- Suggestions for Pre-Surgical Psychological Assessments
of Bariatric Surgery Candidates
American Society for Bariatric Surgery
Diane LeMont, Ph.D., Melodie K.
Moorehead, Ph.D., Michael S. Parish, Psy.D., Cathy S.
Reto, Ph.D., Stephen J. Ritz, Ph.D.
October, 2004
Edited by William E. Benet, Ph.D., Psy.D.
- Appendix A
- Assessment Tools and Measures
Eating Attitudes and Behaviors
Binge Eating Scale (BES):
Gormally J., Black, S., Datson, S. &
Rardin
Qualification Level:
Description: Designed to assess binge eating
in obese subjects. Addresses the behavioral
features of binge eating as well as the cognitions
and feelings associated with binge eating.
Shown to discriminate between obese individuals
demonstrating no, moderate, or severe binge
eating difficulties. The BES was designed before
Binge Eating Disorder was conceptualized and
although it may be a good screen to detect binge
eating, it does not include the needed criteria to
diagnose Binge Eating Disorder.
Age:
Reading Level:
Format: 16 items. 4-point scale. Self
report.
Completion Time:
Scales:
Availability: Gormally J., Black, S.,
Datson, S. et al. (1982). The assessment of binge eating
severity among obese persons. Addictive Behaviors. 7: 47-55.
Pergamon Press.
Binge Eating Questionnaire (BEQ):
Halmi, Falk, and Schwartz
Qualification Level:
Description: Assessment of bulimic
behaviors. Can be used for both diagnosis and screening in
normal populations. Validated in a treatment-seeking
obese population.
Age:
Reading Level:
Format: 12 demographic questions and 11
multiple-choice items specific to bulimic behaviors.
Completion Time:
Scales:
Availability: Halmi (1985).
Three- Factor Eating Questionnaire
(TFEQ):
Stunkard & Messick
Qualification Level:
Description: Measure the psychological
constructs of eating. Used in normal, obese, and eating
disordered populations. Can be used for screening,
treatment planning, and monitoring treatment
effects.
Age:
Reading Level:
Format: 51 items. Self report measure that
includes 36 T/F items and 36 multiple-choice items.
Completion Time:
Scales: Measures three dimensions of eating behavior including cognitive
restraint of eating,
disinhibition, and hunger. Two additional subscales
of cognitive restraint have been developed to
distinguish flexible control of eating from rigid
control of eating.
Availability: Public Domain. Stunkard A, &
Messick, S. (1985). The three-factor eating
questionnaire to measure dietary restraint,
disinhibition and hunger. Journal of Psychosomatic
Research (29:1) 71-83. Pergamon Press.
Eating Inventory (EI):
Stunkard, A. & Messick, S.
Qualification Level:
b – level**
Description: Clinical tool developed to
recognize and treat eating disturbances and disorders.
Useful in treatment programs for obesity, predict
weight gain following smoking and explain
weight changes among the depressed. Norms and SD’s
of each dimension have been obtained for
normal and obese groups.
Age: 17 years and older
Reading Level:
Format: 51 multiple-choice questions.
Administration Time:
15 minutes
Scales: Assesses 3 dimensions of eating
behavior: cognitive restraint, disinhibition, and hunger.
Availability: PsychCorp*.
Questionnaire on Eating and Weight Patterns-Revised
(QEWP-R):
Spitzer, R.,
Yanovski, S., & Marcus, M.
Qualification Level:
Description: Provides information that
allows diagnosing of Binge Eating Disorder, Bulimia
nervosa, and related eating disorders. Diagnosis
should be confirmed by interview. Internal
consistency, .75 for a weight control sample, .79
for a community sample. For the examiner, the
measure includes decision rules for diagnosing Binge
Eating Disorder, Bulimia Nervosa (purging
and nonpurging).
Age:
Reading Level:
Format: 28 items that include both
demographics as well as multiple-choice items.
