The Evolving Role of the Psychologist

  • F. Merritt Ayad
  • Louis F. Martin


In the past decade the widespread expansion of the American waistline has driven the increased demand for bariatric surgery. Although obesity surgery has been extant for over 30 years, recent improvements in surgical techniques and the dramatic rise in public awareness have accelerated the pace of both its development and utilization. The changing role of the psychologist in the university-based weight management center has been part of this evolution. The major sources of the change in the psychologist’s role are the following: problems with patient adherence to medical and surgical treatments, developments in the areas of health psychology and behavioral medicine, psychology billing code expansion by the American Medical Association’s Current Procedural Terminology (CPT) Editorial Panel, recommendations from published guidelines for bariatric surgery practice and research, clinical implications of obesity surgery outcome research, and the recent developments in our understanding of the change process.


Bariatric Surgery Obese Patient Eating Disorder Obesity Surgery Binge Eating 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Reich L, Romano I, Kolbasovsky A. Primary Care partnership benefits psychologists and patients. National Psychol 2004;13(5):22.Google Scholar
  2. 2.
    Dawes R, Faust D, Meehl P. Clinical versus actuarial judgment. Science 1989;243:1668–1674.CrossRefPubMedGoogle Scholar
  3. 3.
    Meehl PE. Clinical versus statistical prediction. Minneapolis: University of Minnesota Press, 1954.Google Scholar
  4. 4.
    Weston D, Weinberger J. When clinical description becomes statistical prediction. Am Psychol 2004;59:595–613.CrossRefGoogle Scholar
  5. 5.
    Dittman M. CPT codes: use them or lose them. Monit Psychol 2004;October:58–59.Google Scholar
  6. 6.
    Seligman M, Csikszentmihalyi M. Positive psychology: an introduction. Am Psychol 2000;55:5–14.CrossRefPubMedGoogle Scholar
  7. 7.
    Wadden W, Foster G. Behavioral assessment of markedly obese patients. In: Wadden TA, VanItallie TB, eds. Treatment of the Seriously Obese Patient. New York: Guilford Press, 1992:290–330.Google Scholar
  8. 8.
    Wadden T, Phelan S. Behavioral assessment of the obese patient. In: Wadden TA, Stunkard AJ, eds. Handbook of Obesity Treatment. New York: Guilford Press, 2002:186–226.Google Scholar
  9. 9.
    Crowther J, Sherwood N. Assessment. In: Garner DM, Garfinkel PI, eds. Handbook of Treatment for Eating Disorders, 2nd ed. New York: Guilford Press, 1997:34–49.Google Scholar
  10. 10.
    Stunkard A, Wadden T. Psychological aspects of severe obesity. Am J Clin Nutr 1991;55:524s–532s.Google Scholar
  11. 11.
    Wadden T, Stunkard A. Social and psychological consequences of obesity. Ann Intern Med 1985;103(6 pt 2): 1062–1067.CrossRefPubMedGoogle Scholar
  12. 12.
    Witkiewitz K, Marlatt G. Relapse prevention for alcohol and drug problems: that was Zen, this is Tao. Am Psychol 2004;59(4):224–235.CrossRefPubMedGoogle Scholar
  13. 13.
    Perri M. Improving maintenance of weight lost in behavioral treatment of obesity. In Wadden TA, Stunkard AJ, eds. Handbook of Obesity Treatment. New York: Guilford Press, 2002:357–379.Google Scholar
  14. 14.
    Obesity: preventing and managing the global epidemic. Report of a World Health Organization Consultation on Obesity, Geneva, 1998.Google Scholar
  15. 15.
    Friedman M, Brownell K. Psychological correlates of obesity: moving to the next research generation. Psychol Bull 1995;117(1):3–20.CrossRefPubMedGoogle Scholar
  16. 16.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association Press, 2000.Google Scholar
  17. 17.
    Mueller T, Leon A, Keller M, et al. Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. Am J Psychiatry 1999;156:1000–1006.PubMedGoogle Scholar
  18. 18.
    Judd L. The clinical course of unipolar major depressive disorders. Arch Gen Psychiatry 1997;54:989–991.CrossRefPubMedGoogle Scholar
  19. 19.
