Connie Stapleton PhD

I was raised by an angry father and had intense anger at times when i was young. The best therapy was a long walk. I also think regular exercise and physical activities ( hiking, riding) are awesome.
I have always felt that the screaming, crying, punching pillows actually contributed to and activated the " fight" response so was not helpful to me.
I am not sure how it happened, but my anger is way reduced now. I feel much more peace which is such a blessing.

Folks.....Dr. Stapleton is a real treasure.
I had the supreme pleasure to have her perform my psych eval while on my path to my wls.
Sitting and chatting with her was a wonderful way to spend an hour. I only wish we had occasion to spend more time chatting. That hour with her helped me find myself.
Her pre-work videos struck home some ideals and tenets that have proven themselves to be truth.
@@Connie Stapleton PhD , I am very glad to see you here. You helped me in a big way. The wonderful people in this place have helped me on many days since.
Do your thing and help us find our way so we can do ours.

When I was a young teenager, I had serious anger issues. I never hurt anyone else but I often took my anger and frustration out on my own body in absolutely unhealthy ways (self-harm, binging, starving, staying awake for days, etc). The only thing that ever helped even a little to cope with those intense feelings of anger and frustration, mostly frustration at my life, my body, and my limitations, was to wear a rubber band around my wrist and snap it whenever I felt like doing or saying something harmful to myself. I found it also worked when I wanted to give someone else a good slap!
It's tough for people who have a hard time coping with intense amounts of these bad feelings. Just talking it out or taking deep breaths sometimes just doesn't cut it.
Great list!

Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.


Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.
I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored.
Not to me, they aren’t. And these will be addressed in this series.
In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…)
I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real.
Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series.
Alcohol Use After WLS
This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment.
Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders.
And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot.
Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA?
No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality.
Food Addiction
Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction.
“Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real.
Ask your patients. They believe food addiction is real.
So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives?
I’m frustrated.
Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS!
The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for?
Connie Stapleton, PhD
connie@conniestapletonphd.com
Facebook: Connie Stapleton
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD

“Why do we always talk about such ‘nice’ ways of dealing with anger? When I’m angry, I need to do something physical and not so nice!”


Get that Anger OUT!
In the group class I am currently leading, we have been talking about the importance of learning to identify feelings – the word that describes the feeling (mad, sad, glad, scared) AND where and how you feel it in your body (heaviness in your heart, tension in your jaw, tingling in your arms). We have also been discussing healthy ways to express and deal with feelings.
A woman who I’ve known and worked with in therapy for several years has been very quiet throughout the first nine weeks of class. To my surprise, as we were talking about some of the most noted healthy ways to deal with anger (breathe deeply, set aside time to talk to the person using fair fighting techniques, talking to a friend), from the back of the room, this woman, who I will refer to as Kathy, blurts out in a healthy vocal level: “Why do we always talk about such ‘nice’ ways of dealing with anger? When I’m angry, I need to do something physical and not so nice!” Being like Kathy myself in that I have a pretty intense anger response, I laughed and told her I completely understood where she was coming from. The class offered a few helpful suggestions for dealing with anger in physical ways. I promised her that I would create a list just for her delineating healthy physical ways to deal with anger.
Tonight, sitting at my favorite calming spot, the swing on my second-story deck that looks out into the sky and newly budding trees of the woods behind my house, I saw a dinosaur in the clouds. Its ribs were showing, it’s head rather distorted, and it’s tail very, very long. I thought of taking a picture for my grandkids, but my phone was upstairs charging and I didn’t want to move from my swing. Wish I had. I guess it was actually a dissipating jet stream, but I thought it was cool and remembered seeing some really cool cloud pictures recently online. I don’t know for sure what that has to do with anything, but all of a sudden I decided I needed to make Kathy’s list.
I did the very scientific thing and Googled, “Healthy ways to physically express anger,” “Physical expression of anger,” “Ways to work out your anger,” etc. I found ONE little article that had four lame little suggestions. Everything else focused on… yep, the standard things - breathe deeply, set aside time to talk to the person using fair fighting techniques, and talking to a friend.
Too passive for folks like Kathy and me who need to find a physical outlet when we are really ticked off and want to scream at someone. Of course, that option is just not okay (which I worked really hard to try to convince Kathy of)! Because I couldn’t find anything worthwhile on line, I sat down and to my own surprise, came up with this list in just minutes!
Enjoy it. Share it with your friends (and family)! And use it!!!!
Kathy’s List of Ways to Express Anger in a Physical Way that Won’t Harm Anyone
1. Scream – where no one can hear you.

a. Scream into your pillow.
b. Go into a closet, shut the door and scream.
c. Sit in your car with the windows up and scream.
d. Then get a cold glass of Water and cool down. 2. Do an ANGER dance!

a. Be like Goldie Hawn in Housesitter and have yourself a good old “expressive” dance! shake what your mama gave ya!
b. Jump up and down like you’re on a trampoline – and scream while you’re doing it!
c. Actually jump on a trampoline if you have one handy!
d. Then turn on a love song and have a good cry. 3. Exercise … yes, move your groove thing!

a. Walk or run – outside or inside on the treadmill.
b. Get a kickboxing DVD and kick some arse!
c. Do that strenuous type of yoga – you’ll get the energy out and relax yourself all at the same time!
d. Then lay on the cool floor and have a laughing fit, remembering it’s probably not so serious after all. 4. Find a dog…

a. Chase it in circles… big circles, small circles…
b. Play tug of war with it.
c. Have a growling contest with it.
d. Then, pet the little friend and you’ll feel much better! 5. Get one of those old toys that kids practice doing hair on…

a. Comb the mess out of it with all your might!
b. Pull that hair!
c. Tell the mannequin head all about your anger.
d. Then listen to what it says back to you… 6. Stand in front of the mirror…

a. Tell yourself what the matter is.
b. Use foul language.
c. Make horrible, mean, ugly faces at yourself.
d. Then laugh with yourself. 7. Have an imaginary conversation with the person or situation you’re mad at…

a. Exaggerate the details so they/it sound really horrible.
b. Tell them about how wonderful you.
c. Remind them how valuable you are to them.
d. Then find some rational thought and calm yourself down! 8. Go outside…

a. Pull some weeds.
b. Throw some twigs.
c. Stomp some dirt.
d. Then look at the clouds and find a fun shape. (Maybe that’s the connection to the dinosaur I saw in the sky.) 9. Make some angry art…

a. Watercolor a dark scene.
b. Draw out the situation you’re mad about.
c. Write an angry poem.
d. Then write yourself a love note. 10. Write the “THERAPEUTIC Letter!”