Completion Time:
Scales:
Availability: Available from the Health and
Psychosocial Instruments (HAPI) database. *
Eating Disorder Examination-Questionnaire
(EDE-Q):
Fairburn & Beglin
Qualification Level:
Description: Self-report questionnaire
adapted from the Eating Disorder Examination (EDE
Fairburn & Cooper) that measures the frequencies of
eating disorder behaviors and identifies
different forms of overeating. Used in assessing
episodes of binge eating among the obese
(Kalarchian et al, 2000; Grilo et al, 2001) and in
discriminating obese binge eaters from obese
non-binge eaters (Wilson et al 1993) Internal
consistency: Chronbach’s alpha ranged from .78 to
.93; test-retest reliability ranged from
Pearson’s r .81 to .94.Looks at
objective versus subjective
bulimic episodes.
Age:
Reading Level:
Suggestions for Pre-Surgical Assessments
19
Appendix A
Format: 41-items. 7 –point format.
Completion Time:
Scales: Subscales: dietary restraint, eating
concern, weight concern, and shape concern.
Availability:
Eating Disorder Inventory - 2
(EDI-2):
Garner, D.
Qualification Level:
Description: Used extensively in Eating
Disorder research. Useful as screening instrument in
nonpatient populations.. Use is not intended to
yield a diagnosis but assess severity of
symptomatology on dimensions clinically relevant to
eating disorders. Normative data for
bulimic and anorexic patients, male and female high
school and college students. Hand score and
computer versions available
Age: Ages 12 years and older.
Reading Level:
Format: Self report, 91 items, using 6-point scale.
Completion Time:
Approximately 20 minutes.
Scales: Eight subscales and three
provisional subscales: Drive for Thinness, Ineffectiveness,
Body Dissatisfaction, Interpersonal Distrust,
Bulimia, Perfectionism, Maturity Fear,
Interoceptive Awareness, Impulse Regulation, Social
Insecurity, and Asceticism.
Availability: Published by PAR*.
Eating Disorder Symptom Checklist
(EDI-SC):
Garner, D.
Qualification Level:
Description: Structured, self-report form
regarding frequency of eating disorder symptoms as
well as demographic information. Good as aid in
formulating an eating disorder diagnosis.
Age: Ages 12 years and older.
Reading Level:
Format:
Completion Time:
5-10 minutes.
Scales: Content areas: Dieting, exercise,
binge eating, purging, laxatives, diet pills, diuretics,
menstrual history, and current medications.
Availability: Published by PAR*.
Weight and Lifestyle inventory
(WALI):
Wadden, T. & Foster, G.
Qualification Level:
Description: A multidimensional, multi
format questionnaire designed to obtain very specific
information about weight history, past weight loss
attempts, weight loss goals, historical eating
habits and associated patterns of behavior, physical
activity, self-perceptions,
psychological/emotional status and medical history.
Section J of the WALI incorporates the
Questionnaire on Eating and Weight Patterns-Revised
(QEWP-R; Yanovski, 1993).
Age:
Reading Level:
Format: 16 self-administered sections
Completion Time:
60 – 90 minutes
Scales:
Availability: Copyright: Thomas A. Wadden, PhD and
Gary D. Foster, PhD. (2001). Printed in:
Wadden, T. A. & Stunkard, A. J. (Eds.). (2002). Handbook of obesity
treatment. New York:
Guilford Press.
Personality and Psychopathology
- Basic Personality Inventory
(BPI):
Jackson, D.
- Qualification Level:
c-level**
- Description: Personality inventory for use
with both clinical and normal populations. Used to
- identify both maladjustments and personal strengths.
Normed on adults, adolescents, and special
- populations. Validity data is presented in the
manual.
- Age: adolescents and adults
- Reading Level: Grade 5
- Format: 240 T/F items.
- Completion Time:
Approximately 35 minutes
- Scales: 12 Clinical Scales: hypochondriasis,
anxiety, depression, thinking disorder, denial,
- impulse expression, interpersonal problems, social
introversion, alienation, self-deprecation,
- persecutory ideas, deviation.
- Availability: Published by WPS* and Sigma
Assessment Systems*
- Personality Assessment Inventory
(PAI):
Morey, L.