    Tennen H, Affleck G, Armeli S, et al. A daily process approach to coping. Am Psychol 2000;55:626–636.CrossRefPubMedGoogle Scholar
  20. 20.
    Perri M, McKelvy W, Renjilian D, Nezu A, Shermer R, Viegener B. Relapse prevention training and problemsolving therapy in the long-term management of obesity. J Consult Clin Psychol 2001;69:722–726.CrossRefPubMedGoogle Scholar
  21. 21.
    Hamburger W Emotional aspects of eating. Med Clin North Am 1951;35:483–499.PubMedGoogle Scholar
  22. 22.
    Bruch H. Eating Disorders. New York: Basic Books, 1973.Google Scholar
  23. 23.
    Rand C. Psychoanalytic treatment of obesity. In: Wolman BB, ed. Psychological Aspects of Obesity: A Handbook. New York: Van Nostrand Reinhold, 1982.Google Scholar
  24. 24.
    Fitzgibbon M, Stolley M, Kirschenbaum D. Obese people who seek treatment have different characteristics than those who do not seek treatment. Health Psychol 1993; 12(5):342–345.CrossRefPubMedGoogle Scholar
  25. 25.
    Polivy J, Herman C. Etiology of binge eating: psychological mechanisms. In: Fairburn CF, Wilson GT, eds. Binge Eating: Nature, Assessment and Treatment. New York: Guilford Press, 1993:173–205.Google Scholar
  26. 26.
    Marlatt G. Craving for alcohol, loss of control, and relapse: a cognitive behavioral analysis. In: Nathan PE, Loberg T, eds. New Directions in Behavioral Research and Treatment. New York: Plenum Press, 1978:271–314.Google Scholar
  27. 27.
    Leon G, Chamberlain K. Emotional arousal, eating patterns and body image as differential factors associated with varying success in maintaining weight loss. J Consult Clin Psychol 1973a;40:474–480.CrossRefPubMedGoogle Scholar
  28. 28.
    Leon G, Chamberlain K. Comparison of daily eating habits and emotional states of overweight persons successful or unsuccessful in maintaining weight loss. J Consult Clin Psychol 1973;41:108–115.CrossRefPubMedGoogle Scholar
  29. 29.
    Leon G. Personality, body image, and eating pattern changes in overweight persons after weight loss. J Consult Clin Psychol 1975;31:618–623.CrossRefGoogle Scholar
  30. 30.
    Ganley R. Emotion and eating in obesity: a review of the literature. Int J Eating Disord 1989;8(3):343–361.CrossRefGoogle Scholar
  31. 31.
    Rodin J, Schank D, Striegel-Moore R. Psychological factors in obesity. Med Clin North Am 1989;73(1):47–66.PubMedGoogle Scholar
  32. 32.
    Arnow B, Kenardy J, Agras S. The emotional eating scale: the development of a measure to assess coping with negative affect by eating. Int J Eating Disord 1995;18(1):79–90.CrossRefGoogle Scholar
  33. 33.
    Des Jarlais D. Harm reduction: a framework for incorporating science into drug policy. Am J Public Health 1995;85:10–12.PubMedCentralCrossRefPubMedGoogle Scholar
  34. 34.
    Denning P. Practicing Harm Reduction Therapy: An Alternative Approach to Addictions. New York/London: Guilford Press, 2004.Google Scholar
  35. 35.
    Edelman B. Binge-eating in normal weight and overweight individuals. Psychol Rep 1981;49:739–746.CrossRefPubMedGoogle Scholar
  36. 36.
    Fairburn C, Wilson G. Binge Eating: Nature, Assessment, and Treatment. New York: Guilford Press, 1993:361–404.Google Scholar
  37. 37.
    Carter W, Pindyck J. Pharmacologic treatment of bingeeating disorder. Prim Psychiatry 2003;10(10):31–36.Google Scholar
  38. 38.
    Devlin M, Goldfein J, Carino J, Wolk S. Open treatment of overweight binge eaters with phentermine and fluoxetine as an adjunct to cognitive behavioral therapy. Int J Eating Disord 2000;28:325–332.CrossRefGoogle Scholar
  39. 39.
