Many people who struggle with morbid obesity find themselves virtually ”invisible”, feeling like or choosing to stay an anonymous person in the crowd as opposed to being an individual and standing out.

In our complex and busy lives, we all belong to a system of people, places and things that connect us to others who, in turn, impact our lives in a variety of ways. Many people who struggle with morbid obesity find themselves virtually ”invisible”, feeling like or choosing to stay an anonymous person in the crowd as opposed to being an individual and standing out. Conversely, many bariatric patients maintain busy and interactive lifestyles regardless of body size or physical impediments. Human nature is strange; we often cannot decide how we would like to be perceived by others. In the area of bariatric support services, we are often reminded that both the internal (your own) response to your comprehensive changes and the external (everyone else) response are both quite evident as a patient begins, and continues on, the journey of recovery from morbid obesity. Either way, bariatric surgery will somehow spotlight your changing physical and psychological selves due to a dramatic change in body appearance and personal presentation.

In attempting to assess how a pre-operative or new post-operative patient is filtering feedback from those around them, it is often helpful to ask a few pertinent questions to focus in on potentially difficult areas:

• Do you feel that people in your support system are fully aware of your needs as a pre-operative/new post-operative bariatric surgery patient? Have the people in your life system received adequate information/education regarding the basics of bariatric surgery and the importance of a supportive and behaviorally appropriate environment?
  
• Do you perceive friends or family members unable to relate to you/isolate from you due to the newness of bariatric surgery? Are support people feeling unsure as to how your relationship will be affected by your bariatric surgery in the future?
  
• Are there feelings of resentment or frustration apparent to you around old eating habits or the appearance of new ones?
  

As support service facilitators, we are keenly aware of the possibilities of external (outside) reactions to bariatric patients and how it may impact the internal (sense of self) reactions patients are experiencing at an already heightened rate. When a patient decides to undergo surgery, that decision can be an alarming, even threatening event, for people in their life system, be it family, friends, co-workers or intimate partners. A change in a relationship between two people may possibly shift the focus of eating behaviors from one to another, possibly putting the spotlight on someone else and their less than perfect lives. We all, to some degree, experience scrutiny around our behaviors but as we all know, body image and self-worth are very susceptible to criticisms from those in our life system.

Expectations of what bariatric surgery will change also affects the patients issues about their own acceptance in a mirror image sort of way. Patients often wonder:

• Will I be accepted by my old crowd of friends even though I may not eat the same way or for the same reasons after my surgery
  
• Will I be able to enjoy socializing, holidays and celebrations following bariatric surgery?
  
• What if my feelings towards some people in my life change and I decide to minimize certain relationships because they do not support my new style of life?
  

Most people want to be accepted for who they are in a holistic sense, not just what they look like. The adjustment needs for both patient and support persons are often the same: that the newness of the situation will pass and interaction between people will become less uncomfortable. Often, patients report having to reinforce the importance of certain relationships with others just as patients need to receive the

same “validation” from others. Patience, tolerance and acceptance are three areas that everyone could benefit from as patients and support people learn from each other that the most valuable teaching tool is life experience. Bariatric surgery begins a journey toward a healthier, improved quality of life the patient will pursue in their physical and emotional recovery from the devastating affects of morbid obesity.

Excellent article. Losing weight has so many ups and downs and a new set of problems around every corner. I feel one of the most important steps in successful weight loss is continued follow up with your surgeon, nutritionist and psychologist. So many try to do this on their own and fail to under stand why they fail. After all the did have WLS and why is it not working. I wish the medical community would stress the needed follow up for their patients. The emotional side of this journey is extremely hard and requires a lot of behavior modification. Relationships do change afte weight loss no matter how hard you try to keep them the same. I am a different person now after losing 112 lbs. I look at food differently and I chose not to place myself in situations with people that continue to not eat healthy. Now I can't a avoid my family or family events but I can always chose to bring healthy alternatives and show my family that Healthy Food does taste good. I think in the beginning I really believed that I would not change but I have and I really like me better now than I did before. I like my choice to live healthy, eat healthy and exercise. I feel very passionate about what an opportunity WLS has given me, it has given me my life back.

I would like to add to this, I wish the medical community not just our WLS surgeon but other doctors, understood that as a patient we cannot have NSAIDS, anything that is going to reduce or relieve inflammation in our bodies such as all cortisone shots due to the fact that we could develop ulcers. My surgeon said absolutely no on anything that could damage our knew stomachs. I have found that all relationsips change. My immediate family is supportive, my mom and sisters still don't get it, so I always take my own food and then they ask why and how my weightloss is going. For my mom she is all about the number of pounds I have lost, she is actually a downer unfortunately in her eyes I will never be pretty enough or thin enough, she even suggested that I start wearing face makeup with a blush!! Because she thinks that I look pale lol and in other words not pretty enough. I look at food differently and not place myself in situations where there is going to be bbq's or drinking. I can eat that stuff, but its that stuff that got me where I was before I had WLS.

Sorry I probably got alittle off topic