- Qualification Level:
c-level**
- Description: Inventory of adult personality
and psychopathological syndromes. Useful for
- diagnosis, treatment planning, and screening.
- Age: 18 years and older
- Reading Level: 4th
grade reading level
- Format: 344 item, 4-point scale
- Completion Time:
Time: 50 – 60 minutes.
Score time: 10 – 20 minutes
- Scales: Twenty-two nonoverlapping scales of
adult psychopathology. 4 Validity Scales:
- (inconsistency, infrequency, negative impression,
positive impression), 11 Clinical Scales:
- (somatic complaints, depression, anxiety, anxiety
related disorders, mania, schizophrenia,
- paranoia, borderline and antisocial features, drug,
and alcohol), 5 Treatment Scales (aggression,
- suicidal ideation, stress, nonsupport, treatment
rejection), and 2 Interpersonal Scales (dominance,
- warmth).
- Availability: Published by PsychCorp*.
Published by PAR*.
- Structured Clinical Interview for DSM-IV – Axis I,
Clinical Version
(SCID-I:CV):
- First, M, Spitzer, R., Gibbon, M, &Williams, J.
- Qualification Level:
b-level**
- Description: Designated Structured clinical
interview for Axis I disorders. Also available:
- Structured Clinical Interview for DSM-IV Axis II
personality Disorders (SCID-II).
- Age: 18 years and older
- Format: Interview
- Completion Time:
Administration Time: 45 –
90 minutes.
- Availability: Published by MHS*
- Beck Depression Inventory-II
(BDI-II):
Beck, A, Steer, R., Brown, G.
- Qualification Level:
c-level**
- Description: Assesses the level of clinical
depression in normal patients in keeping with DSMIV
- criteria. Reliability: Coefficient Alpha = .92. Used
for screening, diagnosis, and follow –up.
- Age: Ages 13 to 80 years.
- Reading Level:
- Format: 21- items, 4 levels of severity.
- Completion Time:
Administration time: 5
minutes. Self-administered or verbally administered
- by trained administrator.
- Scales:
- Availability: Published by PsychCorp*
- Beck Anxiety Inventory
(BAI):
Beck, A.
- Qualification Level:
c-level**
- Description: Assesses the level of and
severity of client anxiety. Shown to discriminate between
- anxious and nonanxious groups in clinical
populations.
- Age: Ages 17 to 80 years
- Reading Level:
- Format: 21 items rated on a scale of 0 – 3.
- Completion Time:
Administration time 5 – 10
minutes. Self-administered or verbally
- administered by trained administrator.
- Scales:
- Availability: Published by PsychCorp*
- Minnesota Multiphasic Personality Inventory - 2
(MMPI-2):
Hathaway, S. & McKinley, J.C.
- Qualification Level:
a-level**
- Description: Used to assess major symptoms
of social and personal maladjustment. For
- complete description and normative data please refer
to Pearson Assessments*.
- Age: 18 years and older.
- Reading Level: 6th
grade reading level.
- Format: 567 true/false items. Paper and
pencil, audiocassette, or computer administration.
- Completion Time:
60 – 90 minutes.
- Scales: 8 Validity Scales, 5 Superlative
Self-Presentation Subscales, 10 clinical Scales, 9 RC
- (Restructured Clinical) scales, 15 content scales,
27 Content Component Scales, 20
- Supplementary Scales, 31 Clinical Subscales.
- Availability: Published by Pearson
Assessments*
- Millon Behavioral Medicine Diagnostic
(MBMD):
Millon, T., Antoni, M., Millon, C.,
- Meagher, S., & Grossman, S.
- Qualification Level:
m-level**
- Description: See Website for complete
reliability and validity data as well as sample test and
- interpretive reports.
- Age: Ages 18 – 85
- Reading Level: 6th
grade reading skills
- Format: 165 item, self-report inventory. Administration: paper and pencil,
audiocassette,
- computer. Scoring: handscoring, mail-in, system
software.