    Hudson J, McElroy S, Raymond N, et al. Fluvoxamine in the treatment of binge-eating disorder: a multicenter placebocontrolled, double-blind trial. Am J Psychiatry 1998;155: 1756–1762.CrossRefPubMedGoogle Scholar
  40. 40.
    Stunkard A, Berkowitz R, Tanrikut C, Reiss E, Yound L. d-Fenfluramine treatment of binge eating disorder. Am J Psychiatry 1996;153:1455–1459.CrossRefPubMedGoogle Scholar
  41. 41.
    Agras W, Telch C, Arnow B, et al. Weight loss, cognitivebehavioral, and desipramine treatments in binge eating disorder: an additive design. Behav Ther 1994;25:225–238.CrossRefGoogle Scholar
  42. 42.
    Stunkard A, Grace W, Wolff H. The night-eating syndrome: a pattern of food intake among certain obese patients. Am J Med 1955;19:78–86.CrossRefPubMedGoogle Scholar
  43. 43.
    Rand C, Macgregor M, Stunkard A. The night eating syndrome in the general population and among post-operative obesity surgery patients. Int J Eating Disord 1997;22:65–69.CrossRefGoogle Scholar
  44. 44.
    Birketvedt G, Florholmen J, Sundsfjord J, et al. Behavioral and neuroendocrine characteristics of night-eating syndrome. JAMA 1999;282:657–663.CrossRefPubMedGoogle Scholar
  45. 45.
    Saunders R. “Grazing”: high-risk behavior. Obes Surg 2004; 14:98–102.CrossRefPubMedGoogle Scholar
  46. 46.
    Shape Up America and the American Obesity Association; Koop CE, Keller GC, eds. Guidelines for the Treatment of Adult Obesity, 2nd ed. Bethesda, MD: Shape Up America, 1998.Google Scholar
  47. 47.
    Hamoui N, Kingsbury S, Anthone G, et al. Surgical treatment of morbid obesity in schizophrenic patients. Obes Surg 2004;14:349–352.CrossRefPubMedGoogle Scholar
  48. 48.
    National Institutes of Health; National Heart, Lung, and Blood Institute, and North American Association for the Study of Obesity. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Washington, DC: NIH, 2002.Google Scholar
  49. 49.
    Dunbar-Jacob J, Mortimer-Stephens M. Treatment adherence in chronic disease. J Clin Epidemiol 2001;54:S57–S60.CrossRefPubMedGoogle Scholar
  50. 50.
    Zweben A, Zuckoff A. Motivational interviewing and treatment adherence. In: Miller WR, Rollnick S, eds. Motivational Interviewing: Preparing People for Change, 2nd ed. New York: Guilford Press, 2002:299–319.Google Scholar
  51. 51.
    Polivy J, Herman C. If at first you don’t succeed: false hopes and change. Am Psychol 2002;57(9):677–689.CrossRefPubMedGoogle Scholar
  52. 52.
    Engle D, Arkowitz H. Ambivalence in Psychotherapy, Facilitating Readiness to Change. New York: Guilford, 2006.Google Scholar
  53. 53.
    Heidenreich P. Patient adherence: the next frontier in quality improvement. Am J Med 2004:117:130–132.CrossRefPubMedGoogle Scholar
  54. 54.
    Wing R, Phelan S, Tate D. The role of adherence in mediating the relationship between depression and health outcomes. J Psychosom Res 2002:52:877–881.CrossRefGoogle Scholar
  55. 55.
    Nemeroff C. Improving antidepressant adherence. J Clin Psychiatry 2003;64(suppl 18):25–30.PubMedGoogle Scholar
  56. 56.
    Giannetti V. Adherence with antidepressant medication. P T Dig 2004;13:42–47.Google Scholar
  57. 57.
    Vergouwen A, Bakker A, Katon W, et al. Improving adherence to antidepressants: a systematic review of interventions. J Clin Psychiatry 2003:64:1415–1420.CrossRefPubMedGoogle Scholar
  58. 58.
