WHY DO PATIENTS STRUGGLE WITH MAINTAINING WEIGHT LOSS FOLLOWING WEIGHT LOSS SURGERY

Collins Hodges, PsyD, LP

As both a clinical psychologist and a bariatric patient, I am intimately familiar with the struggle to lose weight. We have spent hundreds of dollars on diets, only to end up right where we started. Unfortunately, we likely will wallow in the pit of self-doubt and self-criticism as we try to make sense of our perceived failures. It can be extremely frustrating and even depressing. To make matters worse, those who don’t struggle with their weight are often mean-spirited and dismissive of our efforts and quick to label us as lazy or unmotivated. However, in the vast majority of cases, the polar opposite is true. We will do almost anything to free ourselves from the self-limiting nature of being overweight.

Even more problematic than achieving significant weight loss is the ensuing challenge of maintaining it. Of course, this is certainly true for all of us who have been on fad diets only to quickly realize that the initial weight loss is only half the battle. Inevitably, we end up on a yo-yo cycle. However, those of us who have undergone bariatric surgery also struggle with weight loss maintenance. We make all of the sacrifices necessary both pre-operatively and post-operatively to help ensure our success. Yet, for many of us, long-term maintenance becomes an issue. How could it be that we still fight this battle after taking such a big step towards achieving a healthy weight?

There are a number of things to consider with respect to weight regain following bariatric surgery. Of course, as we have all heard ad nauseum, weight loss surgery is only “a tool.” Optimizing your success is often a matter of immersing yourself in the dietary, psychological, and exercise protocols for postoperative bariatric patients. However, the initial step is creating a dialogue with your physician in exploring what specifically may be contributing to the issue. For example, patients will need to determine whether the issue is anatomical, medical, or behavioral. Anatomical issues can be diagnosed with an upper GI series or an upper endoscopy. Certain medical conditions may also contribute to weight regain. Some of these may include thyroid issues, adrenal issues, or kidney and/or heart problems. More often than not, however, patients will likely need to focus their attention on the behavioral component.

Successful long-term weight loss maintenance will require patients to make permanent changes in certain behaviors, eating habits, and activity patterns. These may include any number of the following and should be carefully evaluated with both your surgeon and a bariatric psychologist:

• Regular consultation with a dietician or nutritionist
• Keep a food diary
• Drastically reduce intake of sugar, fat, calories, and carbohydrates
• Eat more fruits and vegetables
• Take in significantly more protein
• Cut out alcohol and tobacco
• Consultation with a trainer to create an individualized exercise routine

Perhaps most importantly, patients who continue to struggle with weight gain following bariatric surgery will need to work with a mental health professional in assessing their issues related to mindless eating. The following components of mindless eating will require your attention:

• Are you eating in response to physical hunger?
• Do you have a good understanding of your physical hunger cues?
• Are you aware of the extent to which you eat in response to emotional or environmental triggers?
• Do you find yourself “food-focused” for most of the day?
• Do you view exercise as a punishment for overeating?
• Do you engage in “distracted eating” (i.e., while working, watching tv, etc.)?
• Are you choosing healthy food choices?
• Do you eat quickly?
• Are the food portions large?