Many insurance companies and bariatric surgeons require patients to have a psychological evaluation prior to undergoing weight loss surgery. Some weight loss surgery patients simply are unable to comply with the changes they will need to make, are unable to understand, or they have compulsive eating behaviors that need treatment.

A number of weight loss surgery patients have clinical depression, which is not cured by weight loss surgery, and it may even be exacerbated by the procedure. Those with depression need to be on medication for a month before undergoing the operation. A lot of my weight loss surgery patients get a bit nervous about seeing a psychiatrist or psychologist before the procedure and ask me what it is all about—I tell them it’s just routine, just not to tell about the voices they hear. However, psychological issues are important and I became a firm believer after meeting Larry—unfortunately.

Larry was the nicest fellow you could imagine. He came to my office and consulted with me about weight loss surgery. He was so happy that there was an answer to his obesity. He also had Hepatitis C and had not been treated for it, so we arranged treatment prior to his operation. He was a thoughtful fellow and sent me a card—through email—and thanked me for not judging him for his obesity. Four days later, he committed suicide. Not only was I shocked, so was my staff—because he didn’t display any signs of depression. I don’t know if I should have felt honored that he thanked me in his suicide note or ashamed that I didn’t see his underlying depression and send him off to see the psychiatrist. Depression is very common among weight loss surgery patients with obesity, but there is medication to treat it. If you are depressed, please see someone, please!

Age is a factor with obesity also. While there is a chapter about obesity in young folks in this book, older people often ask about weight loss surgery. I worry that obesity might have already done irreparable damage to older people by the time they get to me, but I have to tell you about Dottie. Dottie is about the nicest person you could ever meet. She was 63 years old when I met her and in great health—we even had her undergo some heart tests. She loved the support group and adopted all of my weight loss surgery patients as her children. She lived many miles away from Phoenix Arizona, she said, because she lived on a fixed income and couldn’t afford to live in a big city. To pay for her trips to the monthly support groups, she made jewelry and sold it—she was quite talented, I might add. I was hesitant to do her procedure, but she sailed through like a champion, and at her one-year anniversary had lost 135 pounds and felt great. Sometimes age is more than a number. Not only am I so happy that we operated on Dottie, my support group does a lot better when Dottie is there to give us all hugs.

You need a support system after you have Lap-band surgery

You really need to belong to a support group, believe it or not, and there is more about that later in this book. More importantly, you need someone who can be supportive during this process. Some weight loss surgery patients don’t want friends or family to know about their procedure and that is fine. That is your business, but you do need someone to help you through it.

Everyone worries about their ability to comply with the life changes weight loss surgery requires. They come because they have failed countless diets and weight loss programs. They have tried the funny little machines to lose weight, or even have had liposuction before and these have failed. The vast majority of people will be successful with the weight loss surgery program, but some will not. Contrary to a popular, slightly overweight, psychologist, it isn’t psychology or willpower that causes obesity, it is biology. In weight loss surgery we change your biology and a strange thing happens: patients feel full with less and that gives them a sense of control over food they never felt before. Not that there isn’t a bit of willpower involved, and not that you won’t be on a diet for life, because you will. But guess what, most of my patients lose more weight than the procedure is designed for them to lose. Why is that? Is it because I am a great weight loss surgeon, or that I have a 100-watt smile? No (okay, I really want to take credit, but the smile is because of Crest), it is because they have far more willpower than their skinny sister-in-law or the pop-television psychologist ever gave them credit for. All those diets you lost weight on—remember those? Those proved you had will power. Remember, we change the biology, and all of a sudden you can lose weight.

So, don’t worry about it, but recognize that once your guts are rearranged so is your life—forever (unless you have the operation reversed). That can be a good thing, but it can also be a bad thing, depending on your attitude. You have to know what you are getting into.