each trigger.
- Consult with prescribing physician regarding sertraline optimization — given residual depressive symptoms (PHQ-9 = 11), a dosage increase or augmentation strategy may improve mood stability before surgery. Note: medication absorption may be altered post-sleeve; discuss liquid or alternative formulations with prescriber.
- Marco (partner) should attend at least one pre-surgical education session and ideally a joint meeting with the therapist to discuss household dietary changes and his role in supporting post-surgical recovery.
Post-Surgical Recommendations:
- Continue individual therapy post-surgery — minimum monthly sessions for the first 12 months. Post-surgical therapy should address: grief over loss of food as a coping mechanism, body image adjustment, marital dynamics around food and lifestyle changes, and management of emotional eating urges.
- Join a bariatric surgery support group. Peer support is associated with improved dietary adherence and long-term weight maintenance.
- Monitor for transfer addiction behaviors (increased alcohol use, compulsive shopping, gambling) particularly during months 6-24 post-surgery, when rapid weight loss and neurobiological changes are most pronounced.
- Reassess binge eating disorder status at 6 months post-surgery. Loss-of-control eating may re-emerge in modified form (grazing, repeated small overeating episodes) and should be addressed promptly if identified.
- Develop a regular physical activity plan post-surgery as tolerated — prioritize low-impact activities initially (walking, water exercise) and increase as knee pain improves with weight loss.
This is a sample for educational purposes only — not real patient data.
How to Write It Step by Step
Step 1: Clarify Program Requirements
Contact the bariatric surgery program and the patient's insurance company to determine what specific domains must be addressed and what format is required. Some programs provide a structured template. Others accept any comprehensive format. Medicare and Medicaid have their own documentation requirements for bariatric surgery pre-authorization.
Step 2: Send Screening Measures in Advance
Mail or electronically deliver self-report questionnaires before the appointment so the patient can complete them without eating into interview time. A standard battery includes a depression measure, anxiety measure, binge eating measure, and alcohol screening. Review results before the interview so you can follow up on elevated scores and identify areas needing deeper exploration.
Step 3: Conduct a Comprehensive Clinical Interview
The bariatric interview differs from a standard psychiatric intake. Weight history, dieting history, and eating behavior patterns require substantial time and specific questioning. Ask about binge eating with precise behavioral definitions — many patients do not self-identify as binge eaters unless asked specifically about loss of control, eating speed, and distress. Assess emotional eating directly: "When you are stressed or upset, what happens with your eating?"
Step 4: Evaluate Surgical Understanding and Expectations
Do not assume the patient understands the procedure because they attended a seminar. Ask them to explain in their own words what the surgery involves, what their diet will look like at 1 week, 1 month, and 1 year post-surgery, and what they expect to be different in their life after losing weight. Unrealistic expectations (surgery will fix depression, save a marriage, eliminate all food cravings) are red flags that warrant psychoeducation and, in some cases, delay.
Step 5: Assess Coping and Support Systems
This is the domain most predictive of post-surgical behavioral success. After surgery, the patient can no longer use food as their primary emotional regulation tool. Evaluate what non-food coping resources exist, how robust the patient's social support is, and whether the household environment will support or undermine dietary changes. A patient with no coping skills beyond food, an unsupportive partner, and no therapeutic relationship is at high risk for post-surgical difficulty.
Step 6: Formulate Your Recommendation with Specificity
Avoid binary approved/denied language when possible. Most patients fall into the "approved with recommendations" category. Your recommendations should be specific and actionable: name the type of therapy, specify the number of sessions, identify the treatment targets, and define the follow-up plan. Generic recommendations ("continue therapy") are unhelpful to the surgical team, the patient, and the referring provider.
Step 7: Write for a Multidisciplinary Audience
Your report will be read by surgeons, dietitians, primary care physicians, and insurance reviewers — not psychologists. Minimize jargon, lead with your recommendation, and organize findings clearly by domain. Use tables for screening measure results. Make your diagnostic impressions and recommendation unmistakably clear.
Common Mistakes
Treating the evaluation as pass/fail gatekeeping. The bariatric psychological evaluation is designed to optimize surgical outcomes, not to deny patients surgery. An evaluator who approaches every patient looking for reasons to say "no" misunderstands the purpose of the assessment. Most patients are appropriate for surgery with concurrent support.
Failing to assess binge eating with adequate depth. Binge eating disorder is the most common eating disorder in bariatric surgery candidates (prevalence 15-30%), and untreated binge eating is a risk factor for post-surgical weight regain. A single screening question is insufficient. Use a validated measure, ask behaviorally specific questions, and distinguish true binge eating from emotional eating and grazing.
Ignoring post-surgical alcohol risk. Transfer addiction, particularly to alcohol, is a well-documented phenomenon after bariatric surgery. Altered alcohol metabolism following Roux-en-Y bypass results in faster absorption, higher peak blood alcohol concentrations, and prolonged impairment. Every bariatric evaluation should screen for alcohol use patterns, family addiction history, and the patient's understanding of this risk.
Writing vague recommendations. "Continue therapy" and "address eating issues" give the surgical team, the patient, and any treating therapist no actionable direction. Specify the treatment modality (CBT for binge eating), frequency (weekly for 8 sessions), targets (reduce binge eating frequency, develop 5 non-food coping strategies), and follow-up plan (re-evaluate at 6 months post-surgery).
Not assessing the patient's support system. Post-surgical success depends heavily on the home environment. A partner who is threatened by the patient's weight loss, a household that keeps the same triggering foods available, or a patient with no social connections outside of food-centered activities — these are modifiable risk factors that belong in your evaluation.
Conducting the evaluation without bariatric-specific knowledge. This is a specialty assessment. Psychologists who apply a generic psychiatric intake template without understanding the behavioral demands of bariatric surgery, the predictors of surgical outcomes, and the post-surgical psychological complications will miss the clinically relevant issues. Seek training, supervision, or consultation before taking referrals in this area.
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