Suggestions for Pre-Surgical Psychological Assessments
of Bariatric Surgery Candidates
American Society for Bariatric Surgery
Diane LeMont, Ph.D., Melodie K. Moorehead, Ph.D., Michael S. Parish, Psy.D., Cathy S. Reto, Ph.D., Stephen J. Ritz, Ph.D.
October, 2004
Edited by William E. Benet, Ph.D., Psy.D.
Appendix A
Assessment Tools and Measures
Eating Attitudes and Behaviors
Binge Eating Scale (BES): Gormally J., Black, S., Datson, S. & Rardin
Qualification Level:
Description: Designed to assess binge eating in obese subjects. Addresses the behavioral
features of binge eating as well as the cognitions and feelings associated with binge eating.
Shown to discriminate between obese individuals demonstrating no, moderate, or severe binge
eating difficulties. The BES was designed before Binge Eating Disorder was conceptualized and
although it may be a good screen to detect binge eating, it does not include the needed criteria to
diagnose Binge Eating Disorder.
Reading Level:
Format: 16 items. 4-point scale. Self report.
Completion Time:
Availability: Gormally J., Black, S., Datson, S. et al. (1982). The assessment of binge eating
severity among obese persons. Addictive Behaviors. 7: 47-55. Pergamon Press.
Binge Eating Questionnaire (BEQ): Halmi, Falk, and Schwartz
Qualification Level:
Description: Assessment of bulimic behaviors. Can be used for both diagnosis and screening in
normal populations. Validated in a treatment-seeking obese population.
Reading Level:
Format: 12 demographic questions and 11 multiple-choice items specific to bulimic behaviors.
Completion Time:
Availability: Halmi (1985).
Three- Factor Eating Questionnaire (TFEQ): Stunkard & Messick
Qualification Level:
Description: Measure the psychological constructs of eating. Used in normal, obese, and eating
disordered populations. Can be used for screening, treatment planning, and monitoring treatment
Reading Level:
Format: 51 items. Self report measure that includes 36 T/F items and 36 multiple-choice items.
Completion Time:
Scales: Measures three dimensions of eating behavior including cognitive restraint of eating,
disinhibition, and hunger. Two additional subscales of cognitive restraint have been developed to
distinguish flexible control of eating from rigid control of eating.
Availability: Public Domain. Stunkard A, & Messick, S. (1985). The three-factor eating
questionnaire to measure dietary restraint, disinhibition and hunger. Journal of Psychosomatic
Research (29:1) 71-83. Pergamon Press.
Eating Inventory (EI): Stunkard, A. & Messick, S.
Qualification Level: b – level**
Description: Clinical tool developed to recognize and treat eating disturbances and disorders.
Useful in treatment programs for obesity, predict weight gain following smoking and explain
weight changes among the depressed. Norms and SD’s of each dimension have been obtained for
normal and obese groups.
Age: 17 years and older
Reading Level:
Format: 51 multiple-choice questions.
Administration Time: 15 minutes
Scales: Assesses 3 dimensions of eating behavior: cognitive restraint, disinhibition, and hunger.
Availability: PsychCorp*.
Questionnaire on Eating and Weight Patterns-Revised (QEWP-R): Spitzer, R.,
Yanovski, S., & Marcus, M.
Qualification Level:
Description: Provides information that allows diagnosing of Binge Eating Disorder, Bulimia
nervosa, and related eating disorders. Diagnosis should be confirmed by interview. Internal
consistency, .75 for a weight control sample, .79 for a community sample. For the examiner, the
measure includes decision rules for diagnosing Binge Eating Disorder, Bulimia Nervosa (purging
and nonpurging).
Reading Level:
Format: 28 items that include both demographics as well as multiple-choice items.
Completion Time:
Availability: Available from the Health and Psychosocial Instruments (HAPI) database. *
Eating Disorder Examination-Questionnaire (EDE-Q): Fairburn & Beglin
Qualification Level:
Description: Self-report questionnaire adapted from the Eating Disorder Examination (EDE
Fairburn & Cooper) that measures the frequencies of eating disorder behaviors and identifies
different forms of overeating. Used in assessing episodes of binge eating among the obese
(Kalarchian et al, 2000; Grilo et al, 2001) and in discriminating obese binge eaters from obese
non-binge eaters (Wilson et al 1993) Internal consistency: Chronbach’s alpha ranged from .78 to
.93; test-retest reliability ranged from Pearson’s r .81 to .94.Looks at objective versus subjective
bulimic episodes.
