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We sought to describe the occupational performance issues of a sample of bariatric surgery candidates and to explore the relationships among occupational performance, satisfaction with performance, demographic characteristics, and mental health factors.We reviewed the health records of 241 bariatric surgery candidates and analyzed their scores on the Canadian Occupational Performance Measure (COPM) and standardized mental health questionnaires.Exercise and eating behavior were the most common occupational performance issues. Cognitive and affective issues were reported more frequently than physical issues. Occupational performance and satisfaction correlated negatively with anxiety and depression and positively with self-esteem. Self-esteem contributed 27% of the variance in occupational performance.COPM scores revealed a wide range of occupational performance issues and significant associations with mental health factors, supporting a psychosocial approach to occupational therapy with this population. Routine mental health screening can help ensure that mental health factors are adequately addressed.Mental health factors, particularly self-esteem, may hold the key to occupational performance in bariatric surgery candidates.