Standards for Pre-Operative Bariatric Surgery Psychological Evaluations
VA Bariatric Surgery Workgroup
Last Updated: May, 2007

The pre-operative psychological evaluation should be conducted by a psychologist or psychiatrist qualified in the assessment and diagnosis of mental health illness with familiarity of bariatric surgery procedures, follow-up, and required behavioral changes.

This evaluation should consist of:

• A review of the medical record including any separate mental or behavioral health record
• The use of specific psychological instruments as recommended below. Other instruments and/or intake forms can be used in addition to these at the evaluating provider’s discretion.
• A clinical interview.
• Alcohol Use Disorder Test-core (AUDIT-C)
  • 3 items, < 4 minutes to administer and score
  • Available on VISTA
• Drug Abuse Screening Test (DAST©)
  • 20 items, < 7 minutes to administer and score
  • Paper or online formats available on the MOVE! website:
• Millon Behavioral Medicine Diagnostic (MBMD©)
  • 165 items, 30-45 minutes to administer
  • Available on VISTA
• Multidimensional Health Locus of Control (MHLC)
  • 18 items, < 10 minutes to administer
  • Available on VISTA
• Questionnaire on Weight and Eating Patterns-Revised (QEWP-R©)
  • 28 items, < 20 minutes to administer
  • Paper format available on the NCP website:

Specific items to assess with interview and review of medical record include:

• 1. Active psychosis and alcohol or substance use disorders
• 2. Other mental health illness (active, inactive, hospitalizations)
• 3. Borderline personality disorder
• 4. Social/family situation and supports
• 5. Follow up "abnormal" results from psychological instruments used
• 6. Discussion of alternative plans should patient be turned down for surgery
• 3. Appropriate follow-up should be arranged for patients with mental health or behavioral concerns identified during this evaluation regardless of the decision for surgery.