Part of the problem is that although patients looking at weight-loss surgery go through significant physical examinations, they go through minimal — if any — mental-health screening. And while any major surgery may come with emotional challenges, these patients could be especially vulnerable to new issues or an exacerbation of existing ones. At this point, it's becoming clear that we don't have an adequate system to make sure they get the help they need.Patients who go into the bariatric-surgery process with an established need for therapy, will usually return to that, says Amir Ghaferi , MD, assistant professor of surgery at the University of Michigan. "But for patients who may have new diagnoses pop up [after surgery], there is no rigorous or routine method for treatment.We live in a society that often paints losing weight as the ultimate solution to every problem. Our obsession with shows like Biggest Loser , before-and-after Instagram transformations, and countless ads for weight-loss supplements only strengthens the idea that this change can be a quick, simple fix. So it's no surprise that, after what is often a lifetime of weight-based stigma , many bariatric-surgery patients may come to believe their lives will become better quickly and all at once.However, after surgery, things don't usually pan out that way. Instead, Dr. Ghaferi says that with surgery, patients may lose 50-70% of their weight in about a year. But "even with that amount of weight loss, most people don’t get down to a 'normal' BMI," he explains. "A lot of people are still classified as overweight."Generally a patient will be warned about these realities in some way, as part of making sure they give informed consent. But in a series of recent focus groups in his clinic, Dr. Ghaferi says he's found that most people may simply hear what they want to hear during this process. "For a lot of the dangerous or bad stuff," he says, "patients may minimize it and say, 'That won’t happen to me.' It’s [normal] human behavior." That mindset — plus patients' high standards for success — may set them up for severe disappointment.No one is really sure how exactly to address that disappointment, but one thing that could help is if surgeons had more explicit discussions with patients about the potential mental-health effects.