- Completion Time:
Completion time 20 to 25
minutes.
- Scales: Twenty-nine clinical scales: 3
Response Pattern Scales: (disclosure, desirability,
- debasement), 1 Validity Indicator, 6 Negative Health
Habits Indicators: (alcohol, drug, eating,
- caffeine, inactivity, smoking), 11 Coping Styles:
(introversive, forceful, inhibited, respectful,
- dejected, cooperative, oppositional, denigrated,
confident, sociable, nonconforming), 6
- Psychiatric Indicators Believed To Create Problems
In Medical Treatment: (anxiety-tension,
- depression, cognitive dysfunction, emotional
lability, guardedness), 6 Stress Moderators: (illness
- apprehension vs. illness acceptance, functional
deficits vs. functional competence, pain
- sensitivity vs. pain tolerance, social isolation vs.
social support, future pessimism vs. future
- optimism, spiritual absence vs. spiritual faith), 5
Treatment Prognostics: (interventional fragility /
- interventional resilience, medication abuse /
medication conscientiousness, information
- discomfort / information receptivity, utilization
excess / appropriate utilization, problem
- compliance / optimal compliance), 2 Management
Guidelines: (adjustment difficulties-risk of
- complications due to coping and psychological issues
and psychological referral – whether or not
- individual would benefit from psychosocial
interventions).
- Availability: Published by Pearson
Assessments*
- Rosenberg Self-Esteem Scale
(SES) (RSE):
Rosenberg, M.
- Qualification Level:
none
- Description: global and one-dimensional
measure of self-esteem. Coefficient alpha’s range
- from .77 to .87.
- Age: adolescents and adults
- Reading Level:
- Format: 10 items, 4-point scale.
- Completion Time:
Less than 5 minutes
- Scales:
- Availability: Public Domain. Author’s family
would like to be kept informed of its use.
- The Morris Rosenberg Foundation
- c/o Dept. of Sociology
- University of Maryland
- 2112 Art/Soc Building
- College Park, MD 20742-1315
- Symptom Checklist 90 -R
(SCL-90-R):
Derogatis, L.
- Qualification Level:
m-level**
- Description: Self report inventory designed
for the psychological assessment of symptoms of
- psychopathology. May be used as a measure for
screening as well as a measure of progress or
- outcome. Normed on adult nonpatients, adult
psychiatric outpatients, adult psychiatric inpatients,
- and adolescent nonpatients.
- Age: Ages 13 years and older
- Reading Level: 6th
grade reading level.
- Format: 90 items; 5 point rating scale.
- Completion Time:
Completion time: 12 – 15
minutes.
- Scales: 9 Primary Symptom Dimensions: (somatization, obsessive-compulsive,
interpersonal
- sensitivity, depression, anxiety, hostility, phobic
anxiety, paranoid ideation, psychoticism. 3
- Global Indices: (global severity index, positive
symptom distress index, positive symptom total.
- Availability: Published by Pearson
Assessments*
- Health Related Quality of Life
- Quality of Life Questionnaire
(QLQ):
Evans, D & Cope, W.
- Qualification Level:
b-level**
- Description: Measures the relationship
between the client’s quality of life and behaviors such
- as substance use, psychological health, and physical
health. Highlights areas of life that may
- need addressing in order to change to take place.
Screening tool for employee assistance,
- wellness, stress, and weight control.
- Age: 18 years and older.
- Reading Level:
- Format: 192 items.
- Completion Time:
Administration time: 30
minutes.
- Scales: 15 content scales and a social
desirability scale. Covers 5 major domains (general wellbeing,
- interpersonal relations, organizational activity,
occupational activity, leisure and recreational activity.
- Availability: Published by MHS*
- Quality of Life Inventory
(QOLI):
Frish, M.
- Qualification Level:
b-level**
- Description: Measure of life satisfaction
that can be used to measure outcomes and establishing
- efficacy of treatments or services.. Helps identify
people at risk for developing health problems.
- Used in behavioral medicine assessments. Normed on
nonclinical adults.
- Age: 18 years and older.