a. Spill it all out on paper! (Do NOT send this letter!)
b. Use red ink or red font color.
c. Use whatever language feels best.
d. Then thank the person or situation for the lessons you’ll eventually glean from this. Connie Stapleton, Ph.D.
www.connie@conniestapletonphd.com
FB: https://www.facebook.com/connie.stapleton.923
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD
YouTube: Connie Stapleton

“Why do we always talk about such ‘nice’ ways of dealing with anger? When I’m angry, I need to do something physical and not so nice!”


Get that Anger OUT!
In the group class I am currently leading, we have been talking about the importance of learning to identify feelings – the word that describes the feeling (mad, sad, glad, scared) AND where and how you feel it in your body (heaviness in your heart, tension in your jaw, tingling in your arms). We have also been discussing healthy ways to express and deal with feelings.
A woman who I’ve known and worked with in therapy for several years has been very quiet throughout the first nine weeks of class. To my surprise, as we were talking about some of the most noted healthy ways to deal with anger (breathe deeply, set aside time to talk to the person using fair fighting techniques, talking to a friend), from the back of the room, this woman, who I will refer to as Kathy, blurts out in a healthy vocal level: “Why do we always talk about such ‘nice’ ways of dealing with anger? When I’m angry, I need to do something physical and not so nice!” Being like Kathy myself in that I have a pretty intense anger response, I laughed and told her I completely understood where she was coming from. The class offered a few helpful suggestions for dealing with anger in physical ways. I promised her that I would create a list just for her delineating healthy physical ways to deal with anger.
Tonight, sitting at my favorite calming spot, the swing on my second-story deck that looks out into the sky and newly budding trees of the woods behind my house, I saw a dinosaur in the clouds. Its ribs were showing, it’s head rather distorted, and it’s tail very, very long. I thought of taking a picture for my grandkids, but my phone was upstairs charging and I didn’t want to move from my swing. Wish I had. I guess it was actually a dissipating jet stream, but I thought it was cool and remembered seeing some really cool cloud pictures recently online. I don’t know for sure what that has to do with anything, but all of a sudden I decided I needed to make Kathy’s list.
I did the very scientific thing and Googled, “Healthy ways to physically express anger,” “Physical expression of anger,” “Ways to work out your anger,” etc. I found ONE little article that had four lame little suggestions. Everything else focused on… yep, the standard things - breathe deeply, set aside time to talk to the person using fair fighting techniques, and talking to a friend.
Too passive for folks like Kathy and me who need to find a physical outlet when we are really ticked off and want to scream at someone. Of course, that option is just not okay (which I worked really hard to try to convince Kathy of)! Because I couldn’t find anything worthwhile on line, I sat down and to my own surprise, came up with this list in just minutes!
Enjoy it. Share it with your friends (and family)! And use it!!!!
Kathy’s List of Ways to Express Anger in a Physical Way that Won’t Harm Anyone
1. Scream – where no one can hear you.

a. Scream into your pillow.
b. Go into a closet, shut the door and scream.
c. Sit in your car with the windows up and scream.
d. Then get a cold glass of Water and cool down. 2. Do an ANGER dance!

a. Be like Goldie Hawn in Housesitter and have yourself a good old “expressive” dance! shake what your mama gave ya!
b. Jump up and down like you’re on a trampoline – and scream while you’re doing it!
c. Actually jump on a trampoline if you have one handy!
d. Then turn on a love song and have a good cry. 3. Exercise … yes, move your groove thing!

a. Walk or run – outside or inside on the treadmill.
b. Get a kickboxing DVD and kick some arse!
c. Do that strenuous type of yoga – you’ll get the energy out and relax yourself all at the same time!
d. Then lay on the cool floor and have a laughing fit, remembering it’s probably not so serious after all. 4. Find a dog…

a. Chase it in circles… big circles, small circles…
b. Play tug of war with it.
c. Have a growling contest with it.
d. Then, pet the little friend and you’ll feel much better! 5. Get one of those old toys that kids practice doing hair on…

a. Comb the mess out of it with all your might!
b. Pull that hair!
c. Tell the mannequin head all about your anger.
d. Then listen to what it says back to you… 6. Stand in front of the mirror…

a. Tell yourself what the matter is.
b. Use foul language.
c. Make horrible, mean, ugly faces at yourself.
d. Then laugh with yourself. 7. Have an imaginary conversation with the person or situation you’re mad at…

a. Exaggerate the details so they/it sound really horrible.
b. Tell them about how wonderful you.
c. Remind them how valuable you are to them.
d. Then find some rational thought and calm yourself down! 8. Go outside…

a. Pull some weeds.
b. Throw some twigs.
c. Stomp some dirt.
d. Then look at the clouds and find a fun shape. (Maybe that’s the connection to the dinosaur I saw in the sky.) 9. Make some angry art…

a. Watercolor a dark scene.
b. Draw out the situation you’re mad about.
c. Write an angry poem.
d. Then write yourself a love note. 10. Write the “THERAPEUTIC Letter!”

a. Spill it all out on paper! (Do NOT send this letter!)
b. Use red ink or red font color.
c. Use whatever language feels best.
d. Then thank the person or situation for the lessons you’ll eventually glean from this. Connie Stapleton, Ph.D.
www.connie@conniestapletonphd.com
FB: https://www.facebook.com/connie.stapleton.923
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD
YouTube: Connie Stapleton

“Why do we always talk about such ‘nice’ ways of dealing with anger? When I’m angry, I need to do something physical and not so nice!”


