Moving beyond dichotomous psychological evaluation: the Cleveland Clinic Behavioral Rating System for weight loss surgery

Abstract

Background Most bariatric programs require a preoperative psychological evaluation. The criteria for such decision-making and acceptance rates have been well described in published reports. Most programs have made categorical distinctions of accept, reject, or delay, although this limits utility. Methods Bariatric surgery candidates (n = 389; 77.1% women; 74.3% white; mean ± SD BMI 49.84 ± 11.51 kg/m 2) were evaluated using the CCBRS across 8 domains of interest in the psychological bariatric literature. Each domain was graded using a 5-point scale (poor, guarded, fair, good, excellent). A summary assessment was also given. The in-patient length of stay and preoperative, 1-, 3-, 6-, 9-, and 12-month BMI changes were assessed in the subset (n = 241) who had undergone surgery. Results The CCBRS had excellent internal consistency (Chronbach's alpha = .88) and good consistency across providers (test-retest for overall determination r = .82). Most candidates were deemed acceptable, but 25.7% were initially considered guarded or poor candidates. Only 2.6% of the sample was unable to achieve the goals to improve their candidacy and undergo surgery. Hierarchical regression analyses on the overall CCBRS score demonstrated that unemployment, less education, greater BMI, smoking, and psychiatric medication use were associated with lower assessment scores. Guarded candidates spent significantly longer in the hospital and fair candidates had less preoperative BMI change than guarded or good candidates, although no significant postoperative BMI changes were demonstrated. Conclusion The results of our study have shown that the CCBRS is an internally consistent and useful tool for multidimensional psychological assessment of preoperative bariatric candidates.