Reading Level:
Suggestions for Pre-Surgical Assessments 19
Appendix A
Format: 41-items. 7 –point format.
Completion Time:
Scales: Subscales: dietary restraint, eating concern, weight concern, and shape concern.
Eating Disorder Inventory - 2 (EDI-2): Garner, D.
Qualification Level:
Description: Used extensively in Eating Disorder research. Useful as screening instrument in
nonpatient populations.. Use is not intended to yield a diagnosis but assess severity of
symptomatology on dimensions clinically relevant to eating disorders. Normative data for
bulimic and anorexic patients, male and female high school and college students. Hand score and
computer versions available
Age: Ages 12 years and older.
Reading Level:
Format: Self report, 91 items, using 6-point scale.
Completion Time: Approximately 20 minutes.
Scales: Eight subscales and three provisional subscales: Drive for Thinness, Ineffectiveness,
Body Dissatisfaction, Interpersonal Distrust, Bulimia, Perfectionism, Maturity Fear,
Interoceptive Awareness, Impulse Regulation, Social Insecurity, and Asceticism.
Availability: Published by PAR*.
Eating Disorder Symptom Checklist (EDI-SC): Garner, D.
Qualification Level:
Description: Structured, self-report form regarding frequency of eating disorder symptoms as
well as demographic information. Good as aid in formulating an eating disorder diagnosis.
Age: Ages 12 years and older.
Reading Level:
Completion Time: 5-10 minutes.
Scales: Content areas: Dieting, exercise, binge eating, purging, laxatives, diet pills, diuretics,
menstrual history, and current medications.
Availability: Published by PAR*.
Weight and Lifestyle inventory (WALI): Wadden, T. & Foster, G.
Qualification Level:
Description: A multidimensional, multi format questionnaire designed to obtain very specific
information about weight history, past weight loss attempts, weight loss goals, historical eating
habits and associated patterns of behavior, physical activity, self-perceptions,
psychological/emotional status and medical history. Section J of the WALI incorporates the
Questionnaire on Eating and Weight Patterns-Revised (QEWP-R; Yanovski, 1993).
Reading Level:
Format: 16 self-administered sections
Completion Time: 60 – 90 minutes
Availability: Copyright: Thomas A. Wadden, PhD and Gary D. Foster, PhD. (2001). Printed in:
Wadden, T. A. & Stunkard, A. J. (Eds.). (2002). Handbook of obesity treatment. New York:
Guilford Press.
Personality and Psychopathology
Basic Personality Inventory (BPI): Jackson, D.
Qualification Level: c-level**
Description: Personality inventory for use with both clinical and normal populations. Used to
identify both maladjustments and personal strengths. Normed on adults, adolescents, and special
populations. Validity data is presented in the manual.
Age: adolescents and adults
Reading Level: Grade 5
Format: 240 T/F items.
Completion Time: Approximately 35 minutes
Scales: 12 Clinical Scales: hypochondriasis, anxiety, depression, thinking disorder, denial,
impulse expression, interpersonal problems, social introversion, alienation, self-deprecation,
persecutory ideas, deviation.
Availability: Published by WPS* and Sigma Assessment Systems*
Personality Assessment Inventory (PAI): Morey, L.
Qualification Level: c-level**
Description: Inventory of adult personality and psychopathological syndromes. Useful for
diagnosis, treatment planning, and screening.
Age: 18 years and older
Reading Level: 4th grade reading level
Format: 344 item, 4-point scale
Completion Time: Time: 50 – 60 minutes. Score time: 10 – 20 minutes
Scales: Twenty-two nonoverlapping scales of adult psychopathology. 4 Validity Scales:
(inconsistency, infrequency, negative impression, positive impression), 11 Clinical Scales:
(somatic complaints, depression, anxiety, anxiety related disorders, mania, schizophrenia,
paranoia, borderline and antisocial features, drug, and alcohol), 5 Treatment Scales (aggression,
suicidal ideation, stress, nonsupport, treatment rejection), and 2 Interpersonal Scales (dominance,
Availability: Published by PsychCorp*. Published by PAR*.
Structured Clinical Interview for DSM-IV – Axis I, Clinical Version (SCID-I:CV):
First, M, Spitzer, R., Gibbon, M, &Williams, J.
Qualification Level: b-level**
Description: Designated Structured clinical interview for Axis I disorders. Also available:
Structured Clinical Interview for DSM-IV Axis II personality Disorders (SCID-II).
Age: 18 years and older
Format: Interview
Completion Time: Administration Time: 45 – 90 minutes.
