SuzanneRC

Bariatric patients should embrace both of these powerful tools to enjoy long term post surgery success, with food and lifestyle choices, that are faced with well into the future.



The Importance of Behavior Modification and the Role of Personal Accountability


As a bariatric patient care professional, I encourage the following mindset with patients from all surgery time frames and life situations:
Lifelong commitment to pursuing a healthier lifestyle,
Compliance to the recommendations of behavior modification, and
Addressing and grappling with the challenges that are life long

Self-awareness and personal accountability are two areas that are not so obvious when assessing one’s own role in the struggle with obesity. We are aware of genetics, family history, medical co-morbid conditions and life stress that impact each patient’s history of their own struggle with being obese. So how do patients obtain the necessary tools to support the physical presence of bariatric surgery? Through engaging in a solution to the past disappointments of weight loss efforts that are already so familiar.
Many patients report the path to insight and reflection often reveals mental justifications, old bargaining behaviors and frustrations that fuel negativity and inappropriate attachments to and uses of food. Although it is easy to lay blame for many things in life, self-deception only facilitates the repetitive cycle of anger and disappointment. In the professional arena, we often discuss the addictive quality of food and how food has a parallel function in the same manner that other behaviors do, i.e. shopping, drugs and alcohol, sex, gambling and the like. The need for emotional escape and mental distance can encourage us to use food as “anesthesia”, a way of shutting down and shutting out the world around us. We are careful to watch for those cross-addictive behaviors following bariatric surgery and recommend supportive resources across the board. These services provide a safe and secure way to investigate and discuss personal issues that are relevant and central to the patient’s path to success following surgery.
The role of a supportive aftercare program or community of patients, even individual therapy, is a vital component to future success and and be a valuable tool on the road to recovery, helping to smooth the transition and adaptation to new food related behaviors and lifestyle choices. The ability for patient’s to share a parallel experience and be able to “relate” to a certain stage of recovery, or a certain type of struggle with others, will provide an opportunity for engagement and bonding with others. On a therapeutic level, individual counseling can expand one’s degree of awareness and promote a greater sense of personal accountability, once the roots of old behaviors and attitudes have been identified and deciphered. A patient can then restructure their responses to daily challenges that may have been inadequate prior to surgery.
As patients walk the road of recovery from obesity, while engaging in physical as well as emotional healing, the element of discovery and pride is tangible and even contagious. Patients will enjoy improved health, greater energy and a strong positive attitude of self worth; what follows can be a heightened sense of calm, balance and overall peace of mind. Once personal discoveries have been made, individually or in a group setting, bariatric patients can feel a greater sense of control in planning the path in front of them. Commitment and compliance are two key elements that promote post surgery success. As patients employ newfound tools and wisdom on a consistent basis, quality of life can be infinitely better as well as profoundly rewarding.

While most of us knew all about the physical side of Weight Loss Surgery, many people have no idea about the emotional ride they're about to face. This article discusses all aspects of the "emotional roller coaster" from the moment you first decide on having bariatric surgery all the way up to the maintenance phase of your weight loss. It's a wild ride baby!


