Received: 20 May 2019 Revised: 11 July 2019 Accepted: 14 August 2019

DOI: 10.1111/cob.12339

REVIEW ARTICLE

British Obesity Metabolic Surgery Society endorsed guidelines

for psychological support pre- and post-bariatric surgery

Jane Ogden1 | Denise Ratcliffe2 | Vanessa Snowdon-Carr3

1
School of Psychology, University of Surrey,
Surrey, UK Summary
2
Phoenix Health, Chester, UK Research teams have argued that some bariatric patients require psychological input
3
Bariatric Surgery Department, Weight pre- and post-surgery and that weight loss surgery should only be undertaken by a
Management and Bariatric Surgery, Musgrove
Park Hospital, Taunton, UK multidisciplinary team (MDT) that can provide psychological support. To date, no
guidelines exist for the provision of psychological support pre- and post-bariatric sur-
Correspondence
Jane Ogden, School of Psychology, University gery. The authors were approached by British Obesity Metabolic Surgery Society
of Surrey, Guildford, GU2 7XH, UK. (BOMSS) in September 2017 to produce guidelines for the provision of psychological
Email: j.ogden@surrey.ac.uk
support for patients pre- and post-bariatric surgery. These guidelines were developed
using seven stages: (a) review of evidence base; (b) expert input; (c) feedback from
BOMSS delegates; (d) feedback from the special interest group; (e) service user feed-
back; (f) presentation to BOMSS council; and (g) presentation to the Association for
the Study of Obesity. The guidelines describe two stepped care service models for
the delivery of psychological support pre-surgery and 6 to 9 months post-surgery
involving online resources, group workshops and one-to-one with a clinical psycholo-
gist. They are founded upon the following principles: (a) a living document to be mod-
ified over time; (b) flexible and pragmatic; (c) advisory not prescriptive; (d) broad
based content; (e) skills based delivery. These guidelines are feasible for use across all
services and should minimize patient risk and maximize patient health outcomes.

KEYWORDS
bariatric, guidelines, obesity, psychological support, surgery

1 | I N T RO D UC T I O N preoccupation with food and a decrease in depressive symptoms.7-10

Bariatric surgery is currently the most successful treatment of obesity
for those with a body mass index over 40 (or 35 with comorbidities),
with the majority of patients achieving weight loss far exceeding that
1
lost through lifestyle interventions alone and the reversal of diabetic
2,3
status. Psychological factors are an integral part of the bariatric pro-
cess. For example, patients attending for bariatric surgery often have
complex psychological histories, including depression, anxiety, poor
self-esteem and body image, eating disorder symptoms, self-harm,
4-6
addiction, suicidality, trauma or abuse. Further, many patients show
positive psychological outcomes after surgery such as improved self-
identified health status, increased self-esteem, a decrease in the
Some patients, however, may have poorer psychological outcomes
post-surgery such as recurrence of binge eating, substance misuse
and suicidality.11-14 Further, these patients may also show suboptimal
weight loss or weight regain.2,14-16 In particular, differences in weight
loss trajectories seem to appear between 6 and 12 months alongside
the re-emergence of loss of control over eating at 6 months which
has led to the suggestion that post-operative interventions are often
too late.6,14,17-19 Some studies also suggest that baseline psychologi-
cal issues including diet, binge eating, depression and anxiety may
relate to outcomes following surgery16,19,20 although this evidence is
mixed.20,21 In line with this, several research teams21-24 have argued
that bariatric patients require psychological input pre- and post-