    Brownell K, Wadden T. Etiology and treatment of obesity: understanding a serious, prevalent, and refractory disorder. J Consult Clin Psychol 1992;60(4):505–517.CrossRefPubMedGoogle Scholar
  59. 59.
    Raum W Postoperative medical management of bariatric patients. In: Martin LF, ed. Obesity Surgery. New York: McGraw-Hill, 2004:133–159.Google Scholar
  60. 60.
    National Institutes of Health, United States Department of Health and Human Services. Gastrointestinal Surgery for Severe Obesity: Consensus Statement, NIH Consensus Development Conference, March 25–27, 1991, Vol. 9, No. 1.Google Scholar
  61. 61.
    Marcus J, Elkins G. Development of a model for a structured support group for patients following bariatric surgery. Obes Surg 2004;14:103–106.CrossRefPubMedGoogle Scholar
  62. 62.
    National Institutes of Health United States Department of Health and Human Services. Strategic Plan for NIH Obesity Research: A Report of the NIH Obesity Research Task Force. Washington, DC: NIH, 2004.Google Scholar
  63. 63.
    Bond D, Evans R, Demaria E, et al. A conceptual application of health behavior theory in the design and implementation of a successful surgical weight loss program. Obes Surg 2004;14:849–856.CrossRefPubMedGoogle Scholar
  64. 64.
    Prochaska J, DiClemente C, Norcross J. In search of how people change: applications to addictive behaviors. Am Psychol 1992;47:1102–1114.CrossRefPubMedGoogle Scholar
  65. 65.
    Prochaska J, Norcross J, DiClemente C. Change for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. New York: Avon, 1994.Google Scholar
  66. 66.
    Diclemente C, Velasquez M. Motivational interviewing and the stages of change. In: Miller WR, Rollnick S, eds. Motivational Interviewing. New York: Guilford Press, 2002: 201–216.Google Scholar
  67. 67.
    Foulds J, Jarvis M. Smoking cessation and prevention. In: Calverly P, Pride N, eds. Chronic Obstructive Pulmonary Disease. London: Chapman Hall, 1995:373–390.CrossRefGoogle Scholar
  68. 68.
    Davison G. Stepped care: doing more with less? J Consult Clin Psychol 2000;68:580–585.CrossRefPubMedGoogle Scholar
  69. 69.
    Sobell L, Sobell M. Using motivational interviewing techniques to talk with clients about their alcohol use. Cogn Behav Pract 2003;10:214–221.CrossRefGoogle Scholar
  70. 70.
    Smyth N. Motivating persons with dual disorders: a stage approach. J Contemp Human Serv 1996;77:606–614.Google Scholar
  71. 71.
    Miller W, Rollnick S. Motivational Interviewing, 2nd ed. New York: Guilford Press, 2002.Google Scholar
  72. 72.
    Miller WR. Enhancing motivation for change in substance abuse treatment: Treatment Improvement Protocol (TIP) Series. Rockville, MD: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 1999.Google Scholar
  73. 73.
    Rogers C. Client-Centered Therapy. Boston: Houghlin-Mifflin, 1951.Google Scholar
  74. 74.
    Kohut H. The Restoration of the Self. New York: International Universities Press, 1977.Google Scholar
  75. 75.
    Wolf E. Treating the Self: Elements of Clinical Self-Psychology. New York: Guilford Press, 1988.Google Scholar
  76. 76.
    Norcross J, Prochaska J. Using the stages of change. Harvard Ment Health Lett 2002;May:5–7.Google Scholar
  77. 77.
    Janus I, Mann L. Decision-Making: A Psychological Analysis of Conflict, Choice, and Commitment. New York: Free Press, 1977.Google Scholar
  78. 78.
    Perri M, McAllister D, Gange J, Jordan R, McAdoo W, Nezu A. Effects of four maintenance programs on the long-term management of obesity. J Consult Clin Psychol 1988;56: 529–534.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • F. Merritt Ayad
    • 1
  • Louis F. Martin
    • 2
  1. 1.Department of PsychiatryLouisiana State University School of MedicineNew OrleansUSA
  2. 2.Department of SurgeryLouisiana State University School of MedicineNew OrleansUSA

Personalised recommendations