Get that Anger OUT!
In the group class I am currently leading, we have been talking about the importance of learning to identify feelings – the word that describes the feeling (mad, sad, glad, scared) AND where and how you feel it in your body (heaviness in your heart, tension in your jaw, tingling in your arms). We have also been discussing healthy ways to express and deal with feelings.
A woman who I’ve known and worked with in therapy for several years has been very quiet throughout the first nine weeks of class. To my surprise, as we were talking about some of the most noted healthy ways to deal with anger (breathe deeply, set aside time to talk to the person using fair fighting techniques, talking to a friend), from the back of the room, this woman, who I will refer to as Kathy, blurts out in a healthy vocal level: “Why do we always talk about such ‘nice’ ways of dealing with anger? When I’m angry, I need to do something physical and not so nice!” Being like Kathy myself in that I have a pretty intense anger response, I laughed and told her I completely understood where she was coming from. The class offered a few helpful suggestions for dealing with anger in physical ways. I promised her that I would create a list just for her delineating healthy physical ways to deal with anger.
Tonight, sitting at my favorite calming spot, the swing on my second-story deck that looks out into the sky and newly budding trees of the woods behind my house, I saw a dinosaur in the clouds. Its ribs were showing, it’s head rather distorted, and it’s tail very, very long. I thought of taking a picture for my grandkids, but my phone was upstairs charging and I didn’t want to move from my swing. Wish I had. I guess it was actually a dissipating jet stream, but I thought it was cool and remembered seeing some really cool cloud pictures recently online. I don’t know for sure what that has to do with anything, but all of a sudden I decided I needed to make Kathy’s list.
I did the very scientific thing and Googled, “Healthy ways to physically express anger,” “Physical expression of anger,” “Ways to work out your anger,” etc. I found ONE little article that had four lame little suggestions. Everything else focused on… yep, the standard things - breathe deeply, set aside time to talk to the person using fair fighting techniques, and talking to a friend.
Too passive for folks like Kathy and me who need to find a physical outlet when we are really ticked off and want to scream at someone. Of course, that option is just not okay (which I worked really hard to try to convince Kathy of)! Because I couldn’t find anything worthwhile on line, I sat down and to my own surprise, came up with this list in just minutes!
Enjoy it. Share it with your friends (and family)! And use it!!!!
Kathy’s List of Ways to Express Anger in a Physical Way that Won’t Harm Anyone
1. Scream – where no one can hear you.

a. Scream into your pillow.
b. Go into a closet, shut the door and scream.
c. Sit in your car with the windows up and scream.
d. Then get a cold glass of Water and cool down. 2. Do an ANGER dance!

a. Be like Goldie Hawn in Housesitter and have yourself a good old “expressive” dance! shake what your mama gave ya!
b. Jump up and down like you’re on a trampoline – and scream while you’re doing it!
c. Actually jump on a trampoline if you have one handy!
d. Then turn on a love song and have a good cry. 3. Exercise … yes, move your groove thing!

a. Walk or run – outside or inside on the treadmill.
b. Get a kickboxing DVD and kick some arse!
c. Do that strenuous type of yoga – you’ll get the energy out and relax yourself all at the same time!
d. Then lay on the cool floor and have a laughing fit, remembering it’s probably not so serious after all. 4. Find a dog…

a. Chase it in circles… big circles, small circles…
b. Play tug of war with it.
c. Have a growling contest with it.
d. Then, pet the little friend and you’ll feel much better! 5. Get one of those old toys that kids practice doing hair on…

a. Comb the mess out of it with all your might!
b. Pull that hair!
c. Tell the mannequin head all about your anger.
d. Then listen to what it says back to you… 6. Stand in front of the mirror…

a. Tell yourself what the matter is.
b. Use foul language.
c. Make horrible, mean, ugly faces at yourself.
d. Then laugh with yourself. 7. Have an imaginary conversation with the person or situation you’re mad at…

a. Exaggerate the details so they/it sound really horrible.
b. Tell them about how wonderful you.
c. Remind them how valuable you are to them.
d. Then find some rational thought and calm yourself down! 8. Go outside…

a. Pull some weeds.
b. Throw some twigs.
c. Stomp some dirt.
d. Then look at the clouds and find a fun shape. (Maybe that’s the connection to the dinosaur I saw in the sky.) 9. Make some angry art…

a. Watercolor a dark scene.
b. Draw out the situation you’re mad about.
c. Write an angry poem.
d. Then write yourself a love note. 10. Write the “THERAPEUTIC Letter!”

a. Spill it all out on paper! (Do NOT send this letter!)
b. Use red ink or red font color.
c. Use whatever language feels best.
d. Then thank the person or situation for the lessons you’ll eventually glean from this. Connie Stapleton, Ph.D.
www.connie@conniestapletonphd.com
FB: https://www.facebook.com/connie.stapleton.923
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD
YouTube: Connie Stapleton

“Why do we always talk about such ‘nice’ ways of dealing with anger? When I’m angry, I need to do something physical and not so nice!”


Get that Anger OUT!
In the group class I am currently leading, we have been talking about the importance of learning to identify feelings – the word that describes the feeling (mad, sad, glad, scared) AND where and how you feel it in your body (heaviness in your heart, tension in your jaw, tingling in your arms). We have also been discussing healthy ways to express and deal with feelings.
A woman who I’ve known and worked with in therapy for several years has been very quiet throughout the first nine weeks of class. To my surprise, as we were talking about some of the most noted healthy ways to deal with anger (breathe deeply, set aside time to talk to the person using fair fighting techniques, talking to a friend), from the back of the room, this woman, who I will refer to as Kathy, blurts out in a healthy vocal level: “Why do we always talk about such ‘nice’ ways of dealing with anger? When I’m angry, I need to do something physical and not so nice!” Being like Kathy myself in that I have a pretty intense anger response, I laughed and told her I completely understood where she was coming from. The class offered a few helpful suggestions for dealing with anger in physical ways. I promised her that I would create a list just for her delineating healthy physical ways to deal with anger.
Tonight, sitting at my favorite calming spot, the swing on my second-story deck that looks out into the sky and newly budding trees of the woods behind my house, I saw a dinosaur in the clouds. Its ribs were showing, it’s head rather distorted, and it’s tail very, very long. I thought of taking a picture for my grandkids, but my phone was upstairs charging and I didn’t want to move from my swing. Wish I had. I guess it was actually a dissipating jet stream, but I thought it was cool and remembered seeing some really cool cloud pictures recently online. I don’t know for sure what that has to do with anything, but all of a sudden I decided I needed to make Kathy’s list.
I did the very scientific thing and Googled, “Healthy ways to physically express anger,” “Physical expression of anger,” “Ways to work out your anger,” etc. I found ONE little article that had four lame little suggestions. Everything else focused on… yep, the standard things - breathe deeply, set aside time to talk to the person using fair fighting techniques, and talking to a friend.
Too passive for folks like Kathy and me who need to find a physical outlet when we are really ticked off and want to scream at someone. Of course, that option is just not okay (which I worked really hard to try to convince Kathy of)! Because I couldn’t find anything worthwhile on line, I sat down and to my own surprise, came up with this list in just minutes!
Enjoy it. Share it with your friends (and family)! And use it!!!!
Kathy’s List of Ways to Express Anger in a Physical Way that Won’t Harm Anyone
1. Scream – where no one can hear you.

