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The decision to pursue Weight Loss Surgery is usually not an impulsive one. Some consider it for years; others for several months. The last straw may be the recommendation of primary care doctor; weight loss in order to have an orthopedic operation; the shame of being denied a ride at an amusement park; seeing the success of a friend, coworker or loved one after their surgery. The decision comes from many sources, but it is almost never an impulsive or lighthearted one. So the call to the bariatric surgeon is made: whether with excitement or dread that important first step is often filled with ambivalence and regret that one has got to this stage.

It is not surprising given how difficult the first step is that it is frustrating after having considered and then reconsidered the decision to be told that one must complete a series of tests before being seen or setting a surgery date : medical tests, psychological tests and nutrition sessions. It seems like once the decision is made it should be full steam ahead, let’s get the surgery over with and on to the new life. The medical and nutrition education make sense and seem to be straight forward, maybe frustrating to schedule but doable.

It’s the psychological evaluation that often causes further angst. Patients often come to the psychological evaluation anxious and defensive. It is not unusual for someone who has struggled with obesity to experience some depression, anxiety or difficulty dealing with stress. Feelings of shame over obesity and the stigma that one suffers at the hands of others takes a toll over time. Many of us eat emotionally…not just an obese person. It is not uncommon for patients to feel at fault, that they have failed at this most important thing and to fear they will be told something is “mentally wrong” with them. Fears that all too common symptoms will lead to being denied often lead to the defensive posture that “everything is completely okay, no problems, no stress, no past conflicts, no emotional eating, no, no and no”

Just as hypertension often occurs with obesity, several psychological disorders or symptoms seem to be prevalent. No one would want their bariatric surgeon to perform surgery if their blood pressure was so out of control that they would have severe complications from the operation. The same should be true for psychological issues. It is not the presence of symptoms, whether depression, anxiety, etc; it is how these can be treated either before or after surgery.

The psychological evaluation is to help design an effective treatment plan to address emotional issues that would adversely affect outcome. Many people believe that after the surgery, their lifestyle automatically changes. They will be able to change eating habits because of the surgery or adverse consequences of eating certain foods. Along with the smaller or new stomach, one will no longer want certain foods, will have time to prepare and cook meals, will not eat due to being tired, lonely, anxious, or stressed. Intellectually, we all know this is not true but we operate on this principle.

Keep this point in mind: during the 12-18 months after surgery, the most significant weight loss is to occur. If you think of the surgery as the Olympics, the call to the surgeon is signing up for to be considered for the Olympic team. You would train well before the actual Olympic event. Consider how successful a skier would be if the first time they strapped on skis was on the chairlift going up to that double black diamond. The months between the first call to the surgeon and the operation are your training time. You practice the dietary changes, you plan for exercise or even begin exercising if possible, you address emotional eating patterns, you learn to track intake, give up carbonated beverages, practice the 30/30/30 rule. The list goes on. This period is the time to fail, to recognize where your weakness are. Maybe it’s dining out or eating watching TV or the siren song of a Sundrop. We know that there are different types of hunger: stomach, mouth, eye and head. The surgery will almost eliminate stomach hunger. What about the others? What is the plan? Practicing the plan before surgery is a key to success. If depression and/or anxiety would interfere with success, often a treatment plan can be implemented without a long delay before surgery.

Finally you are cleared for surgery, a date is set. What does one do once they are accepted to the final Olympic team? Do you stop training: go on a food farewell tour, stop tracking your intake, have one last soda, stop practicing all the skills until it’s time to enter the Olympic village? Surgery is an event, like an Olympic contest. But whether you end up at Disney World and on the cover of Wheaties depends much more on your training.

The psychological evaluation is not another hoop to get through before the promised changes. It can hopefully be an honest exchange comprised of education and exploration of what will be the strengths and challenges one will face on their journey. What skills can be added to make that journey a success. As disappointing as delays can be they likely add up to just a moment in your new life, take the time to prepare. It will be well worth getting that Gold Medal.



Me Too! The social media phenomena of women announcing that they too have been subjected to sexual harassment has taken the world by storm. Yes, the world. This is not hyperbole, women from Germany, Italy, the Arab countries even Nairobi have been posting Me Too! Not that anyone should be surprised that women all over the world are subjected to sexual harassment. This abuse extends way beyond celebrity casting or factory work. However, in addition to the global Me Too! response is something that is different. Men are responding. And men are responding positively: not with rationalizations or minimizations. With tweets of “I hear you! “or even “I was guilty!” Guilty of not standing up, of not saying something when they observed another man making a lewd comment, of shaming the victim who dared to say stoop. This is not just the celebrities rallying against Harvey Weinstein. Everyday men are saying “I understand.”
Women have long been united in trying to empower other women. In the marches, the protests or gatherings there is always a small percentage of men who will stand up for women’s rights. Is this a change to more global activism? We can only hope that men and women unite against all forms of abuse. The message needs to change. One recent article noted that we have depersonalized violence to being out there, as if the perpetrators are some alien force, not human. It’s domestic violence not significant others attacking their loved one What if we read, there was X number of men raping women or X number of teenage boys impregnating teenage girls. Can men join women in standing up to other men or calling expressing their own victimization without shame. Can we hope that someday it will not be Women’s empowerment but Human Empowerment? Well, we just might have taken a step. I look forward to the day it is not about men, women, or any other group. May the next blogger be able to comment “We treat all living being with respect”
Sexual harassment is abuse. Often the dynamics are the same as with more physical forms of sexual violence. The same power differential and the same intimidation. Unfortunately, it can lead to the same lasting PTSD difficulties as well as loss of employment, opportunity and potential. Disclosure can be as difficult as the harassment and lead to even further difficulties. Reading the stories of Me Too posts expose harassment for what it is… simply a longer word for abuse.



