doesn’t just help with obesity. According to a 2016 study in
Diabetologia, bariatric surgery is a much more effective way
to reverse Type 2 diabetes in patients with mild to moderate
obesity than an intensive lifestyle intervention involving
exercise, a dietician-directed diet and medication, for example.
The number of psychologists specializing in bariatric
surgery is small, Goldman says, explaining that most hospitals
simply refer patients to outside psychologists, who often lack
specialized training. As in-house staff members, she and the
center’s other bariatric psychologist are part of a team that
includes surgeons, physician assistants, nurse practitioners and
“Our work is very much built around the idea that we are
a multidisciplinary team because we really need to all work
together to get patients ready for surgery,” she says.
Since joining Bellevue as its first specially trained bariatric
psychologist in 2011, Goldman has spent her days evaluating
patients planning surgery and helping to monitor their needs
before and after procedures.
Goldman begins by going over patients’ motives for having
the procedure, their mental health histories and any symptoms,
such as disordered eating. She checks whether cognitive deficits,
behavioral issues or stressors in patients’ lives might keep
them from adhering to post-surgery lifestyle changes. She also
assesses their social support. Spouses, for instance, can become
jealous or feel neglected when patients want to exercise instead
of watching television the way they used to.
Goldman also educates patients who view surgery as a quick
fix. “Surgery is just a tool, not a cure for obesity,” she tells her
patients. “It’s like we’re giving you a prescription and you have
to fill it.”
She also helps patients understand the recommendations
given by their physicians and other providers. “They might know
they can’t eat certain foods, but not understand the reason,” says
Goldman. Patients may think that chicken breasts and fruit are
healthy, for example, but overly dry chicken and some fruit skins
can get stuck in patients’ rearranged digestive systems.
Goldman helps patients start breaking bad habits even
before they have surgery, encouraging them to make small
changes and helping them plan for such potential pitfalls as
holiday parties. She may meet with patients a few times before
or after surgery or invite them to join one of the center’s
Then she and the surgeons discuss whether patients are
ready for surgery or whether they are depressed or have other
psychological issues that could reduce their chances of success.
“I don’t want to be the one deciding if a patient gets
surgery or not,” says Goldman. “But
surgeons usually want a yes or no
answer.” While deciding whether
patients’ medical need for surgery
outweighs their psychological issues
was challenging at first, it has gotten
easier after almost five years. “I hear
all the time now, ‘If you don’t think
this patient is ready or think he or she
needs more help, we’re going with
it,’” says Goldman. “They really do
appreciate my input.”
Goldman also works closely with
the nutritionists. She helps patients
figure out how to make dietary guidelines work in their day-
to-day lives and avoid overeating, which can cause nausea and
vomiting. Goldman also finds herself fielding questions such as
whether a particular brand of protein shake is safe for patients
with diabetes. “I spend a lot of time with patients, so they feel
comfortable coming to me,” she says.
Goldman and her patients celebrate successes together,
whether achieving a goal weight or simply reviewing food diaries
to see how much better they’re eating than three weeks earlier.
“I sometimes feel like a cheerleader at work,” says Goldman,
who encourages other psychologists to join a field that’s
growing along with the obesity epidemic. “I love seeing patients
who were struggling before so successful and happy.” n
For more information about this area of integrated care, contact
Dr. Goldman at Rachel.Goldman2@nyumc.org.
“Our work is very much built around the
idea that we are a multidisciplinary team
because we really need to all work together
to get patients ready for surgery.”
Rachel L. Goldman, PhD
• American Psychological Association. (n.d.). Getting
your weight under control. Available at www.apa.org/
• Goldman, R. L. (2014, July 15). Bariatric surgery and
mental health. Clinical Psychiatry News.
• Goldman, R. L., Canterberry, M., Borckardt, J. J.,
Madan, A., Byrne, T. K., George, M. S., . . . Hanlon, C. A.
(2013). Executive control circuitry differentiates degree
of success in weight loss following gastric-bypass surgery.
Obesity, 21( 11), 2189–2196.