Clinical Obesity. 2019;e12339. wileyonlinelibrary.com/journal/cob © 2019 World Obesity Federation 1 of 9

https://doi.org/10.1111/cob.12339
2 of 9
surgery. Further, both National Institute for Health and Care Excel-
lence guidelines25 and those by American Association of Clinical End-
ocrinologists/American Association of Metabolic and Bariatric
Surgery/The Obesity Society26 state that bariatric surgery should only
be undertaken by a multidisciplinary team (MDT) that can provide
psychological support. To date, however, although there are guide-
lines for the nutritional management of patients post-bariatric
27
surgery, how weight management services should be structured
and a quality statement by NICE29 on the need for appropriate
follow-up care after surgery, no guidelines exist for the provision of
psychological support pre- and post-bariatric surgery. Psychological
support is therefore often under-funded within both the National
Health Service (NHS) and private sector and there remains much vari-
ability between how different services support their patients' psycho-
logical needs. 30,31
As a result, the authors of this paper were
approached by British Obesity Metabolic Surgery Society (BOMSS)
council in September 2017 to produce guidelines for psychological
support pre- and post-bariatric surgery.
This aim of this paper is to present guidelines for use within both
the NHS and private sector on the provision of psychological support
for patients pre- and post-bariatric surgery. It should be seen as a liv-
ing document and is therefore accompanied by an online resource for
receiving feedback and suggestions for modifications as new evidence
emerges in the literature and as the guidelines are implemented in
practice. It is also accompanied by three brief evidence reviews that
formed the basis of stage 1 of the methodology (see later for details).
This paper first describes the methodology used for the development
of the guidelines. The guidelines will then be presented in terms of
recommendations for psychological support pre-surgery
6-9 months post-surgery.
2 | METHODOLOGY
The guidelines were developed following seven stages involving evi-
dence review, feedback and consultation: (a) review of the evidence
base; (b) expert input; (c) feedback from the BOMSS delegates;
(d) feedback from the special interest group (SIG); (e) service user
feedback; (f) presentation to BOMSS council; (g) presentation to the
UK Association for the Study of Obesity (ASO).
2.1 | Stage 1: Review of the evidence base
The authors carried out three brief evidence reviews
(a) psychological assessment pre-surgery, (b) psychological support
pre- and post-surgery and (c) specific psychological issues to be
addressed pre- and post-surgery (see Appendix S1). It is concluded
from these reviews that the evidence is mixed and inconclusive and
that synthesis is problematic due to different measures, interventions,
samples, time frames and outcome variables. It would seem that pre-
surgical assessment can have one of four roles: to exclude; to provide
psychological intervention; to monitor; or to educate. It would also
seem that psychological support can be classified as either addressing
OGDEN ET AL.
mental health issues or being psychoeducational in its approach and
content and should be delivered by qualified mental health profes-
sionals or by healthcare professionals with sufficient training and
experience. Further, there are specific mental health issues that
should be addressed pre- and post-surgery which require different
types of psychological support. This structure forms the basis of the
guidelines.
28
2.2 | Stage 2: Expert input
The authors (J.O., D.R., V.S.C.) reflect academic and clinical expertise
and have experience in the field of bariatric surgery. J.O. is a Professor
in Health Psychology. She has published widely in the area of eating
behaviour and obesity management and has utilized a multi method
approach. D.R. is a Consultant Clinical Psychologist and V.S.C. is a
Lead Clinical Psychologist for Weight Management and Bariatric Sur-
gery. Both D.R. and V.S.C. have many years of working within private
and NHS settings managing patients pre- and post-bariatric surgery
and both lead/have led clinical psychology teams and have worked
within MDTs. We held a 2-day meeting in December 2017 to review
the evidence and draw upon our expertise to develop the first draft of
the guidelines for a service model pre- and post-surgery.
2.3 | Stage 3: Feedback from the BOMSS community
These preliminary guidelines were presented to the BOMSS delegates
in January 2018 at the 9th Annual Scientific Meeting in Telford,
UK. The conference is attended by those who work with bariatric
patients both as clinicians and researchers and includes surgeons, die-
and
ticians, nutritionists, endocrinologists, counsellors, clinical psycholo-
gists, health psychologists, researchers and bariatric physicians. The
authors presented to an audience of about 400 delegates and
received questions which were mostly regarding clarification on the
structure of the proposed service models. Written feedback was then
received from 19 delegates. These comments were then coded and
illustrate the following recommendations and concerns:
2.3.1 | Recommendations
Upskilling
Twelve delegates emphasized the need for upskilling for healthcare
professionals on psychological issues using online or face-to-face
training. Two suggested that all members of the MDT should be
of trained to detect mental health problems.
Triage tool
Seven described the need for an online validated triage tool and one
suggested that this would save psychologist time to be spent on more
complex cases.
Varied patient support
