The Proof is in the Graphs: How Bariatric Surgery Patients See Their Results in Places Other Than the Mirror
		
			For a 
			lot of people, medical charts may not be the most exciting reading. 
			But when a patient can see in literal, graphic terms exactly how 
			much his life has improved since bariatric surgery, those charts 
			become the feel-good story of the year.
		
			“It’s pretty striking. I literally hold the before and after charts up, 
			side by side, and the patient can see the improvements, like their 
			being more outgoing, having less pain and generally coping better,” 
			says Dr. Jim Keller, director of behavioral health at the Foundation 
			Bariatric Hospital of Oklahoma (FBHO) and the WeightWise® program in 
			Edmond, Oklahoma. The charts contain the data acquired from Pearson’s MBMD™ 
			(Millon™ Behavioral Medicine Diagnostic) psychological test, before 
			bariatric surgery, and from when patients take it again, 12 months later. 
			The data includes a patient’s coping styles, stress moderators, treatment 
			prognostics and management guides.
			
			“We want them to anticipate the changes they’ll see in their quality of 
			life, so we stress, pre-surgery, how they’re not only going to feel 
			great, they’ll be able to see a visual representation of their 
			improvement,” Dr. Keller says. “And then at the 12 months 
			post-surgical follow-up, it makes conveying the outcome to the 
			patient so much more impactful. It wasn’t until I started doing 
			post-surgical testing that I really started to appreciate the value 
			of the assessments.”
			
			In addition to the striking visual representation of patient 
			improvement, Dr. Keller has an old-fashioned reason for favoring the 
			Pearson assessments: trust. “Pearson as a company gives credibility 
			to the tool you’re using,” he says. “Clinically, that means peace of 
			mind. It gives clinicians a sense of comfort when they’re 
			administering something that’s been overseen by a reputable company. 
			And the authors of the tests themselves are well-respected.”
						
			WeightWise has used various combinations of the MBMD, BSI®(Brief 
			Symptom Inventory) and QOLI®(Quality of Life Inventory) tests over 
			the years for pre-surgical and follow-up assessment. He has also 
			developed his own quality of life questionnaire, Weight Mediated 
			Quality of Life (WMQL), which he gives as an adjunct to the process.
	
			After the patient has gone through the pre-surgery assessment and 
			diagnostic interview, Dr. Keller prepares his summary of the data 
			for the surgeon. Foundation Bariatric Hospital of Oklahoma performs 
			three types of bariatric surgery: gastric bypass, Lap-Band® and 
			gastric sleeve. Although some surgeons simply want to know that the 
			patient has been cleared, others want to know if there are any 
			extenuating circumstances. The report briefly summarizes factors 
			like relevant personal history, psychological history, eating 
			history, weight loss goals and mental status. Dr. Keller also 
			includes a system of color-coded boxes, which serve as visual flags 
			for the surgeon to delve deeper into the report if there are indeed 
			extenuating factors in a specific area.
	
			Once patients are cleared, success stories roll in. Dr. Keller tells of a 
			man who walked into his office with a cane and an oxygen tank, 
			weighing more than 320 pounds. The man had clinical depression, 
			chronic pain and a Body Mass Index close to 60. One year after 
			gastric bypass surgery, he returned. “One hundred seventy-eight 
			pounds,” says Dr. Keller. “Wearing a size 34 slack. He was off of 
			his oxygen. Off of all pain medications. Off the anti-depressant. 
			Pre-surgically he was hypertensive, and had type 2 diabetes. He is 
			no longer categorized as either of those. He’s off all meds, he’s no 
			longer diabetic or hypertensive.”
			
			After having done close to 6,000 pre-surgical evaluations, Dr. Keller 
			rarely tells a patient that surgery now or in the future is out of 
			the question. “If somebody has a debilitating psychological or 
			psychiatric condition, such as schizophrenia or a poorly-controlled 
			bi-polar disorder, it’s up to the clinician to determine if the 
			patient might respond favorably to treatment,” he says. “In many 
			cases we refer to that as ‘pending’ and recommend treatment, such as 
			medication or psychotherapy. We then re-evaluate, perhaps in three 
			months, to see if the patient is more stable. The only kind of 
			definitive ‘no’ you’d get, and that’s very, very rare, would be for 
			someone with a chronic mental illness which would remain somewhat 
			debilitating, like a psychotic process.”
			
			Much more common is the reaction bariatric surgery patients have to the 
			incredible improvements they have made, like the man Dr. Keller 
			fondly recalls. “You don’t need tests to show you, ‘Wow, this guy’s 
			changed.’ But when you look at this guy’s MBMD scores, he had a host 
			of these scales in the clinical range, which means long black lines. 
			And when I held them up side by side (next to the short lines), it 
			just blew him away. Almost to the point of tears. He can now play 
			with his grandkids, get on a plane without buying an extra seat. And 
			I remember his seeing that, the visual of where his life has gone 
			and it just blew him away. That’s why bariatrics are so cool."