Whether you are contemplating weight loss surgery or are post-surgery, lifestyle changes are the key to optimize your outcome. Having the right team members with you on this journey will ensure a healthier you and make transitions smoother.
Research shows that individuals who remain in touch with their bariatric centers maintain weight loss and are in better health. Follow ups with your surgeon or Primary Care Provider (who is knowledgeable of post- surgery care) are essential over your life time.
Prior to surgery attendance at one or two nutritional seminars is the norm. The information provided invaluable but often overwhelming. Often your handouts end up loss in a drawer and you struggle with how to vary your diet over time or revert to some unhealthy habits. Learning all you need to know before you have surgery is almost impossible. It’s like reading a book on how to swing a golf club and actually hitting the ball straight onto the green. Consider a Bariatric Specialized Dietician to help over the course of weight loss and management as a valuable team member.
Your significant other and family are crucial members of your team. The more they understand your new normal, both changes in diet and exercise, the more support can be provided. Let family members know your needs, be firm that your health is a priority and what they can do concretely to assist.
Friends become team members only when they are included in your journey. Not all friends may remain on your team. Accept new members who support your lifestyle and cut those who are not able to make the transition with you.
A bariatric support group is another member to add. These groups are a resource to gather new ideas, compare experiences and learn about your new lifestyle.
If you are struggling with emotional hunger, depression or anxiety, counselors can provide a safe place to help learn new coping skills, examine new life goals and resolve any unfinished issues before you sabotage your success.
Most importantly is your bariatric surgery itself on your team? Is it your friend or rival? The framework you place your surgery helps determine future behaviors and motivations. If you treat your surgery as a team mate, one who assists you in keeping obesity in remission, who deserves attention and respect; the guidelines and rules are just part of the game. If you see your surgery as an obstacle, barrier to get around or beat, compliance and ultimately optimal results suffer. Make your surgery your MVP.
So, who is on your team? Add those individuals who will assist you on the way to new opportunities and success.



Bariatric surgery can help psychological and emotional problems.  There is well documented evidence of gains in positive self esteem, sense of taking control of one’s life, energy and vitality.   Anyone who has struggled with obesity is aware of its negative impact on the quality of life over time.  These include difficulties arise in social situations due to discrimination, shame and poor self confidence.  Depression, anxiety and even complete withdrawal from social circles are commonly reported.    Unfortunately losing weight doesn’t always translate into an immediate reversal of social anxiety nor of depression.

Some of the most common post bariatric surgery problems include:

  • A lingering perception of being obese even after losing weight and falling within normal BMI ranges. Years of convincing oneself that they do not look good does not go away in just a few months.
  • Relationships may be affected after weight loss surgery. Most individuals experience an increase in self-confidence.  Good relationships may become stronger while bad relationships may deteriorate further. As the person experiences greater self-confidence and enjoys their new body image, they may improve their sex life. This may strengthen an intimate bond with their significant other.  Those trapped in unhealthy relationships may find the strength to leave or push for changes.
  • Prior to weight loss surgery, individual may have eaten to help cope with negative emotions, to celebrate or just to enjoy the flavors of foods.   Foods high in fats and sugars are often “go to” foods for emotional eaters.  Post surgery, that will no longer be possible. As a result, some patients may feel deprived or resentful, particularly when cravings or hunger returns.  The journey to finding the right combination of foods that satisfy often can be eased by the assistance of a qualified bariatric dietitian
  • Some individuals, in not being able to cope with the change in diet, may develop other addictions to fill the void that food once did. There is an increased risk for abuse of alcohol that all bariatric patients should be aware of.
  • Extra skin after weight loss surgery can be upsetting or depressing. While this is a normal result of weight loss, it can also derail the patient’s journey.

While you will experience challenges after bariatric surgery, there are ways to cope with your changing lifestyle. First, family and friends are important in helping you lose the weight. When family and friends are part of your weight loss solution, you create an intimate group with whom you can brainstorm answers to your problems.

It is also important to attend support groups on a regular basis. You will learn about tips and tricks to lose weight, other people’s experiences and learn what others have done in your position. Support groups have been proven to be a very effective tool in losing weight and keeping the weight off as well as avoiding many psychological issues.

In the end every significant change can affect us. Undergoing bariatric surgery requires a great deal of dedication to your health and diet.  It also opens the door to opportunities for social connectedness,  new interests and passions.  Make sure to take advantage of all the resources and opportunities available to you.

 


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At Chrysalis, we believe that a supportive, healing environment is essential in order for change and growth to occur. We seek to offer such an environment to clients and help them create that in their lives and relationships. Read More

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