a. Scream into your pillow.
b. Go into a closet, shut the door and scream.
c. Sit in your car with the windows up and scream.
d. Then get a cold glass of Water and cool down. 2. Do an ANGER dance!

a. Be like Goldie Hawn in Housesitter and have yourself a good old “expressive” dance! shake what your mama gave ya!
b. Jump up and down like you’re on a trampoline – and scream while you’re doing it!
c. Actually jump on a trampoline if you have one handy!
d. Then turn on a love song and have a good cry. 3. Exercise … yes, move your groove thing!

a. Walk or run – outside or inside on the treadmill.
b. Get a kickboxing DVD and kick some arse!
c. Do that strenuous type of yoga – you’ll get the energy out and relax yourself all at the same time!
d. Then lay on the cool floor and have a laughing fit, remembering it’s probably not so serious after all. 4. Find a dog…

a. Chase it in circles… big circles, small circles…
b. Play tug of war with it.
c. Have a growling contest with it.
d. Then, pet the little friend and you’ll feel much better! 5. Get one of those old toys that kids practice doing hair on…

a. Comb the mess out of it with all your might!
b. Pull that hair!
c. Tell the mannequin head all about your anger.
d. Then listen to what it says back to you… 6. Stand in front of the mirror…

a. Tell yourself what the matter is.
b. Use foul language.
c. Make horrible, mean, ugly faces at yourself.
d. Then laugh with yourself. 7. Have an imaginary conversation with the person or situation you’re mad at…

a. Exaggerate the details so they/it sound really horrible.
b. Tell them about how wonderful you.
c. Remind them how valuable you are to them.
d. Then find some rational thought and calm yourself down! 8. Go outside…

a. Pull some weeds.
b. Throw some twigs.
c. Stomp some dirt.
d. Then look at the clouds and find a fun shape. (Maybe that’s the connection to the dinosaur I saw in the sky.) 9. Make some angry art…

a. Watercolor a dark scene.
b. Draw out the situation you’re mad about.
c. Write an angry poem.
d. Then write yourself a love note. 10. Write the “THERAPEUTIC Letter!”

a. Spill it all out on paper! (Do NOT send this letter!)
b. Use red ink or red font color.
c. Use whatever language feels best.
d. Then thank the person or situation for the lessons you’ll eventually glean from this. Connie Stapleton, Ph.D.
www.connie@conniestapletonphd.com
FB: https://www.facebook.com/connie.stapleton.923
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD
YouTube: Connie Stapleton

Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.


Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.
I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored.
Not to me, they aren’t. And these will be addressed in this series.
In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…)
I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real.
Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series.
Alcohol Use After WLS
This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment.
Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders.
And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot.
Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA?
No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality.
Food Addiction
Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction.
“Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real.
Ask your patients. They believe food addiction is real.
So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives?
I’m frustrated.
Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS!
The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for?
Connie Stapleton, PhD
connie@conniestapletonphd.com
Facebook: Connie Stapleton
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD

@@Valentina I shared those beliefs until I met the surgeons at my bariatric practice. Never have I experienced the compassion, taking time to educate and encouraging realistic yet life changing results. They are tuned into the emotional issues - don't try to solve them, but do screen for them. Best of all, they believe in follow up. Lately they have been doing radio spots, which I normally detest from doctors, but the tone of theirs is awesome. It isn't just about recruiting new surgical patients, they speak about helping people get back on track in such a welcoming way.
I know my surgeons are a rare breed, but I feel like primary care docs lack training in obesity and really don't know enough about metabolic disorders to fill the role. I do agree there is often a gap, especially over the long haul.
I am 4 years out and haven't been seen by my bariatric team in quite awhile. I think I will go in this year because it gives me some peace of mind and because I have had a rough go of it Healthwise over the last 2 months. Bloodwork is good, but I wonder if something Is"up" or if I am just unlucky lately.
Sent from my KFJWI using the BariatricPal App

I’m writing this article as an invitation for each of you to help educate physicians about the issues you face related to weight loss surgery and what you believe is needed to enhance your care, either before or after weight loss surgery.


