Bariatric surgery is a significant intervention for individuals struggling with obesity. It offers the potential for substantial weight loss, but it also presents a complex array of psychological and nutritional challenges. Understanding these effects can help clients make a fully informed decision about whether to move forward, and it helps the clinician expand the assessment process. Deepening the initial exploration process will also help the clinician implement strategies before and after surgery, should the client move ahead, to mitigate negative consequences and ensure a more successful outcome.

Bariatric surgery works by restricting food intake and altering the appetite to decrease hunger and increase satiety. Despite the physical benefits, predicting who will successfully lose weight and maintain weight loss is difficult due to genetic variations affecting success (Hatoum et al., 2013).

Some patients can experience improved self-esteem, body image, and quality of life post-surgery. Blood sugar may return to normal, and type 2 diabetes can be resolved. As physical health improves and confidence grows, symptoms of depression and anxiety can decrease. However, rapid weight loss and drastic changes in body appearance can be overwhelming, especially where there has been previous body dysmorphia, or they can potentially lead to unrealistic expectations. Additionally, some patients may experience a resurgence of unresolved psychological issues that were previously masked. This is especially so where there is a history of adverse childhood events and sexual abuse.

A concerning aspect of post-surgery life is the risk of substance abuse, known as "addiction transfer" or "cross-addiction." This phenomenon occurs when individuals replace food with other substances, such as alcohol or drugs, to cope with stress or emotional discomfort. The altered physiology post-surgery can also change how substances are metabolized, increasing the risk of dependency (King et al., 2012; Ivezaj, Saules, & Wiedemann, 2014). Furthermore, patients are at risk of continuing or developing disordered eating patterns post-surgery, including restrictive eating,........

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