Availability: Published by MHS*
Beck Depression Inventory-II (BDI-II): Beck, A, Steer, R., Brown, G.
Qualification Level: c-level**
Description: Assesses the level of clinical depression in normal patients in keeping with DSMIV
criteria. Reliability: Coefficient Alpha = .92. Used for screening, diagnosis, and follow –up.
Age: Ages 13 to 80 years.
Reading Level:
Format: 21- items, 4 levels of severity.
Completion Time: Administration time: 5 minutes. Self-administered or verbally administered
by trained administrator.
Availability: Published by PsychCorp*
Beck Anxiety Inventory (BAI): Beck, A.
Qualification Level: c-level**
Description: Assesses the level of and severity of client anxiety. Shown to discriminate between
anxious and nonanxious groups in clinical populations.
Age: Ages 17 to 80 years
Reading Level:
Format: 21 items rated on a scale of 0 – 3.
Completion Time: Administration time 5 – 10 minutes. Self-administered or verbally
administered by trained administrator.
Availability: Published by PsychCorp*
Minnesota Multiphasic Personality Inventory - 2 (MMPI-2): Hathaway, S. & McKinley, J.C.
Qualification Level: a-level**
Description: Used to assess major symptoms of social and personal maladjustment. For
complete description and normative data please refer to Pearson Assessments*.
Age: 18 years and older.
Reading Level: 6th grade reading level.
Format: 567 true/false items. Paper and pencil, audiocassette, or computer administration.
Completion Time: 60 – 90 minutes.
Scales: 8 Validity Scales, 5 Superlative Self-Presentation Subscales, 10 clinical Scales, 9 RC
(Restructured Clinical) scales, 15 content scales, 27 Content Component Scales, 20
Supplementary Scales, 31 Clinical Subscales.
Availability: Published by Pearson Assessments*
Millon Behavioral Medicine Diagnostic (MBMD): Millon, T., Antoni, M., Millon, C.,
Meagher, S., & Grossman, S.
Qualification Level: m-level**
Description: See Website for complete reliability and validity data as well as sample test and
interpretive reports.
Age: Ages 18 – 85
Reading Level: 6th grade reading skills
Format: 165 item, self-report inventory. Administration: paper and pencil, audiocassette,
computer. Scoring: handscoring, mail-in, system software.
Completion Time: Completion time 20 to 25 minutes.
Scales: Twenty-nine clinical scales: 3 Response Pattern Scales: (disclosure, desirability,
debasement), 1 Validity Indicator, 6 Negative Health Habits Indicators: (alcohol, drug, eating,
caffeine, inactivity, smoking), 11 Coping Styles: (introversive, forceful, inhibited, respectful,
dejected, cooperative, oppositional, denigrated, confident, sociable, nonconforming), 6
Psychiatric Indicators Believed To Create Problems In Medical Treatment: (anxiety-tension,
depression, cognitive dysfunction, emotional lability, guardedness), 6 Stress Moderators: (illness
apprehension vs. illness acceptance, functional deficits vs. functional competence, pain
sensitivity vs. pain tolerance, social isolation vs. social support, future pessimism vs. future
optimism, spiritual absence vs. spiritual faith), 5 Treatment Prognostics: (interventional fragility /
interventional resilience, medication abuse / medication conscientiousness, information
discomfort / information receptivity, utilization excess / appropriate utilization, problem
compliance / optimal compliance), 2 Management Guidelines: (adjustment difficulties-risk of
complications due to coping and psychological issues and psychological referral – whether or not
individual would benefit from psychosocial interventions).
Availability: Published by Pearson Assessments*
Rosenberg Self-Esteem Scale (SES) (RSE): Rosenberg, M.
Qualification Level: none
Description: global and one-dimensional measure of self-esteem. Coefficient alpha’s range
from .77 to .87.
Age: adolescents and adults
Reading Level:
Format: 10 items, 4-point scale.
Completion Time: Less than 5 minutes
Availability: Public Domain. Author’s family would like to be kept informed of its use.
The Morris Rosenberg Foundation
c/o Dept. of Sociology
University of Maryland
2112 Art/Soc Building
College Park, MD 20742-1315
Symptom Checklist 90 -R (SCL-90-R): Derogatis, L.
Qualification Level: m-level**
Description: Self report inventory designed for the psychological assessment of symptoms of
psychopathology. May be used as a measure for screening as well as a measure of progress or
outcome. Normed on adult nonpatients, adult psychiatric outpatients, adult psychiatric inpatients,
and adolescent nonpatients.