When was the last time you were on a roller coaster? If you’re like me, it’s been a while. In fact, the last time I was on a roller coaster I was 310 lbs and could barely fit into the seat. The restraint almost didn't go around my tummy. I was squeezed in like Cinderella’s step-sister’s foot must have tried to squeeze into that tiny shoe. Yep. I was Drizella’s foot and the coaster seat was the glass slipper. I’m sure it was a comical, if not sad and pathetic site, for those around me. It was embarrassing to me, to say the very least. But I laughed it off and went on, as I tended to do.
That roller coaster was a wild ride. It had huge climbs, steep drops, loop-de-loops, sharp turns, and at one point it feels like you’re lying on your side. Honestly, it’s a wonder I stayed in the coaster even with the restraint!! The end of the ride was abrupt - it felt like my insides were coming out of my mouth when it stopped short back at the beginning of the track. When it was over, I felt accomplished, in a way. I’d survived that coaster ride, wild and uncomfortable as it was.
Many people don’t realize that life before, during, and after weight loss surgery becomes a roller-coaster ride of it’s own. It has the huge climbs of elation and joy and excitement, the steep drops into anxiety and depression, and the loop-de-loops, sharp turns, and lying on your side moments of uncertainty, worry, and fear. Here are some of the emotional dealings that will occur before, during, and after surgery that you might not know.
1. Pre-Surgery Elation. This happens when you are finally approved for surgery. It’s going to be a reality! You are going to get a brand new lease on life! The period of life where you are having to go through diet after diet is finally coming to an end! You might tell everyone you know or you might decide to keep your secret to yourself. Regardless, you are excited and ready to go!
2. Pre-Surgery Blues. This is when you realize that you are going to have to say good-bye to one of your best friends ... Food. You come to the realization that there are some favorites that you are just not going to be able to eat anymore. Depression sets in slightly, and you might even go on a food bender - similar to what an addict might do. At this point you might even question your decision to go through surgery.
3. Day of Surgery. You’re going to be going through a myriad of emotions during this time. You’ll feel excitement, anxiety, apprehension, and impatience all at the same time. You’ll be worried because, after all, it is a major surgery you’re about to go through. But at the same time, you’ll be excited at what’s about to happen. When you wake up from anesthesia, you might be scared, especially if you’re having a rough transition out of anesthesia. You might be a little confused, wondering where you are. When your body settles down a bit and you remember where you are and what just happened, you might feel a little concerned. "Did everything go okay?" "Is this going to work?" "Did I just make the biggest mistake in my life?" On the other hand, you might wake up beautifully, singing the praises of your surgeon and his/her team, excited to begin your new life. These feelings and emotions will likely cycle throughout the day as you’re getting used to the idea of what just happened and your body relaxes and comes out of shock from surgery.
4. Going Home. When you’re finally released to go home, you’ll either be excited or scared. Thoughts might rush your brain like “will I be able to do this on my own?” and anxiety might set in again. You might, again, question your decision to undergo surgery, especially once the monotony of the liquid diet phases set in. The first few days might be easy, and the next might be excruciating. You’ll be in some discomfort because of incisions and if the surgeon inflated your abdomen with gas prior to surgery (commonly done in laparoscopic surgeries), and this might heighten your doubts and anxieties. You might begin to worry about issues such as leaks, slippage, or staples coming loose.
5.The first few months. You will be going through a mourning period at some point, and for some that occurs during the first few months after surgery. You no longer are able to lean on food for emotional support, so you might feel sad. You might even go through a type of “withdraw” from food, similar to what an addict might be going through their first few days in rehab. You’ll be able to eat more some days than others, and that will lead you to worry if your surgery is working or if there’s something wrong. Some days you’ll be jealous of watching everyone around you eat foods that you once loved. Others, you’ll be glad you can’t/don’t eat those things anymore. By the time you've finished all of your phases and are on to real food, you’ll be relieved and excited, and likely worried and anxious as well. Whereas before, you were relying on liquids for sustenance, now you’re on your own and have to rely on figuring your food choices out for yourself.
6. The losing phase. From the moment you leave the hospital until you reach your goal you are considered to be in the losing phase of surgery. For the purposes of this article, we’re going to call the losing phase the time period from month 3 (about the time you transition into full solids) to the point where you reach your goal. There will be many frustrations, joys, and concerns in the months ahead. Some days you’ll forget everything you were taught about nutrition and make yourself sick on something you shouldn't have eaten. Other days you’ll be 100% on track. You’ll have moments of pride and joy, and moments of shame and weakness. You’ll revel in finding out you can eat something as simple as asparagus and despair over not being able to eat rice pilaf. You’ll finally reach your “groove” point sometime during month four or five, and things begin to go well. You’ll reach a stall or two (or five ...) and wonder if you’re doing something wrong or if you've messed up your new tummy. You’ll marvel over losing 10 lbs in one week. You’ll wonder why you only lost 2 lbs the next week. When your loss starts to slow down, you’ll worry that you’re not exercising enough, that you’re eating too much or too little, or worry that your surgery is beginning to fail. You’ll relax more when you are consistently losing, even if it has gone down to 1-2 lbs a week.
7. The maintenance phase. When you reach your goal weight, you will have reached what is called “maintenance”. This is the final stage that you will likely be in for the rest of your life. Here, you will change your diet slightly in order to not lose or gain any more weight. You will get frustrated a time or two - especially the first time you gain a few pounds. You will marvel at what you've lost, but are concerned with the way your body looks now. You will have loose skin, which may cause body image issues. If you’re single, you might notice more possible suitors paying more attention to you. You might fall from one addiction (food) into another (sex). You might also be tempted into other addictive substances or habits such as alcohol, cigarettes, shopping, or pornography. Alternatively, you may look back at your loss, as meaningful and inspirational. You might revel in the way your life has changed and be happier than you have ever been and be ready to branch out and help others succeed in their bariatric surgery journeys.
Tips on Riding the Roller Coaster
Knowing that these emotions are possible doesn't mean they will happen for everyone, and doesn't mean you can’t get through them. The following tips will help you stay on the road to success and prevent you from falling off the wagon and into an abyss of self-doubt and depression:
1. Support. This is the number one most important thing for WLS patients. Even more important than food is support. Support can be found at home, through friends and family, in a hospital or surgery center support group, or even online forums such as Bariatric Pal.
2. Stick to the plan. As tempting as it might be to veer off and eat something you’re not supposed to, stick with your doctor or nutritionist’s eating plan as closely as possible. This will ensure that you continue to lose steadily, decrease the length and amount of stalls you’ll experience, and will speed up the healing process.
3. Vitamins. It sounds very cliche, but remember to take your vitamins! Focus on Iron and B Complex vitamins especially.A vitamin deficiency can result in depression, physical weakness, and poor sleep habits.
4. Speaking of sleep ... Make sure you’re getting plenty of it! At least 8 hours a day for an adult! Lack of sleep can lead to fatigue, weight gain, and (you guessed it!) depression!
5. Remember that “this too shall pass” ... These stages of emotional turmoil certainly won’t last forever. You’ll get over them as quickly as they overcame you. And keep in mind that each stage after surgery only lasts a short time in the grand scheme of things. Most eating phases last, at most, a month. After which you’re on to the next phase.
6. Keep a plan handy. Know that you will likely feel some unpleasant emotions or feelings and plan for them. Know what you’re going to do when you get upset, depressed, feel head hunger, or even feel physical pain from surgery. Have a list of friends to call at the drop of a hat, have a bottle of water ready to sip on at all times, or have your doctor’s phone number on speed dial. Know that these feelings will likely happen at some point in time, and be ready to deal with them when they do.
7. Remember that everything you’re going through is completely normal and OKAY. It’s important and helpful to know that everyone goes through a stall at some point. Everyone has pain during the first couple of weeks after surgery. Everyone eats something they shouldn't at some point. Whatever it is you’re going through - someone else has likely gone through it!
8. Finally, DON’T GIVE UP! Remember that this is a journey. As the old saying goes, “It’s a marathon, not a sprint.” There will be ups and downs on this wild roller-coaster ride. There will be twists and turns and loop-de-loops and there will be many moments when you feel like you’re laying over on your side. But, in the end, it will all be worth it. Your health, your life, and YOU ARE WORTH IT!!