- Reading Level: 6th
grade
- Format: 32 items. 3-point rating of
importance and 6-pont rating scale for satisfaction. Paper-and-
- pencil or on-line administration.
- Completion Time:
Approximately 5 minutes.
- Scales: 16 scales: Health, self-esteem,
goals and values, money, work, play, learning, creativity,
- helping, love, friends, children, relatives, home,
neighborhood, community.
- Availability: Published by Pearson
Assessments*
- Impact of Weight on Quality of Life
(IWQOL):
Kolotkin, R., Crisby, R., Kosloski, K, & Williams, R.
- Qualification Level:
- Description: Quality of life measure
designed specifically for an obese population. Data
- indicate that the questionnaire has good test-retest
reliability and internal consistency. The
- authors of the IWQOL are currently recommending the
use of the IWQOL-Lite over this version.
- Age:
- Reading Level:
- Format: 74 items. 5-point scale.
- Completion Time:
15 minutes
- Scales: 8 areas of functioning (health,
social/interpersonal, work, mobility, self-esteem, sexual
- life, activities of daily living, and comfort with
food.
- Availability: Copyright owned by Duke
University Medical Center. *
- Impact of Weight on Quality of Life
(IWQOL-Lite):
Kolotkin, R. & Hamilton, M.
- Qualification Level:
none
- Description: Recommended version by test
authors. Brief measure to assess the impact of
- weight on quality of life specifically for obese
populations. Derived from the Impact of Weight
- on Quality of Life (IWQOL), Kolotkin, R., Crisby,
R., Kosloski, K, & Williams, R. Correlation
- between the IWQOL-Lite and the original IWQOL is
.97. Normed on overweight treatment seekers,
- community volunteers of all weights, and diabetics.
Currently in the process of being
- validated in clinical populations with schizophrenia
and bipolar disorder who are taking
- antipsychotic medications.
- Age: 18 and above.
- Reading Level: 6.3 grade level
- Format: 31-items. 5-point scale
- Completion Time:
3 minutes.
- Scales 5 scales: physical function,
self-esteem, sexual life, public distress, and work. Total score
- and scale scores provided.
- Availability: Copyright owned by Duke
University Medical Center. *
- Impact of Weight on Quality of Life-Kids
(IWQOL-Kids):
Kolotkin, R.
- Qualification Level:
- Description: New measure currently being
developed.
- Age: Targeted for ages 11 and up.
- Reading Level:
- Format:
- Completion Time:
- Scales:
- Availability:
- OMS 36-item Short Form Health Survey
(SF-36):
Ware, J.
- Qualification Level:
- Description: Generic measure of health
related quality of life used to evaluate health status in
- medical outcome studies. Has been used to look at
the relative burden of disease as well as
- differentiating. The SF-36 has established internal
consistency, validity, and test-retest reliability.
- Test does not cover or screen for eating disorders
or mood.
- Age:
- Reading Level:
- Format: 36 items. 5-choice response.
Self-administered, computerized administration, or
- administration by a trained interviewer.
- Completion Time:
5-10 minutes.
- Scales: 8 scales: Physical functioning,
role-physical, bodily pain, general health, vitality, social
- functioning, and mental health.
- Availability: Requires licensing agreement. Quality
Metric* or www.sf-36.com
- Moorehead-Ardelt Quality of life Questionnaire
(M-A QoLQ):
- Qualification Level:
Professional/Patient use
- Description: Developed as a disease specific
instrument to measure postoperative, selfperceived,
- quality of life in people undergoing
medical/surgical intervention for obesity and severe obesity.
- Age: 18 years old and above
- Reading Level: 6th
Grade
- Format: 5 items. 5 -choice responses,
culture free for International use.
- Completion Time:
Less than 1 minute.
- Scales: Assesses self-esteem, physical
well-being, social relationships, work, and sexuality.
- Availability: Copyright owned by: M.K.
Moorehead, Elisabeth Ardelt. *
- Moorehead-Ardelt Quality of life Questionnaire
II (M-A QoLQ II):
Moorehead, M.K. & Ardelt, E.