Age: Ages 13 years and older
Reading Level: 6th grade reading level.
Format: 90 items; 5 point rating scale.
Completion Time: Completion time: 12 – 15 minutes.
Scales: 9 Primary Symptom Dimensions: (somatization, obsessive-compulsive, interpersonal
sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism. 3
Global Indices: (global severity index, positive symptom distress index, positive symptom total.
Availability: Published by Pearson Assessments*
Health Related Quality of Life
Quality of Life Questionnaire (QLQ): Evans, D & Cope, W.
Qualification Level: b-level**
Description: Measures the relationship between the client’s quality of life and behaviors such
as substance use, psychological health, and physical health. Highlights areas of life that may
need addressing in order to change to take place. Screening tool for employee assistance,
wellness, stress, and weight control.
Age: 18 years and older.
Reading Level:
Format: 192 items.
Completion Time: Administration time: 30 minutes.
Scales: 15 content scales and a social desirability scale. Covers 5 major domains (general wellbeing,
interpersonal relations, organizational activity, occupational activity, leisure and recreational activity.
Availability: Published by MHS*
Quality of Life Inventory (QOLI): Frish, M.
Qualification Level: b-level**
Description: Measure of life satisfaction that can be used to measure outcomes and establishing
efficacy of treatments or services.. Helps identify people at risk for developing health problems.
Used in behavioral medicine assessments. Normed on nonclinical adults.
Age: 18 years and older.
Reading Level: 6th grade
Format: 32 items. 3-point rating of importance and 6-pont rating scale for satisfaction. Paper-and-
pencil or on-line administration.
Completion Time: Approximately 5 minutes.
Scales: 16 scales: Health, self-esteem, goals and values, money, work, play, learning, creativity,
helping, love, friends, children, relatives, home, neighborhood, community.
Availability: Published by Pearson Assessments*
Impact of Weight on Quality of Life (IWQOL): Kolotkin, R., Crisby, R., Kosloski, K, & Williams, R.
Qualification Level:
Description: Quality of life measure designed specifically for an obese population. Data
indicate that the questionnaire has good test-retest reliability and internal consistency. The
authors of the IWQOL are currently recommending the use of the IWQOL-Lite over this version.
Reading Level:
Format: 74 items. 5-point scale.
Completion Time: 15 minutes
Scales: 8 areas of functioning (health, social/interpersonal, work, mobility, self-esteem, sexual
life, activities of daily living, and comfort with food.
Availability: Copyright owned by Duke University Medical Center. *
Impact of Weight on Quality of Life (IWQOL-Lite): Kolotkin, R. & Hamilton, M.
Qualification Level: none
Description: Recommended version by test authors. Brief measure to assess the impact of
weight on quality of life specifically for obese populations. Derived from the Impact of Weight
on Quality of Life (IWQOL), Kolotkin, R., Crisby, R., Kosloski, K, & Williams, R. Correlation
between the IWQOL-Lite and the original IWQOL is .97. Normed on overweight treatment seekers,
community volunteers of all weights, and diabetics. Currently in the process of being
validated in clinical populations with schizophrenia and bipolar disorder who are taking
antipsychotic medications.
Age: 18 and above.
Reading Level: 6.3 grade level
Format: 31-items. 5-point scale
Completion Time: 3 minutes.
Scales 5 scales: physical function, self-esteem, sexual life, public distress, and work. Total score
and scale scores provided.
Availability: Copyright owned by Duke University Medical Center. *
Impact of Weight on Quality of Life-Kids (IWQOL-Kids): Kolotkin, R.
Qualification Level:
Description: New measure currently being developed.
Age: Targeted for ages 11 and up.
Reading Level:
Completion Time:
OMS 36-item Short Form Health Survey (SF-36): Ware, J.
Qualification Level:
Description: Generic measure of health related quality of life used to evaluate health status in
medical outcome studies. Has been used to look at the relative burden of disease as well as
differentiating. The SF-36 has established internal consistency, validity, and test-retest reliability.
Test does not cover or screen for eating disorders or mood.
Reading Level:
Format: 36 items. 5-choice response. Self-administered, computerized administration, or
administration by a trained interviewer.
Completion Time: 5-10 minutes.
Scales: 8 scales: Physical functioning, role-physical, bodily pain, general health, vitality, social
functioning, and mental health.
Availability: Requires licensing agreement. Quality Metric* or
Moorehead-Ardelt Quality of life Questionnaire (M-A QoLQ):
Qualification Level: Professional/Patient use
Description: Developed as a disease specific instrument to measure postoperative, selfperceived,
quality of life in people undergoing medical/surgical intervention for obesity and severe obesity.
