CBC Behavioral Care 3 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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.
CBC Behavioral Care 3
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?