1. PSYCHOSOCIAL COUNSELING AND BARIATRIC SURGERY OUTCOMES Rebecca Hammond, RN State University of New York Institute of Technology

2. ABSTRACT Bariatric surgery involves a significant physical and psychological change. For patient’s undergoing such procedures, an extensive amount of preparation, dedication, and change is required. One of the biggest changes with surgical intervention is the mental and emotional changes and outcomes. With mental and emotional health being such a determinant in the well-being of a surgical patient, ensuring bariatric candidates receive psychosocial counseling prior to and following surgery may have a positive impact on the overall success of the procedure. The purpose of this integrative literature review is to determine whether or not perioperative psychological counseling leads to improved success of surgery in comparison to no psychosocial intervention.

3. PICO  Is perioperative psychosocial counseling more effective vs. standard preparation in bariatric surgery success?

4. FROM THE RESEARCH The preoperative evaluation is critical to identify and follow those at risk of persistent or worsening psychopathology after surgery. It also shows that long-term intensive postoperative follow-up to evaluate and support lifestyle change and mental health can have a tremendous effect on weight loss outcomes and decrease in comorbidities (Kubik, Gill, Laffin, & Karmali, 2013).

5. FROM THE RESEARCH  Aspects of the pre-op evaluation analyze psychosocial factors such as reason for surgery, weight and diet history, history of eating disorders, understanding of the surgery, social supports, psychiatric history, and many more. All of the factors have a significant impact on candidates’ potential surgical outcomes. Issues such as these can be addressed and managed to increase success (Snyder, 2009).

6. FROM THE RESEARCH  One research article found it difficult to identify a relationship between psychological support and improved success. The partial correlation analysis indicated that social support predicted weight loss only in the dieting program group. These results suggest that social/psychiatric support could be a predictor of outcome in some type of programs but not in others (Canetti, Berry, & Elizur, 2009)

7. CONCLUSIONS  The overall idea that is brought about through the integrative review of multiple sources is that bariatric surgery candidates have an increased risk for psychiatric problems, both pre and post-operatively. Each piece of research suggests the importance of perioperative evaluation of patients’ psychiatric well-being for increased success post-operatively, but does not show a direct correlation in comparison with no intervention.  After conducting the research and consolidating the information, the thesis of my integrative literature review could not be supported. I found that there was not yet adequate research to support that psychosocial counseling before and after bariatric surgery did in fact lead to better outcomes.

8. NURSING IMPLICATIONS  Nurses who care for bariatric surgery patients both pre and post- operatively have the responsibility to provide multi-disciplinary care. Although this is done with all patients, bariatric surgery patients have an increased need for psychosocial support.  It is important for nurses to be educated on the proper physical and psychological care of this particular patient population. Knowing the right things to say and do helps to provide the best possible care for patients, which can potentially lead to improved outcomes.

9. PLANS FOR IMPLEMENTATION  It has been determined that there is a significant need for research that shows improved outcomes with psychosocial counseling. Not only this, but it has been seen that many bariatric surgery programs do not include anything more than just a short psychiatric evaluation. With this, I would like to evaluate many different bariatric surgery programs and compare the required psychosocial counseling between them.  Continuing the research and discovering what works well in different facilities can help to establish a standard for bariatric surgeries that can potentially have a significant impact on outcomes and success.

10. REFERENCES  Canetti, L., Berry, E., & Elizur, Y. (2009). Psychosocial predictors of weight loss and psychological adjustment following bariatric surgery and a weight-loss program: the mediating role of emotional eating.The International Journal Of Eating Disorders, 42(2), 109- 117.  Kubik, J., Gill, R., Laffin, M., & Karmali, S. (2013). The impact of bariatric surgery on psychological health.Journal of Obesity, Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625597/  Snyder, A. (2009). Psychological assessment of the patient undergoing bariatric surgery. The Ochsner Journal,9(3), 144-148. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096263/