young woman with overweight sharing her problem with psychologist


Patients who have bariatric surgery stand to lose not only lots of weight but often an identity and way of life as an obese person, which changes many of their relationships. Experts discuss these changes and means of coping with them.

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  • Dr. Adam Crane, psychologist, Kane Center for Advanced Surgical Weight Solutions and Suburban Surgical Care Specialists, Hoffman Estates, IL
  • Dr. Nick Nicholson, Medical Director, Nicholson Clinic for Weight Loss Surgery, Plano, TX

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The Psychology of Bariatric Surgery

Nancy Benson: It’s no secret that obesity is increasing. About two-thirds of Americans are at least overweight, and a third of us are obese. Severe obesity is increasing even faster. So it’s probably no surprise that hundreds of thousands of Americans every year are turning to bariatric surgery to lose the weight they’ve tried so hard to shed. But weight loss surgery is no walk in the park, even beyond the risk of complications. Successful patients lose a lot more than all that extra weight. They also stand to lose an entire way of life, and that’s not easy for anyone.

Dr. Adam Crane: There’s so many changes that take place for a patient going into surgery as well as when they come out of surgery. There’s a whole new lifestyle they need to adjust to.

Benson: That’s Dr. Adam Crane, a clinical psychologist with the Kane Center for Advanced Surgical Weight Solutions and Suburban Surgical Care Specialists in Hoffman Estates, Illinois.

Crane: It’s not just about their stomach being made to a more manageable size; they have to learn how to eat in a different way, they need to learn to appreciate the relationship they have with food from an emotional standpoint in a different way, the way that people relate to them oftentimes changes. So it’s going to be necessary for them to be prepared mentally and behaviorally as well as physically to make the best changes possible. That’s where psychology comes in.

Benson: At most centers, people seeking bariatric surgery must take a battery of psychological tests to screen out poor candidates.

Crane: Anyone who exhibits any kind of binge eating behaviors, significant binge eating behaviors, even associated with bulimic behaviors, self-induced purging, they would not be good candidates because we want someone who is looking to loose weight for the right reasons. They can also do a lot of physical damage to their system if they are intentionally making themselves sick. Other people that wouldn’t be good candidates would be people with substance abuse issues, or others with untreated or uncontrolled mental health issues. Someone who isn’t thinking properly or rationally about the surgery.

Dr. Nick Nicholson: We know for instance that people that come in that are expecting a magic bullet — they think they’re going to have surgery on Monday and they’re going to get skinny on Tuesday. Unfortunately, that’s not a reality. Obesity took a lifetime to develop and it’s takes a long time to cure. So the people with unrealistic expectations are a major tipoff right out of the gate.

Benson: That’s Dr. Nick Nicholson, Medical Director of Nicholson Clinic for Weight Loss Surgery in Plano, Texas, and author of Weight Loss Surgery: The Real Skinny.

Nicholson: Those are people that think that the surgery itself is going to restrict them from eating and therein is going to lie all of their success. Unfortunately, you can cheat any of these operations. We have patients who have their entire stomach removed due to cancer or ulcers or trauma, and we have ways of telling them to eat such as drinking high-calorie liquids, Ensure, and things of that nature, where they can actually maintain or even gain weight. So people need to understand that it’s not just the surgery. That’s maybe 10 percent of the while deal. But 90 percent of this is the behavioral change and the lifestyle changes that have to come along.

Benson: Crane says candidates for weight loss surgery can expect to spend three to six months preparing for the lifestyle changes ahead of them.

Crane: We actually have a pre-surgical psychological education group that we require patients to come to. One of the topics that we focus on is self-esteem and self-image, because it is such an important part of recovery, emotional recovery from the surgery. So some of the things that we encourage people to do is set smaller goals, make them more measureable, make them more achievable. So instead of 200 pounds, set a goal of 25 pounds, 50 pounds and achieve that. Through the smaller achievement there starts to be a better sense of accomplishment, a better sense of pride and people tend to do much better.

Benson: But it’s not just a patient’s own identity that may change. A large weight loss can also drastically alter relationships with spouses, partners, and friends. It can often get rocky.

Nicholson: People have always known you for quite some time anyway in the context of being morbidly obese. So your spouse may have only known you as a morbidly obese person. They may be very comfortable with their wife being overweight. She was safe, nobody was asking her out on the side, nobody was giving her attention. They were always themselves the center of attention, and now that dynamic has completely changed. Friends of yours may have viewed you as the person that they could go to the pizza buffet with or go out to happy hour and eat and have high calories liquids, and now you’re not that person anymore. So you may not be as fun or appealing to them any longer.

Benson: All that can mean even more stress than the patient was dealing with beforeAnd their old tried and true coping mechanism—eating is gone. Nicholson says keeping the weight off for good depends on developing new ways to deal with stress.

Nicholson: The reality is for a lot of people, eating is a coping mechanism. Whether you are excited, stressed, nervous, depressed, angry – the things that made you stressed are going to be there the day after surgery. If you’re in a bad marriage it’s still going to be bad, if you have financial troubles you’re still going to have financial troubles. If you have a sick child, the child is still going to be sick. So you still need coping mechanisms, that’s not going to go away. Our job is to try to help you find more sophisticated coping mechanisms and healthier coping mechanisms, because if you don’t then you’re either going to find a way to eat around your operation or worse, which we do see, you’re going to find some very destructive behaviors, you’re going to start drinking, you’re going to start smoking.

Benson: New coping mechanisms can include psychotherapy counseling for behavior modification. Crane also advises staying in touch with their surgeon, working with the bariatric team,  and seeing a dietician regularly.

Crane: Other things that they can do to remind themselves of how far they’ve come is, I always encourage them to create a photo journal. So through their process I would say every month take a couple of pictures, a front view, a side view of themselves, and when they are feeling down they can thumb through these pictures, put them in an album and look back and look at themselves in a mirror and compare. What does the picture from three months ago look like compared to what I’m seeing in the mirror? And the more they can identify more provable, more tangible results the easier it is to accept the new image and to believe that they are actually accomplishing what they set out to do.

Benson: To avoid complications and stay healthy after weight loss surgery, it’s important for patients to follow the rules they get from their doctor. But experts are saying it’s just as important to be mentally and emotionally prepared for the challenges ahead ...or put it off until theyre ready. You can learn more about the psychological aspects of bariatric surgery by visiting our web siteradio health journal dot net.

Our writer this week is Polly Hansen.

Our production director is Sean Waldron.  

I’m Nancy Benson.

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