Nine delegates emphasized the need for a range of support for
patients using methods such as telephone contact, group workshops,
OGDEN ET AL.
apps, books and online information and two specifically mentioned
that group work would be more efficient.
Signposting
Seven members described the need for help with signposting to other
sources of support including psychiatric services and mental health
support. One mentioned that this was particularly needed in the pri-
vate sector.
Welcomed the guidelines
Seven explicitly stated that they were pleased that the guidelines
were being developed saying “Good luck,” that we had their “full sup-
port” and that it was “about time.”
2.3.2 | Concerns
Delay
Three delegates expressed concern that the proposed service model
could delay patients' pathway through to surgery saying that patients
could get stuck in the psychology department (n = 1) and that the tri-
age tool should be advisory not a process of gatekeeping (n = 2).
Variability in psychology
Four delegates expressed concerns about the variability between ser-
vices in terms of access to psychologists, particularly in the private
sector.
Funding
Related to this variability, five delegates emphasized how psychologi-
cal services were under funded.
Structure of the service
One delegate raised a specific point concerning the timing of the
follow-up and suggested that it should be at 6 not 9 months although
one delegate specifically preferred the 9-month timing.
2.4 | Stage 4: Feedback from SIG
Next D.R. presented the guidelines to the SIG which consists of
healthcare professionals working in the MDT for bariatric patients.
The meeting was attended by about 40 people and consisted of dieti-
cians, clinical psychologists, nutritionists, psychiatrists, counselling
psychologists and GPs. Overall the guidelines were very positively
received and there was general support for their development and
implementation. Compared to feedback from BOMSS, more concern
was expressed about workload capacity and funding particularly
within a struggling NHS system. Comments were classified into three
areas as follows:
2.4.1 | Variation
Discussions revealed variability between services in terms of the
focus and timings and administration of pre-surgical assessments,
3 of 9
variability in the different skills across different services and variability
in the level of follow-up post-surgery. The general consensus was that
although this variability could be reduced by a prescriptive set of
guidelines it was preferable to keep the guidelines as advisory and
flexible. It was therefore agreed to accept a degree of variability and
to take a pragmatic approach to the guidelines which could be used as
a framework to guide best practice.
2.4.2 | Competency and training
Members of the SIG were enthusiastic about the possibility of
upskilling health professionals to improve their understanding of psy-
chological issues which could be achieved through online and face to
face courses, mentoring and supervision. It was debated whether
decisions about who was responsible for delivering which compo-
nents of the service model should be based upon a framework of
competencies rather than professional labels or qualifications. The
case for Improving Access to Psychological Therapies workers as part
of the MDT was also made.
2.4.3 | Sharing resources
Members described a wide range of resources that could be made
available across different bariatric services including online educa-
tional information, online and face to face workshop materials and
assessment tools. This was seen as a means to facilitate best practice
and to make sure that the new guidelines could be implemented as
quickly as possible not to systematize practice.
2.5 | Stage 5: Service user feedback
Service user feedback was received from those attending the BOMSS
presentation (approximately n = 10), those at the SIG (n = 1) and from
one service user who provided detailed feedback on the proposed
service models. This feedback highlighted three key issues:
2.5.1 | The breadth of psychological issues
Services users emphasized the wide range of psychological issues to
be considered within the service. Examples given were comorbidities
such as fibromyalgia which can lead to depression and additional
physical symptoms, mood swings post-surgery and lack of confidence
with exercise.
2.5.2 | Support groups
Service users emphasized the need to meet people pre- and post-
surgery in support groups to access support and information. These
groups could reflect patients at different stages of the surgery
journey.
4 of 9
2.5.3 | Appropriate online information and support
They also highlighted the need for reliable and evidence based infor-
mation throughout the surgical process to help them avoid mis-
information.
2.5.4 | Timing of the follow-up
One service user suggested that the screening post-surgery be
brought forward to before 9 months.
2.6 | Stage 6: Presentation to BOMSS Council
The guidelines and a draft of this paper were presented to the
BOMSS council meeting in July 2018. The feedback was that the
guidelines should be advisory, flexible and organic and should be
appropriate for both the NHS and private sectors. The guidelines were
endorsed by BOMSS Council in October 2018.
2.7 | Stage 7: Presentation to the UK ASO
The final guidelines were made available for feedback at the ASO,
Newcastle, UK, in September 2018. All feedback was supportive.
2.8 | Key principles for the guidelines
To reflect these seven stages the final guidelines were founded upon
the following principles:
2.8.1 | A living document
Given the mixed evidence base and the variability between existing
services these guidelines should be considered a living document