The American Society for Metabolic and Bariatric Surgery (ASMBS) emails each new edition of “connect,” their official news magazine to its members upon publication. In it, they provide a synopsis of recent articles of interest related to WLS. One noted article this week is titled, “What Matters: What’s the magic behind successful bariatric patients?” and is written by Dr. Jon O. Ebbert, an internist at mayo Clinic.
In the article, Dr. Ebbert states, “I was left wondering how I can best help my patients using this information.” Let’s help him help his patients!
I’ll share the short article, give my editorial (what I didn’t share with Dr. Ebbert) and then write the response I did share with him. Finally, I’ll provide the link where you, too, can share feedback directly about the article, or send it to me and I will be happy to forward it!
The article:
“MARCH 3, 2016
A fair number of my patients have had or are undergoing bariatric surgery. Disconcertingly, a not insignificant number of them are regaining the weight after surgery. Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.
When this occurs, not only do we have a patient with an altered gut putting them at risk for nutritional deficiencies if we are not fastidious in our follow-up, but they are discouraged and overweight again.
Add this to the concern that bariatric surgery has been associated with an increase in suicides (2.33-3.63 per 1000 patient-years), and we may have some cause for alarm.
So, what predicts success – and can we facilitate it?
Several factors have been shown to predict successful weight loss after bariatric surgery. An “active coping style” (that is, planning vs. denial) and adherence to follow-up after bariatric surgery have both been shown to be associated with a higher percentage of excess weight loss. Interestingly, psychological burden and motivation have not been associated with weight loss.
In a recent article, Lori Liebl, Ph.D., and her colleagues conducted a qualitative study of the experiences of adults who successfully maintained weight loss after bariatric surgery (J Clin Nurs. 2016 Feb 23. doi: 10.1111/jocn.13129). Success was defined as 50% or more of the excessive weight loss 24 months after bariatric surgery.
The voice of the successful bariatric patient is an interesting and important one. Several themes were identified:
1) taking life back (“I did it for myself”);
2) a new lease on life (“There are things I can do now that I am not exhausted”);
3) the importance of social support;
4) avoiding the negative (terminating unhealthy relationships in which “food is love”);
5) the void (food addiction and sense of loss);
6) fighting food demons;
7) finding the happy weight; and
8) a ripple effect (that is, if you don’t eat it, the rest of family doesn’t, either).
I was left wondering how I can best help my patients using this information.
First, I think the themes can mature our empathy for the struggles that these patients face, and perhaps help us combat bias. Second, I think this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure, such as social support.
Finally, I think the themes can be universalized and help us counsel patients who may be struggling with weight, but who are otherwise not candidates for bariatric surgery.”
My Editorial
I’m grateful that an internist is addressing the topic of WLS. I love that he is thinking about ways to use the information gleaned from the research he notes related to the behaviors of those who have “successful weight maintenance” following weight loss surgery.
Pardon my sarcasm, but, WOW! Getting information about the behaviors that led to weight loss from patients who have 50% or more of excessive weight loss 24 months after bariatric surgery? Does that really tell us anything? I’d venture to say that the majority of professionals in the field would note the surgery itself as being primarily responsible for the “success” of the weight loss at 24 months out. I’m NOT saying that many patients fail to put forth a great deal of effort at that point, because I know many do work very hard during those first 24 months. But come on… let’s talk to successful weight maintainers at 5 years after surgery to get a better indication of what they are doing to manage a healthy weight.
I’d also be curious to know at what point in time after surgery the statistic was obtained noting “Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.” How much weight regain? After how much time? If you look closely at research in many fields, you can find numbers that vary widely on a particular topic.
Dr. Ebbert states, “Psychological burden and motivation have not been associated with weight loss.” I wasn’t at all sure what this meant. Questioning my comprehension skills, I asked some other people how they interpreted that statement, and they couldn’t tell, either. If the implication is that psychological issues have no impact on weight loss or lack thereof, I have to disagree. But then, I have no research to back up my hypothesis. I do have 11 years working in this field and the anecdotal evidence of hundreds of patients that says otherwise. I’d say depression interferes with the desire/ability to follow through with certain behaviors that require significant energy. I’d say that intense shame interferes with the perceived efficacy to follow through for the long haul with behaviors necessary to sustain weight loss – well past two years of having WLS. I don’t know… I believe poor self-esteem, a history of “failing” with “diets,” unresolved grief, loss, and abuse issues sometimes affect a person’s perceived ability to succeed. I also believe treating these psychological issues in conjunction with treating one’s physiology and teaching important skills such as healthy coping mechanisms, positive self-talk, and efficacy-enhancing skills is a recipe for better outcomes.
My Response to Dr. Ebbert (in an attempt to be brief):
“Dr. Ebbert -
With all due respect, the medical field is, in my opinion, missing several very large pieces of the puzzle with the surgical weight loss population in terms of treating them. I am a licensed clinical psychologist. I work in a surgical weight loss clinic and have spoken with literally thousands of patients who have had weight loss surgery. Obesity is a complicated disease that is more than just physiological. I treat the underlying and associated psychological co-morbidities, which the medical community largely ignores, except under the broad category of "Behavior Modification." I assure you that there is a lot more than changing behaviors that needs to be addressed with this population. A vast majority of this population suffers with deep shame and low self-esteem, both rendering them inefficient at maintaining motivation to follow through on a long-term basis with "behavior modification." I am working tirelessly to try to address the elephants in the OR, but surgeons don't really want to listen to myself - or the patients - who are clamoring for additional mental health care (MORE than behavior modification) following WLS when their "issues" interfere with healthy behaviors - just like before surgery. More suicides? Maybe because in a sense, we take away the patients’ coping skill (food) and throw them to the wolves. I've created a video series that I require all of my patients to watch before surgery to help them understand the deeper issues they may face and to urge them to seek counseling. I could use help in the medical community. You in?”
I do believe, and I thank Dr. Ebbert for noting, “this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure.” Let’s all pitch in and share with Dr. Ebbert and other interested physicians what you need to be successful, on and off the scale, for years and years following WLS. Please share your comments at:
http://www.clinicalendocrinologynews.com/comments/what-matters-whats-the-magic-behind-successful-bariatric-patients/016f71fe2abdc0198ac42d75d039d712.html?comments_link=1
Or, post your comments here or contact me via my web page: www.conniestapletonphd.com
Let’s pitch in and help!
Connie Stapleton, Ph.D.

My own personal experience was that specific, ongoing and comprehensive education was a key success factor. When I was banded didn't get clear education on how to manage food and I was often hungry but would vomit too easily eating dense Protein...so I gravitated towards sliders. When I revised to sleeve I specifically sought out a program that had what I knew I missed and have been very successful and maintaining too. I was very motivated both times, and had very different outcomes.
I understand there are emotional, psychological issues at play too, but it it was a good procedure that initially limited my quantity capacity and hunger...and then the education over the long haul of how to keep"working the sleeve" were much more important in my case.
It seems hard to believe but one of the reasons I always failed at weight management was my all consuming drive to eat, my 24/7 hunger. Once that was reduced, it became much more possible to be compliant.

