CBC Behavioral Care — Questions and Answers

Question 1: A patient six months post-sleeve gastrectomy reports eating small amounts of food continuously throughout the day when stressed. Which maladaptive eating pattern does this describe?

Grazing (Correct answer)
Binge eating disorder
Night eating syndrome
Plugging

Correct answer: Grazing

Grazing is the repeated consumption of small amounts of food over extended periods, a common post-surgical maladaptive pattern often triggered by emotion.

Question 2: In motivational interviewing with a bariatric patient ambivalent about exercise, which counselor response best exemplifies reflective listening?

"It sounds like part of you wants to be more active, but you're worried about joint pain." (Correct answer)
"You really need to start walking daily or your weight loss will stall."
"Why haven't you followed the exercise plan we discussed?"
"Most patients who don't exercise regain their weight within two years."

Correct answer: "It sounds like part of you wants to be more active, but you're worried about joint pain."

Reflective listening mirrors the patient's own ambivalence without judgment, a core motivational interviewing skill.

Question 3: Which behavioral strategy involves a patient recording everything they eat, along with hunger levels and emotions, to identify eating triggers?

Self-monitoring (Correct answer)
Stimulus control
Cognitive restructuring
Contingency management

Correct answer: Self-monitoring

Self-monitoring through food and mood journals is a foundational behavioral technique for building awareness of eating triggers.

Question 4: A bariatric counselor notices a post-operative patient has replaced compulsive eating with excessive alcohol use. This phenomenon is best described as:

Addiction transfer (Correct answer)
Dumping syndrome
Food aversion
Behavioral extinction

Correct answer: Addiction transfer

Addiction transfer (cross-addiction) occurs when one compulsive behavior is substituted for another, and alcohol risk is elevated after bariatric surgery.

Question 5: Which cognitive distortion is a patient displaying when they say, "I ate one cookie, so my whole diet is ruined and I might as well quit"?

All-or-nothing thinking (Correct answer)
Catastrophizing about health
Emotional reasoning
Personalization

Correct answer: All-or-nothing thinking

All-or-nothing (dichotomous) thinking frames a single lapse as total failure, a distortion strongly linked to diet abandonment.

Question 6: According to the Transtheoretical Model, a patient who says "I plan to start preparing healthier meals within the next month and have bought a cookbook" is in which stage of change?

Preparation (Correct answer)
Contemplation
Precontemplation
Maintenance

Correct answer: Preparation

The preparation stage involves intending to act within roughly 30 days and taking small concrete steps toward change.

Question 7: Stimulus control as a weight-management technique would most directly involve which of the following?

Removing high-calorie snack foods from visible kitchen counters (Correct answer)
Rewarding oneself with a movie after a week of exercise
Challenging negative thoughts about body image
Practicing diaphragmatic breathing before meals

Correct answer: Removing high-calorie snack foods from visible kitchen counters

Stimulus control modifies the environment to reduce cues that trigger unwanted eating behavior.

Question 8: A patient reports consuming most of their daily calories after dinner and waking at night to eat. Which condition should the bariatric counselor screen for?

Night eating syndrome (Correct answer)
Bulimia nervosa
Avoidant/restrictive food intake disorder
Pica

Correct answer: Night eating syndrome

Night eating syndrome is characterized by evening hyperphagia and nocturnal awakenings to eat, and it can undermine surgical outcomes.

Question 9: Which screening instrument is most commonly used to identify binge eating behavior in bariatric surgery candidates?

Binge Eating Scale (BES) (Correct answer)
Beck Anxiety Inventory
AUDIT-C
Mini-Mental State Examination

Correct answer: Binge Eating Scale (BES)

The Binge Eating Scale is a validated self-report tool widely used in pre-surgical psychological evaluations to assess binge severity.

Question 10: During a pre-surgical evaluation, a patient states they expect surgery to fix their marriage and depression. The counselor's best initial response is to:

Explore and gently correct unrealistic expectations about surgical outcomes (Correct answer)
Refer the patient for couples therapy before proceeding further
Document the response and approve the patient for surgery
Advise the patient that surgery will likely improve both issues

Correct answer: Explore and gently correct unrealistic expectations about surgical outcomes

Unrealistic expectations predict post-operative dissatisfaction, so counselors should address them directly during evaluation.

Question 11: A patient two years post-bypass has regained 15 pounds and avoids follow-up appointments out of shame. Which counseling approach is most appropriate?

Normalize the regain, reduce shame, and re-engage the patient in behavioral strategies (Correct answer)
Warn the patient that continued regain will require revision surgery
Recommend an aggressive very-low-calorie diet immediately
Discharge the patient for non-adherence to the program

Correct answer: Normalize the regain, reduce shame, and re-engage the patient in behavioral strategies

Shame drives avoidance, so a nonjudgmental, re-engagement approach is most effective for addressing post-surgical weight regain.