which can be amended in light on new research evidence and feed-
back from service providers and service users. This document is
therefore linked to an online blog where new evidence and feed-
back can be added so that the guidelines can be amended
over time.
2.8.2 | Flexible and pragmatic
Variability between services exists in terms of funding; case mix;
access to psychological expertise; staffing; existing service models.
The guidelines are therefore designed to be flexible and pragmatic to
encourage a better service model which is feasible rather than an ideal
service model which will never be implemented.
2.8.3 | Advisory
Given the variability described above and concerns expressed in the
feedback these guidelines are advisory rather than prescriptive.
OGDEN ET AL.
2.8.4 | Broad based content
The service models presented involve a range of different types of
psychological support which can be classified as either psychothera-
peutic (eg, Dealing with mental health issues; emotional eating etc.) or
psychoeducational (eg, Preparation for surgery; behaviour change;
lifestyle advice etc.). It is envisaged that these different types of sup-
port can be delivered using a range of modes such as face to face,
online, workshops and groups.
2.8.5 | Skills based delivery
It is recommended that the different components of the service
models are delivered by healthcare professionals deemed suitably
skilled according to the necessary competencies rather than by pro-
fessional label. It is envisaged that skills based training programmes
will be developed to enable appropriate upskilling.
3 | T H E G U I D E L I N E S FO R P S Y C H O L O G I C A L
SUPPORT PRE- AND POST-SURGERY
This paper proposes the inclusion of psychology in all services using a
stepped care model. The stepped care model has been widely adopted
to deliver psychological input and interventions for common mental
health problems32,33 whereby resources are allocated according to
patient complexity and professional skill mix. Patients with the most
complex issues are therefore seen by the most highly trained profes-
sionals whilst interventions for those with less complex needs are pro-
vided by upskilled, and suitably supervised, staff. The proposed
stepped care model for the provision of psychological support within
bariatric surgery services is illustrated in Figure 1.
We recommend the use of different modalities (group and online
resources) to improve cost-effectiveness and accessibility. We also
recommend that all patients have access to step 1 so they can access
it as needed. For some patients, assessment only in step 3 will be
required before they can access step 2. For other patients, interven-
tion should be provided at the step 3 level (either individually or in a
group format).
3.1 | Step 1: Online resources
We recommend the use of online resources in the form of information
pages or training modules covering a range of topics which patients
could access as many as required. This would provide a cost-effective
psychological resource that patients could access beyond the point of
discharge from the bariatric surgery service to reduce the risk of later
complications/weight regain. For those patients within services an
online resource would improve access and work as a complimentary
intervention.
OGDEN ET AL.
FIGURE 1 Stepped care model for psychological support pre- and post-surgery
3.2 | Step 2: Group based workshops
There are a range of post-operative psychological and behavioural
issues that can be addressed in a group setting. Stand-alone work-
shops as well as fixed session groups are a cost effective way of deliv-
ering interventions and also has the additional benefit of peer
support. These could be facilitated by upskilled members of the MDT,
assistant psychologists and/or health psychologists. These interven-
tions would be co-designed with the clinical psychologist who would
offer training and supervision to those providing the interventions.
Step 2 could be provided by a range of professionals with appropriate
upskilling, training and ongoing supervision, including assistant
psychologists, nurses and dietitians. The competencies required to
provide these roles need to be operationalized.
3.3 | Step 3: 1:1 with clinical psychologist
As part of the stepped care approach, we recommend utilizing a range
of modalities to provide psychological interventions—these include
signposting to online resources, online workshops, face to face groups
5 of 9
and/or workshops and individual psychological intervention. There
will clearly need to be flexibility regarding these modalities depending
on the size of the service, resources available and the clinical need of
the client. However, we strongly recommend that provision of 1:1
clinical psychology (or equivalent) is the priority for step 3 in order to
offer appropriate interventions for complex clients and to manage
safety/risk reasons. In addition, clinical psychologists (or equivalent)
can co-ordinate and provide training, and supervision for other staff
delivering less complex interventions. In some cases patients will
require both external psychological support as well as bariatric
surgery-specific psychological intervention.
The stepped care models pre- and post-surgery will now be
described. Please note that we use the term clinical psychologist as a
short hand to refer to all appropriately specialist and qualified mental
health professional (eg, psychiatrist, counselling psychologist).
3.4 | Pre-operative psychological service model
It is recommended that all individuals seeking bariatric surgery have a
psychological triage assessment to identify challenges, strengths and
6 of 9 OGDEN ET AL.