Age: 18 years old and above
Reading Level: 6th Grade
Format: 5 items. 5 -choice responses, culture free for International use.
Completion Time: Less than 1 minute.
Scales: Assesses self-esteem, physical well-being, social relationships, work, and sexuality.
Availability: Copyright owned by: M.K. Moorehead, Elisabeth Ardelt. *
Moorehead-Ardelt Quality of life Questionnaire II (M-A QoLQ II): Moorehead, M.K. & Ardelt, E.
Qualification Level: Professional/Patient use
Description: Developed as a disease specific instrument, the improved M-A QoLQ II is a valid
and reliable tool developed to measure both pre and post medical/surgical intervention of self-perceived
quality of life in 6 key areas, i.e. self-esteem, physical well being, social relationships,
work, sexuality, and eating behavior. Being unbiased, physician and patient friendly, this six item
questionnaire is designed specifically to address those aspects of quality of life concerns to
the morbidly obese. To promote patient follow up it can be mailed or emailed to the patient and
self-administered or administered directly by the multidisciplinary team. It is culture free and
design with colorful universal symbols for International use.
Age: 18 years old and above
Reading Level: 6th Grade
Format: This 6 items 10-point Likert scale is a sensitive, culture free instrument designed for
International use. To be scored independently or in combination with BAROS.
Completion Time: Less than 1 minute.
Scales: 10 point Likert scale assesses six areas of Quality of Life: self-esteem, physical wellbeing,
social relationships, work, sexuality, eating behavior.
Availability: Copyright owned by: M.K. Moorehead, Elisabeth Ardelt. For permission to use
contact Dr. Moorehead. *
Outcome Measures
Bariatric Analysis and Reporting Outcome System (BAROS): Oria H. & Moorehead M.
Qualification Level: Professional
Description: BAROS analyzes bariatric outcomes in a simple, one page, objective, unbiased,
and evidence-based fashion. While it can be adapted to evaluate other forms of medical
intervention for weight control, it was specifically designed to create a standardized system to
define five groups, (failure, fair, good, very good, and excellent), outcomes after bariatric surgery.
Reading Level:
Format: Uses concepts via pictures versus specific questions. Concepts include Self esteem,
physical well-being, social relationships, work, and sexuality. Five choices ranging from
negative to positive (adding or subtracting points) illustrated with simple drawings.
Completion Time:
Scales: Based on a scoring table that adds and subtracts points while evaluating three main areas:
Weight loss, Changes in medical conditions and Quality of Life. Complications and reoperative
surgery deduct points, thus avoiding the controversy of considering reoperations as failures. This
instrument is designed and intended for International use. (It Incorporates the Moorehead-Ardelt
Quality of life Questionnaire II.) .
Availability: Copyright owned by Horacio Oria, M.D. and Melodie Moorehead, Ph.D.*
*Publisher information
Duke University Medical Center
     H. Gilbert Smith, Ph.D.
     Duke University
     Office of Science and Technology
     Davison Building, Room M454
     DUMC 3664
     Durham, NC 27710 USA
     (919) 681-6497
MHS, Multi-Health Systems, Inc. 1-800-456-3003 or
PAR, Psychological Assessment Resources, Inc. 1-800-331-8378 or
Pearson Assessments 1-800-627-7271,
PsychCorp Harcourt Assessment, Inc. 1-800-211-8378 or
Quality Metric
Sigma Assessment Systems
The Health and Psychosocial Instruments (HAPI) database is available online with a
University password. Database can be accessed via OVID Technologies
WPS Western Psychological Services
Moorehead-Ardelt Quality of Life Questionnaire II or Bariatric Analysis Reporting Outcome
System (BAROS)
For a sample of a “Mental Health Report” and 9 page Skeleton Worksheet for Evaluation
contact Melodie Moorehead, Ph.D.
**Qualification Level
a -level – Licensure to practice psychology independently, or a graduate degree in
psychology (or related fields) OR have taken graduate courses in Tests and Measurements,
OR proof that they have been granted the right to administer tests at this level.
b- level – Must have completed graduate level courses in tests and measurements or
equivalent documented training.
c -level – Have b-level qualification and training/experience in testing, and completed an
advanced degree in an appropriate profession. Some states may have additional requirements.
m -level – Requires specialized degree in the health care field with accompanying licensure
or certification OR proof of permission to administer test at this level.