• Eating behaviors

Among the obese population, there is a high prevalence of individuals with comorbid Binge Eating Disorder (BED), mainly characterized by frequent episodes of binge eating in the absence of following compensatory strategies such as vomiting or purging. Other common eating disorders are Bulimia Nervosa (BN) and Night Eating Syndrome (NES). BM refers to recurrent binge episodes associated with compensatory extreme weight-control behaviors such as vomiting, purging, strict dieting, excessive physical activity. NES consists of morning anorexia, evening hyperphagia, and insomnia. Patients with an eating disorder need to understand that surgery alone cannot modify their problematic eating behaviors, but further efforts in changing their lifestyle behaviors related to eating and physical activity are required in order to achieve lifelong weight loss.

• Psychiatric conditions

Any previous or current psychiatric disturbance should be addressed during the pre-surgical assessment. The evaluation for psychiatric disorders is aimed to identify symptoms of depression, anxiety, mania, psychosis, suicidal ideation, substance abuse, history of abuse or familial history of mental health problems and previous treatment experienced. Diverse opinions exist about the influence of psychiatric disturbances on surgery outcomes. According to some authors, the presence of one or more mentioned psychiatric disturbances alone is not a contraindication for bariatric surgery. However, it is important to evaluate the severity of symptomatology and, if necessary, referring patients for additional psychological support previous to surgery. Other authors suggest that the presence of uncontrolled eating, current substance abuse, poor adherence to recommendation, psychosis, severe mood disorders, major life stressors should be considered as contraindications to bariatric surgery [12, 13].

• Social support

Given the impact that surgery will have not only on their lives but also on the environment where patients live, during the psychological assessment clinicians should explore the familial and the social context that surrounds patients. Candidates should be asked to describe the people who live with them, their opinion relative to bariatric surgery decision and whether their family will help them after surgery. Patients should be informed about the possible social consequences that may occur after surgery.