future support that an individual may need prior to, or after, bariatric
surgery. The primary role of the triage is NOT to screen out potential
candidates from bariatric surgery but rather to identify the support
that they require to optimize their weight loss and psychosocial out-
comes. There are a number of outcomes for further psychological
input based on the initial triage assessment using a stepped care
model. Table 1 below details the issues which need to be addressed
pre-operatively using the stepped care model approach (see Appendix
S1 for details).
3.5 | Post-operative psychological service model
These guidelines recommend that all patients have a psychological
screening assessment between 6 and 9 months post-surgery to

TABLE 1 Stepped care model for pre-operative psychological support

Potential impact if not

Issue/s addressed
Behaviour change/ Unrealistic expectations
preparation for surgery Limited engagement
Ambivalence for surgery
Weight/eating specific Emotional eating as an
difficulties for example, ongoing coping strategy
eating disorders
Binge eating disorder
Weight regain
Un/conscious sabotage to
protect self for example,
linked to trauma
Consistency with
engagement
Low self-efficacy
Anxiety about eating
changes
Risk factor for post op eating
disorder
Trauma (past and current) Complications
which impacts on weight post-operatively
and/or eating. Emotional Eating
Un/conscious sabotage of
progress
Negative impact on mental
health
Weight regain
Existing mental health Change in mental health
issue status (if not supported)
may interfere with:
Engagement
Adherence
Weight
Post op coping
?Risk factor for post op MH
destabilization (?suicide)
Previously Uncertain risk
unidentified/unmanaged Complications
mental health issue post-operatively
Step 1 Step 2
Online information/ Group based workshop
directed self-help: Upskilled Allied Health
Professional (AHP) and/or
practitioner psychologist
Online information/ Screening by AHP/practitioner
directed self-help: psychologist to consider if
appropriate for step 2.
Group based workshop
facilitated by upskilled AHP
and/or practitioner
psychologist.
Not appropriate for Not appropriate for trauma—
trauma—needs to needs to have Step 3
have Step 3 assessment to determine
assessment to appropriate options
determine
appropriate options
Online 1. Referral (self or by clinician) to Assessment with clinical
information/directed Improving Access to
self-help: Psychological Therapies if
support is required.
Relationship between 2. Flag as requiring monitoring
mental health, before and after surgery.
coping, eating habits
and adjustment after
surgery
NA NA
Step 3
1:1 with clinical psychologist
or other practitioner
psychologist with
appropriate skills and
experience
Assessment with clinical
psychologist and 1:1
intervention as required.
Assessment with clinical
psychologist and 1:1
intervention or referral to
external service as required.
psychologist to consider
coping resources,
previous/current
psychological support.
Liaison with current MH
services.
Assessment with clinical
psychologist to ascertain
risk, support requirements
and refer to Community
Mental Health Team
(CMHT) as needed
OGDEN ET AL. 7 of 9