Thank you for sharing. I am not a physician but consider myself literate and pretty well educated, but I too had trouble following much of what he was trying to say (and I have read up on the study/studies? he seems to be relying on).
For instance "gaining the weight". Does he mean gaining weight? Gaining some weight? Gaining more weight?
I could go on...
Another big piece that is missing is how the medical community in general treats obese patients. There is a recent thread on BariatricPal that has some real horror stories. Unfortunately, they seem to be more common than not.
I agree that General Practitioners and other MDs need a great deal of education about obesity, weight loss surgery, and post-surgery care, however far after surgery.
You are spot on when you note that too many post-op patients are thrown to the wolves post-op when it comes to mental health issues.
I will definitely have to think about this to see what additional response I could provide.

I’m writing this article as an invitation for each of you to help educate physicians about the issues you face related to weight loss surgery and what you believe is needed to enhance your care, either before or after weight loss surgery.


The American Society for Metabolic and Bariatric Surgery (ASMBS) emails each new edition of “connect,” their official news magazine to its members upon publication. In it, they provide a synopsis of recent articles of interest related to WLS. One noted article this week is titled, “What Matters: What’s the magic behind successful bariatric patients?” and is written by Dr. Jon O. Ebbert, an internist at mayo Clinic.
In the article, Dr. Ebbert states, “I was left wondering how I can best help my patients using this information.” Let’s help him help his patients!
I’ll share the short article, give my editorial (what I didn’t share with Dr. Ebbert) and then write the response I did share with him. Finally, I’ll provide the link where you, too, can share feedback directly about the article, or send it to me and I will be happy to forward it!
The article:
“MARCH 3, 2016
A fair number of my patients have had or are undergoing bariatric surgery. Disconcertingly, a not insignificant number of them are regaining the weight after surgery. Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.
When this occurs, not only do we have a patient with an altered gut putting them at risk for nutritional deficiencies if we are not fastidious in our follow-up, but they are discouraged and overweight again.
Add this to the concern that bariatric surgery has been associated with an increase in suicides (2.33-3.63 per 1000 patient-years), and we may have some cause for alarm.
So, what predicts success – and can we facilitate it?
Several factors have been shown to predict successful weight loss after bariatric surgery. An “active coping style” (that is, planning vs. denial) and adherence to follow-up after bariatric surgery have both been shown to be associated with a higher percentage of excess weight loss. Interestingly, psychological burden and motivation have not been associated with weight loss.
In a recent article, Lori Liebl, Ph.D., and her colleagues conducted a qualitative study of the experiences of adults who successfully maintained weight loss after bariatric surgery (J Clin Nurs. 2016 Feb 23. doi: 10.1111/jocn.13129). Success was defined as 50% or more of the excessive weight loss 24 months after bariatric surgery.
The voice of the successful bariatric patient is an interesting and important one. Several themes were identified:
1) taking life back (“I did it for myself”);
2) a new lease on life (“There are things I can do now that I am not exhausted”);
3) the importance of social support;
4) avoiding the negative (terminating unhealthy relationships in which “food is love”);
5) the void (food addiction and sense of loss);
6) fighting food demons;
7) finding the happy weight; and
8) a ripple effect (that is, if you don’t eat it, the rest of family doesn’t, either).
I was left wondering how I can best help my patients using this information.
First, I think the themes can mature our empathy for the struggles that these patients face, and perhaps help us combat bias. Second, I think this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure, such as social support.
Finally, I think the themes can be universalized and help us counsel patients who may be struggling with weight, but who are otherwise not candidates for bariatric surgery.”
My Editorial
I’m grateful that an internist is addressing the topic of WLS. I love that he is thinking about ways to use the information gleaned from the research he notes related to the behaviors of those who have “successful weight maintenance” following weight loss surgery.
Pardon my sarcasm, but, WOW! Getting information about the behaviors that led to weight loss from patients who have 50% or more of excessive weight loss 24 months after bariatric surgery? Does that really tell us anything? I’d venture to say that the majority of professionals in the field would note the surgery itself as being primarily responsible for the “success” of the weight loss at 24 months out. I’m NOT saying that many patients fail to put forth a great deal of effort at that point, because I know many do work very hard during those first 24 months. But come on… let’s talk to successful weight maintainers at 5 years after surgery to get a better indication of what they are doing to manage a healthy weight.
I’d also be curious to know at what point in time after surgery the statistic was obtained noting “Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.” How much weight regain? After how much time? If you look closely at research in many fields, you can find numbers that vary widely on a particular topic.
Dr. Ebbert states, “Psychological burden and motivation have not been associated with weight loss.” I wasn’t at all sure what this meant. Questioning my comprehension skills, I asked some other people how they interpreted that statement, and they couldn’t tell, either. If the implication is that psychological issues have no impact on weight loss or lack thereof, I have to disagree. But then, I have no research to back up my hypothesis. I do have 11 years working in this field and the anecdotal evidence of hundreds of patients that says otherwise. I’d say depression interferes with the desire/ability to follow through with certain behaviors that require significant energy. I’d say that intense shame interferes with the perceived efficacy to follow through for the long haul with behaviors necessary to sustain weight loss – well past two years of having WLS. I don’t know… I believe poor self-esteem, a history of “failing” with “diets,” unresolved grief, loss, and abuse issues sometimes affect a person’s perceived ability to succeed. I also believe treating these psychological issues in conjunction with treating one’s physiology and teaching important skills such as healthy coping mechanisms, positive self-talk, and efficacy-enhancing skills is a recipe for better outcomes.
My Response to Dr. Ebbert (in an attempt to be brief):
“Dr. Ebbert -
With all due respect, the medical field is, in my opinion, missing several very large pieces of the puzzle with the surgical weight loss population in terms of treating them. I am a licensed clinical psychologist. I work in a surgical weight loss clinic and have spoken with literally thousands of patients who have had weight loss surgery. Obesity is a complicated disease that is more than just physiological. I treat the underlying and associated psychological co-morbidities, which the medical community largely ignores, except under the broad category of "Behavior Modification." I assure you that there is a lot more than changing behaviors that needs to be addressed with this population. A vast majority of this population suffers with deep shame and low self-esteem, both rendering them inefficient at maintaining motivation to follow through on a long-term basis with "behavior modification." I am working tirelessly to try to address the elephants in the OR, but surgeons don't really want to listen to myself - or the patients - who are clamoring for additional mental health care (MORE than behavior modification) following WLS when their "issues" interfere with healthy behaviors - just like before surgery. More suicides? Maybe because in a sense, we take away the patients’ coping skill (food) and throw them to the wolves. I've created a video series that I require all of my patients to watch before surgery to help them understand the deeper issues they may face and to urge them to seek counseling. I could use help in the medical community. You in?”
I do believe, and I thank Dr. Ebbert for noting, “this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure.” Let’s all pitch in and share with Dr. Ebbert and other interested physicians what you need to be successful, on and off the scale, for years and years following WLS. Please share your comments at:
http://www.clinicalendocrinologynews.com/comments/what-matters-whats-the-magic-behind-successful-bariatric-patients/016f71fe2abdc0198ac42d75d039d712.html?comments_link=1
Or, post your comments here or contact me via my web page: www.conniestapletonphd.com
Let’s pitch in and help!
Connie Stapleton, Ph.D.