- Qualification Level:
Professional/Patient
use
- Description: Developed as a disease specific
instrument, the improved M-A QoLQ II is a valid
- and reliable tool developed to measure both pre and
post medical/surgical intervention of self-perceived
- quality of life in 6 key areas, i.e. self-esteem,
physical well being, social relationships,
- work, sexuality, and eating behavior. Being
unbiased, physician and patient friendly, this six item
- questionnaire is designed specifically to address
those aspects of quality of life concerns to
- the morbidly obese. To promote patient follow up it
can be mailed or emailed to the patient and
- self-administered or administered directly by the
multidisciplinary team. It is culture free and
- design with colorful universal symbols for
International use.
- Age: 18 years old and above
- Reading Level: 6th
Grade
- Format: This 6 items 10-point Likert scale
is a sensitive, culture free instrument designed for
- International use. To be scored independently or in
combination with BAROS.
- Completion Time:
Less than 1 minute.
- Scales: 10 point Likert scale assesses six
areas of Quality of Life: self-esteem, physical wellbeing,
- social relationships, work, sexuality, eating
behavior.
- Availability: Copyright owned by: M.K.
Moorehead, Elisabeth Ardelt. For permission to use
- contact Dr. Moorehead. *
- Outcome Measures
- Bariatric Analysis and Reporting Outcome System
(BAROS):
Oria H. & Moorehead M.
- Qualification Level:
Professional
- Description: BAROS analyzes bariatric
outcomes in a simple, one page, objective, unbiased,
- and evidence-based fashion. While it can be adapted
to evaluate other forms of medical
- intervention for weight control, it was specifically
designed to create a standardized system to
- define five groups, (failure, fair, good, very good,
and excellent), outcomes after bariatric surgery.
- Age:
- Reading Level:
- Format: Uses concepts via pictures versus specific questions. Concepts
include Self esteem,
- physical well-being, social relationships, work, and
sexuality. Five choices ranging from
- negative to positive (adding or subtracting points)
illustrated with simple drawings.
- Completion Time:
- Scales: Based on a scoring table that adds
and subtracts points while evaluating three main areas:
- Weight loss, Changes in medical conditions and
Quality of Life. Complications and reoperative
- surgery deduct points, thus avoiding the controversy
of considering reoperations as failures. This
- instrument is designed and intended for International use. (It
Incorporates the Moorehead-Ardelt
- Quality of life Questionnaire II.) .
- Availability: Copyright owned by Horacio
Oria, M.D. and Melodie Moorehead, Ph.D.*
- *Publisher information
- Duke
University Medical Center
- H. Gilbert Smith, Ph.D.
- Duke University
- Office of Science and Technology
- Davison Building, Room M454
- DUMC 3664
- Durham, NC 27710 USA
- (919) 681-6497
- MHS,
Multi-Health Systems, Inc. 1-800-456-3003 or
www.mhs.com
- PAR, Psychological Assessment
Resources, Inc. 1-800-331-8378 or
www.parinc.com
- The Health
and Psychosocial Instruments (HAPI) database is available online
with a
- University password. Database can be accessed via
OVID Technologies
www.ovid.com
- Moorehead-Ardelt Quality of Life Questionnaire II or Bariatric
Analysis Reporting Outcome
- System (BAROS)
-
- For a
sample of a “Mental Health Report” and 9 page Skeleton Worksheet for
Evaluation
- **Qualification Level
- a -level
– Licensure to practice psychology independently, or a graduate
degree in
- psychology (or related fields) OR have taken
graduate courses in Tests and Measurements,
- OR proof that they have been granted the right to
administer tests at this level.
- b- level
– Must have completed graduate level courses in tests and
measurements or
- equivalent documented training.
- c -level
– Have b-level qualification and training/experience in
testing, and completed an
- advanced degree in an appropriate profession. Some
states may have additional requirements.
- m -level
– Requires specialized degree in the health care field with
accompanying licensure
- or certification OR proof of permission to
administer test at this level.
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