TABLE 2 Stepped care model for post-operative psychological support (6–9 months)

Potential impact if not

Issue/s addressed
Behaviour Limited engagement
change/adjustment to Weight regain
post-op requirements
Unmet expectations
Weight/eating specific Emotional eating as an ongoing
difficulties for example, coping strategy
post-op eating
disturbance/ disorder.
Weight regain
Un/conscious sabotage to
protect self, for example,
linked to trauma
Step 1 Step 2
Online information/ Group based workshop
directed self-help Upskilled AHP and/or
practitioner psychologist
Online information/ Screening by
directed self-help AHP/practitioner
psychologist to consider if
appropriate for step 2.
Group based workshop
facilitated by upskilled
AHP and/or practitioner
psychologist
Step 3
1:1 with clinical psychologist
or other practitioner
psychologist with
appropriate skills and
experience
Assessment with clinical
psychologist to consider
nature and function of
eating disorder/
disturbance.
1:1 intervention with clinical
psychologist

Consistency with engagement

Low self-efficacy
Anxiety about eating changes
Erratic eating patterns
Coping with surgical
complications
Food aversion/phobia
Trauma (past and current) Complications post-operatively
which impacts on weight Emotional eating
and/or eating.
Un/conscious sabotage of
progress
Negative impact on mental
health
Weight regain
Mental health risk issues— Uncertain risk
destabilization, concerns Complications post-operatively
about self-harm or
suicidality
Concerns about Alcohol Absorption changes
misuse
Increased risk of developing
dependence problems at
lower levels of intake
Thiamine deficiency
Korsakoff's psychosis
Weight regain
Body image/excess skin Sabotage to avoid anxiety about Online
body
Difficulty with self-care
Social anxiety
Impact on intimate relationships
Depression
Not appropriate for Not appropriate for trauma— Assessment with clinical
trauma—needs to needs to have Step 3 psychologist and 1:1
have Step 3 assessment to determine intervention or referral to
assessment to appropriate options external service as required.
determine
appropriate options
If issues are identified If issues are identified by Assessment with clinical
by MDT recommend MDT recommend patient psychologist to ascertain
patient goes directly goes directly to stage 3 risk, support requirements
to stage 3 and refer to CMHT as
needed
Online information/ Screening by Assessment with clinical
directed self-help AHP/practitioner psychologist to consider
psychologist to consider if nature of difficulties, and
appropriate for step 2. whether 1:1 work with
Information about Group based workshop clinical psychologist is
post-op alcohol use, facilitated by upskilled required or if onward
how to identify AHP and/or practitioner referral to drug and alcohol
problem drinking, psychologist service is appropriate.
alcohol as a
replacement coping
strategy
Screening by Assessment with clinical
information/directed AHP/practitioner psychologist to consider
self-help: psychologist to consider if nature and function of
appropriate for step 2. difficulties.
Information about Group based workshop 1:1 intervention with clinical
experiences with facilitated by upskilled psychologist as required
body image changes AHP and/or practitioner
post-weight loss and psychologist
strategies for coping
(Continues)
8 of 9 OGDEN ET AL.