I’m writing this article as an invitation for each of you to help educate physicians about the issues you face related to weight loss surgery and what you believe is needed to enhance your care, either before or after weight loss surgery.


The American Society for Metabolic and Bariatric Surgery (ASMBS) emails each new edition of “connect,” their official news magazine to its members upon publication. In it, they provide a synopsis of recent articles of interest related to WLS. One noted article this week is titled, “What Matters: What’s the magic behind successful bariatric patients?” and is written by Dr. Jon O. Ebbert, an internist at mayo Clinic.
In the article, Dr. Ebbert states, “I was left wondering how I can best help my patients using this information.” Let’s help him help his patients!
I’ll share the short article, give my editorial (what I didn’t share with Dr. Ebbert) and then write the response I did share with him. Finally, I’ll provide the link where you, too, can share feedback directly about the article, or send it to me and I will be happy to forward it!
The article:
“MARCH 3, 2016
A fair number of my patients have had or are undergoing bariatric surgery. Disconcertingly, a not insignificant number of them are regaining the weight after surgery. Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.
When this occurs, not only do we have a patient with an altered gut putting them at risk for nutritional deficiencies if we are not fastidious in our follow-up, but they are discouraged and overweight again.
Add this to the concern that bariatric surgery has been associated with an increase in suicides (2.33-3.63 per 1000 patient-years), and we may have some cause for alarm.
So, what predicts success – and can we facilitate it?
Several factors have been shown to predict successful weight loss after bariatric surgery. An “active coping style” (that is, planning vs. denial) and adherence to follow-up after bariatric surgery have both been shown to be associated with a higher percentage of excess weight loss. Interestingly, psychological burden and motivation have not been associated with weight loss.
In a recent article, Lori Liebl, Ph.D., and her colleagues conducted a qualitative study of the experiences of adults who successfully maintained weight loss after bariatric surgery (J Clin Nurs. 2016 Feb 23. doi: 10.1111/jocn.13129). Success was defined as 50% or more of the excessive weight loss 24 months after bariatric surgery.
The voice of the successful bariatric patient is an interesting and important one. Several themes were identified:
1) taking life back (“I did it for myself”);
2) a new lease on life (“There are things I can do now that I am not exhausted”);
3) the importance of social support;
4) avoiding the negative (terminating unhealthy relationships in which “food is love”);
5) the void (food addiction and sense of loss);
6) fighting food demons;
7) finding the happy weight; and
8) a ripple effect (that is, if you don’t eat it, the rest of family doesn’t, either).
I was left wondering how I can best help my patients using this information.
First, I think the themes can mature our empathy for the struggles that these patients face, and perhaps help us combat bias. Second, I think this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure, such as social support.
Finally, I think the themes can be universalized and help us counsel patients who may be struggling with weight, but who are otherwise not candidates for bariatric surgery.”
My Editorial
I’m grateful that an internist is addressing the topic of WLS. I love that he is thinking about ways to use the information gleaned from the research he notes related to the behaviors of those who have “successful weight maintenance” following weight loss surgery.
Pardon my sarcasm, but, WOW! Getting information about the behaviors that led to weight loss from patients who have 50% or more of excessive weight loss 24 months after bariatric surgery? Does that really tell us anything? I’d venture to say that the majority of professionals in the field would note the surgery itself as being primarily responsible for the “success” of the weight loss at 24 months out. I’m NOT saying that many patients fail to put forth a great deal of effort at that point, because I know many do work very hard during those first 24 months. But come on… let’s talk to successful weight maintainers at 5 years after surgery to get a better indication of what they are doing to manage a healthy weight.
I’d also be curious to know at what point in time after surgery the statistic was obtained noting “Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.” How much weight regain? After how much time? If you look closely at research in many fields, you can find numbers that vary widely on a particular topic.
Dr. Ebbert states, “Psychological burden and motivation have not been associated with weight loss.” I wasn’t at all sure what this meant. Questioning my comprehension skills, I asked some other people how they interpreted that statement, and they couldn’t tell, either. If the implication is that psychological issues have no impact on weight loss or lack thereof, I have to disagree. But then, I have no research to back up my hypothesis. I do have 11 years working in this field and the anecdotal evidence of hundreds of patients that says otherwise. I’d say depression interferes with the desire/ability to follow through with certain behaviors that require significant energy. I’d say that intense shame interferes with the perceived efficacy to follow through for the long haul with behaviors necessary to sustain weight loss – well past two years of having WLS. I don’t know… I believe poor self-esteem, a history of “failing” with “diets,” unresolved grief, loss, and abuse issues sometimes affect a person’s perceived ability to succeed. I also believe treating these psychological issues in conjunction with treating one’s physiology and teaching important skills such as healthy coping mechanisms, positive self-talk, and efficacy-enhancing skills is a recipe for better outcomes.
My Response to Dr. Ebbert (in an attempt to be brief):
“Dr. Ebbert -
With all due respect, the medical field is, in my opinion, missing several very large pieces of the puzzle with the surgical weight loss population in terms of treating them. I am a licensed clinical psychologist. I work in a surgical weight loss clinic and have spoken with literally thousands of patients who have had weight loss surgery. Obesity is a complicated disease that is more than just physiological. I treat the underlying and associated psychological co-morbidities, which the medical community largely ignores, except under the broad category of "Behavior Modification." I assure you that there is a lot more than changing behaviors that needs to be addressed with this population. A vast majority of this population suffers with deep shame and low self-esteem, both rendering them inefficient at maintaining motivation to follow through on a long-term basis with "behavior modification." I am working tirelessly to try to address the elephants in the OR, but surgeons don't really want to listen to myself - or the patients - who are clamoring for additional mental health care (MORE than behavior modification) following WLS when their "issues" interfere with healthy behaviors - just like before surgery. More suicides? Maybe because in a sense, we take away the patients’ coping skill (food) and throw them to the wolves. I've created a video series that I require all of my patients to watch before surgery to help them understand the deeper issues they may face and to urge them to seek counseling. I could use help in the medical community. You in?”
I do believe, and I thank Dr. Ebbert for noting, “this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure.” Let’s all pitch in and share with Dr. Ebbert and other interested physicians what you need to be successful, on and off the scale, for years and years following WLS. Please share your comments at:
http://www.clinicalendocrinologynews.com/comments/what-matters-whats-the-magic-behind-successful-bariatric-patients/016f71fe2abdc0198ac42d75d039d712.html?comments_link=1
Or, post your comments here or contact me via my web page: www.conniestapletonphd.com
Let’s pitch in and help!
Connie Stapleton, Ph.D.

Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.


Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.
I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored.
Not to me, they aren’t. And these will be addressed in this series.
In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…)
I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real.
Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series.
Alcohol Use After WLS
This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment.
Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders.
And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot.
Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA?
No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality.
Food Addiction
Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction.
“Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real.
Ask your patients. They believe food addiction is real.
So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives?
I’m frustrated.
Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS!
The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for?
Connie Stapleton, PhD
connie@conniestapletonphd.com
Facebook: Connie Stapleton
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD

I am very aware of these types of difficulties. I personally know of a woman (work colleague ) who went off the rails post bypass weight loss. She died in her sleep of organ failure in her early 40s. I was scared I would die too so I inquiries further to find she was type 1 diabetic and had become not a problem drinker but an alcoholic....a lethal combination. I almost didn't go ahead with WLS because of this. I am glad I didn't imagine this needed to be everyone's fate.
I have a friend going g through separation and divorce. She got even skinnier, smoked way more and started drinking booze instead of eating. It happens to non WLS patients too. She is back on track now.
Big life stressor can cause outrageous behavior - but it is the minority and help can be found. I just hope people don't avoid life saving surgery on the chance they might be the one that suffers an addiction transference.
Sent from my SAMSUNG-SGH-I337 using the BariatricPal App

Great article.
I do agree that we still have a lot to learn about obesity, food addiction, etc.
I do disagree that we can't learn more without quantitative evidence based studies. There should be lots of studies that can be done qualitatively using social science methodologies.
Think of the research that Brene Brown has done around shame. These aren't "medical studies" but do seek to answer questions nonetheless.
I look forward to reading more.

Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.


Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.
I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored.
Not to me, they aren’t. And these will be addressed in this series.
In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…)
I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real.
Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series.
Alcohol Use After WLS
This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment.
Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders.
And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot.
Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA?
No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality.
Food Addiction
Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction.
“Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real.
Ask your patients. They believe food addiction is real.
So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives?
I’m frustrated.
Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS!
The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for?
Connie Stapleton, PhD
connie@conniestapletonphd.com
Facebook: Connie Stapleton
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD

Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.


Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.
I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored.
Not to me, they aren’t. And these will be addressed in this series.
In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…)
I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real.
Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series.
Alcohol Use After WLS
This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment.
Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders.
And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot.
Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA?
No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality.
Food Addiction
Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction.
“Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real.
Ask your patients. They believe food addiction is real.
So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives?
I’m frustrated.
Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS!
The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for?
Connie Stapleton, PhD
connie@conniestapletonphd.com
Facebook: Connie Stapleton
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD

Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.


Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.
I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored.
Not to me, they aren’t. And these will be addressed in this series.
In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…)
I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real.
Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series.
Alcohol Use After WLS
This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment.
Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders.
And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot.
Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA?
No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality.
Food Addiction
Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction.
“Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real.
Ask your patients. They believe food addiction is real.
So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives?
I’m frustrated.
Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS!
The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for?
Connie Stapleton, PhD
connie@conniestapletonphd.com
Facebook: Connie Stapleton
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD

Wonderful! I've reread it several times and it becomes more relevant each time.

Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.


Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.
I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored.
Not to me, they aren’t. And these will be addressed in this series.
In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…)
I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real.
Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series.
Alcohol Use After WLS
This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment.
Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders.
And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot.
Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA?
No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality.
Food Addiction
Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction.
“Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real.
Ask your patients. They believe food addiction is real.
So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives?
I’m frustrated.
Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS!
The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for?
Connie Stapleton, PhD
connie@conniestapletonphd.com
Facebook: Connie Stapleton
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD

Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.


Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.
I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored.
Not to me, they aren’t. And these will be addressed in this series.
In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…)
I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real.
Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series.
Alcohol Use After WLS
This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment.
Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders.
And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot.
Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA?
No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality.
Food Addiction
Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction.
“Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real.
Ask your patients. They believe food addiction is real.
So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives?
I’m frustrated.
Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS!
The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for?
Connie Stapleton, PhD
connie@conniestapletonphd.com
Facebook: Connie Stapleton
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD

Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.


Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.
I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored.
Not to me, they aren’t. And these will be addressed in this series.
In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…)
I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real.
Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series.
Alcohol Use After WLS
This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment.
Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders.
And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot.
Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA?
No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality.
Food Addiction
Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction.
“Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real.
Ask your patients. They believe food addiction is real.
So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives?
I’m frustrated.
Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS!
The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for?
Connie Stapleton, PhD
connie@conniestapletonphd.com
Facebook: Connie Stapleton
Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD