By Dr. Collins Hodges
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Moving forward with bariatric surgery will be one of the most significant medical decisions of your life. As a bariatric patient myself, I know it often follows decades of struggling with weight. The majority of us have tried several diets and exercise programs, and eventually we become frustrated by our inability to keep weight off. Oftentimes, we reach a point where the physical illnesses associated with obesity start to affect our quality of life. However, I know the psychological and emotional consequences of obesity can also wreak havoc on our sense of well-being.
The direct result is someone who is physically ill, unhappy with how they look, and unhappy with how they feel. Bariatric surgery becomes the beacon of light ahead. We want to get the procedure done and never go back. However, in order to help ensure you get what you paid for, there are certain things patients can do to help make this happen. As a matter of fact, the patient herself plays the most important role in becoming a bariatric success story.
The #1 reason why patients fail to lose weight, keep it off, and avoid complications is noncompliance. Everything a patient does, beginning the day after surgery, largely controls her fate. As you already know, contrary to popular belief, we are NOT taking the easy way out. The difficult part is the postoperative recovery. The challenge will be establishing a new pattern of behavior that promotes wellness. Following the post-op diet and nutritional guidelines are very important. However, successful bariatric patients report putting a great deal of effort into exploring their ways of thinking and their relationships.
If there is an area of concern during post-op, this is it. The surgeons and dieticians have taken painstaking efforts to create the ideal postoperative plan. The plan is well laid out and logical. However, following it closely takes effort. Ideally, patients go into surgery prepared with the expectation that success will require full adherence to the postop protocol. Successful bariatric patients understand the following: 1) their HEALTH reasons for pursuing bariatric surgery and 2) what THEY have to do after surgery to give them the best odds of achieving their goal. With that in mind, there are so many things to remember, and the pressure is on to be fully compliant with each piece. Successful patients don’t just find a way to closely follow their diet plan. They commit themselves to following the script.
The much more difficult piece of the puzzle will be increasing your self-awareness. Successful patients take the time to address potential psychological and emotional roadblocks to success. How important are insight and self-awareness in laying the groundwork for becoming a bariatric success story? It is THE most undervalued area of post-op. Most of the psychological obstacles patients encounter during post-op are a direct result of a lack of insight into one’s emotional life. Of course, patients and the psychologist will explore any and all psychiatric symptoms consistent with mental health disorders in order to minimize those contributions to a lack of emotional self-understanding. However, all of us, to one extent or another, have psychological vulnerabilities. That being said, obesity brings with it a unique set of significant physical challenges and emotional strain.
When we talk about increasing our self-awareness during post-op, what exactly are we talking about? There will be specific areas of concern for patients, and the idea is to create a dialogue wherein patients are free to examine their thoughts and behaviors. For example, I may ask: What was food doing for you? This is a question that comes up fairly often in therapy. The answer, of course, is A LOT. Therein lies the problem. The duality of overeating eventually traps us. On the one hand, comfort food is exactly that: comforting. It helps us cope with stress and avoid, if only briefly, the feelings of frustration, anger, sadness, loneliness, and/or anxiety we may feel. However, the rush of contentment is very short-lived. The stream of self-critical and self-berating thinking is soon to follow. Just like clockwork, as some point we feel drained from the accompanying negative emotions. Often that means a return to our learned coping skill: emotional eating. It becomes a vicious cycle.
Understanding how our thoughts and emotions get tied into food is an example of increasing our self-awareness. What are some other examples? For instance, I may say: In what ways do you struggle with how you look now? This provides the patient an opportunity to explore this concern, in depth, possibly for the first time. I will often hear patients report not seeing themselves as a thin person, despite the obvious massive weight loss. It brings up difficult psychological situations. For example, family and friends’ compliments on how they look clash with their self-perception.
How about changes in your relationships following surgery? This also comes up very often in therapy. The dynamics of our relationships are likely to change, because we have changed.
Many patients talk about the changes in their romantic relationships. For example, I may ask: In what ways might your husband struggle with your massive weight loss? It may be the case that the spouse has become used to taking care of the patient. Perhaps the spouse will feel less needed or important, and that may cause concern for him. It’s not uncommon for husbands to worry about their wives’ new confidence and sex appeal.
Coworkers may misconstrue your efforts to regain your health as reflecting someone who is “showing off” and “bragging.” They may feel defensive about your weight loss. Or, they may feel jealous and use that to your disadvantage. That is all to say, your relationships may very well take a turn for a worse, at least temporarily. Thinking these things through is invaluable to post-op success.