Question 12: Which of the following best distinguishes emotional hunger from physical hunger when teaching patients hunger awareness?

Emotional hunger tends to come on suddenly and craves specific comfort foods (Correct answer)
Emotional hunger builds gradually over several hours
Physical hunger is satisfied only by sweets and salty snacks
Physical hunger always occurs immediately after a stressful event

Correct answer: Emotional hunger tends to come on suddenly and craves specific comfort foods

Emotional hunger is typically sudden, urgent, and specific to comfort foods, whereas physical hunger builds gradually and accepts a range of foods.

Question 13: A counselor helps a patient plan for a holiday buffet by rehearsing portion choices and identifying an exit strategy for food pushers. This technique is known as:

Relapse prevention planning (Correct answer)
Aversion therapy
Systematic desensitization
Flooding

Correct answer: Relapse prevention planning

Relapse prevention involves anticipating high-risk situations and rehearsing coping strategies in advance.

Question 14: Which factor in a pre-surgical psychological evaluation is generally considered a contraindication requiring stabilization before bariatric surgery?

Active, untreated psychosis (Correct answer)
A remote history of adolescent dieting
Mild situational anxiety about the procedure
Previous participation in a commercial weight-loss program

Correct answer: Active, untreated psychosis

Active untreated psychosis impairs informed consent and post-operative adherence, so stabilization is required before surgery.

Question 15: A patient says, "I know I should stop drinking soda, but it's the only thing that gets me through my shift." In motivational interviewing terms, this statement contains:

Both change talk and sustain talk (Correct answer)
Only change talk
Only sustain talk
A discrepancy confrontation

Correct answer: Both change talk and sustain talk

The statement mixes change talk ("I should stop") with sustain talk ("it gets me through"), reflecting classic ambivalence.

Question 16: Which post-operative behavior most strongly suggests a patient is "eating around" their surgery?

Drinking high-calorie milkshakes because solid food causes fullness (Correct answer)
Eating three small protein-focused meals daily
Taking prescribed vitamin supplements with breakfast
Waiting 30 minutes after meals before drinking fluids

Correct answer: Drinking high-calorie milkshakes because solid food causes fullness

Consuming calorie-dense liquids bypasses the restrictive mechanism of surgery and is a classic form of eating around the pouch.

Question 17: A bariatric counselor teaching mindful eating would most likely instruct a patient to:

Eat slowly without distractions, noticing taste, texture, and fullness cues (Correct answer)
Weigh themselves before and after every meal
Eliminate all carbohydrates for the first year
Eat only when others are present to provide accountability

Correct answer: Eat slowly without distractions, noticing taste, texture, and fullness cues

Mindful eating emphasizes slow, distraction-free eating with attention to sensory experience and satiety signals.

Question 18: Body image dissatisfaction after massive weight loss is most commonly linked to which post-surgical issue?

Excess loose skin (Correct answer)
Improved lipid profiles
Resolution of sleep apnea
Increased mobility

Correct answer: Excess loose skin

Redundant skin after rapid weight loss frequently causes ongoing body image distress even when weight goals are met.

Question 19: A patient describes vomiting intentionally after overeating "to protect the pouch." The counselor should recognize this as:

A compensatory behavior warranting eating disorder assessment (Correct answer)
An expected and harmless adaptation to surgery
A sign of successful restriction awareness
Normal dumping syndrome management

Correct answer: A compensatory behavior warranting eating disorder assessment

Intentional post-meal vomiting is a compensatory purging behavior that requires clinical eating disorder evaluation regardless of the stated rationale.

Question 20: Which social factor is most predictive of better long-term behavioral adherence after bariatric surgery?

Consistent attendance at support groups and follow-up visits (Correct answer)
Living alone without dietary influences
Keeping the surgery secret from family
Returning to work within one week of surgery

Correct answer: Consistent attendance at support groups and follow-up visits

Ongoing engagement with support groups and follow-up care is consistently associated with better weight maintenance and adherence.

Question 21: When a patient repeatedly cancels sessions after disclosing childhood trauma related to food, the counselor's most appropriate action is to:

Address the avoidance supportively and consider referral for trauma-focused therapy (Correct answer)
Terminate counseling for non-compliance
Insist the patient recount the trauma in full detail at the next session
Ignore the disclosures and focus strictly on meal planning

Correct answer: Address the avoidance supportively and consider referral for trauma-focused therapy

Avoidance after trauma disclosure signals distress that should be met with support and appropriate trauma-specialist referral.

CBC Behavioral Care

A patient six months post-sleeve gastrectomy reports eating small amounts of food continuously throughout the day when stressed.
Which maladaptive eating pattern does this describe?

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