TABLE 2 (Continued)

Potential impact if not

Issue/s addressed
Coping with change Engagement with behaviour
change
Relationship difficulties
Difficulty with self-care
Social anxiety
Depression
Emotional eating
Revision surgery Psychological difficulties which
have impacted upon primary
surgery (in the absence of
technical and/or medical
complications), further
complicate revision surgery
Step 1 Step 2 Step 3
Online Screening by Assessment with clinical
information/directed AHP/practitioner psychologist to consider
self-help psychologist to consider if nature and function of
appropriate for step 2. difficulties.
Group based workshop 1:1 intervention with clinical
facilitated by upskilled psychologist as required
AHP and/or practitioner
psychologist
NA NA Assessment with clinical
psychologist to consider
suitability from
psychological perspective of
revision surgery using NHS,
appendix 8 (2016)

identify any difficulties and offer intervention in a timely fashion to
mitigate poorer outcomes. This assessment would focus on weight
loss, together with other difficulties that can emerge. Alongside,
selected patients would already have a pre-booked post-surgery psy-
chology appointment because of their history and contact with the
psychologist before surgery. Alternatively, patients may be referred
back for a psychology appointment by other members of the team if
6 and 9 months. They describe the focus of each step within these
two service models and illustrate the ways in which specific psycho-
logical issues should be matched by the mode and content of inter-
vention for each step. As a living document, however, these
guidelines need to evolve as new evidence emerges and it is hoped
that researchers, health professionals and service users will use the
living document resource to ensure the guidelines remains up to date,

there are earlier concerns for example, difficulties coping with compli- evidence based and useful. Further, there is still work to be done par-
ticularly in terms of identifying the competencies required by clini-
cations post-op, deterioration of mental health post operatively. As in
cians involved in the different steps of the service models, developing
the pre-operative model, a range of options for intervention should be
training to upskill professionals to deliver these different steps and
available depending on the complexity and type of presenting prob-
producing online resources and materials for workshops that can be
lems. The different intervention options for different mental health
shared across the bariatric community.
issues highlighted in the post op screening assessment are illustrated
in Table 2 (see Appendix S1 for details).

AC KNOWLEDG EME NT S

4 | CO NC LUSIO N The authors are grateful for BOMSS council for their support with
these guidelines and to Laura Carter for her help with the literature
This paper presents guidelines for the provision of psychological sup- reviewing process.
port pre- and post-bariatric surgery to be used in both the private sec-
tor and NHS settings. The development process involved seven
stages including a review of the evidence, expert input, feedback and CONFLICTS OF INTEREST
consultation with health professionals and service users. This process
No conflict of interest was declared.
identified key principles which emphasized: the guidelines as a living
document to be modified over time; that are flexible and pragmatic to
promote a service which is feasible across NHS and private sector ser- AUTHOR CONTRIBU TIONS
vices; advisory rather than prescriptive; have a broad based content
J.O., D.R. and V.S.C. jointly wrote the guidelines. J.O. took primary
involving a range of different types of psychological support delivered
responsibility for the methodology and D.R. and V.S.C. took primary
face to face, online, workshops and groups; that involve skills based
responsibility for the design of the service.
delivery based upon evaluated competencies rather than just by pro-
fessional label. The resulting guidelines recommend a stepped care
approach involving: online resources; group workshops; and 1:1 con-
OR CID
tact with a clinical psychologist. They also outline two service models
for pre-surgery involving a triage process and post-surgery between Jane Ogden https://orcid.org/0000-0003-4271-5621
OGDEN ET AL.
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SUPPORTING INF ORMATION
Additional supporting information may be found online in the
Supporting Information section at the end of this article.
How to cite this article: Ogden J, Ratcliffe D, Snowdon-
Carr V. British Obesity Metabolic Surgery Society endorsed
guidelines for psychological support pre- and post-bariatric
surgery. Clin Obes. 2019;e12339. https://doi.org/10.1111/
cob.12339