Being obese in America is hard-even traumatic. We are discriminated against for being "fat, lazy slobs" and expected to be "jolly" all the time. We are treated rudely by store clerks, doctors, flight attendants, etc and considered to have no will power and to eat all the wrong foods and know nothing about nutrition. We learn to have guilt and feel shame about ourselves, our appearance, our eating habits, our sexual needs, etc. We even start discriminating against ourselves with the same mores of our culture.

My experience as an obese person for 45 years and a Licensed Professional Counselor for over 20 years has led me to some conclusions about our therapy needs while undergoing a lifestyle change as is possible with the sleeve. I do not think we need the services of a bariactric specialist who specializes in bulumia or anorexia. Most of us have considerable knowledge of nutrition and don't need another diet plan or to be told what foods we should eat.

Therapy needs to be centered around the traumas( yes, I mean TRAUMAS) that we have suffered through being discriminated against, ridiculed and ignored and the guilt and shame we feel about our eating, our size, our value to society, the way we have learned to hide what we eat, and the way we connect food with love and nuturance. We need to learn to accept ourselves for who we are and how we got here. Work can be done on reframing the importance that food has on our happiness and in our lives. We need to be able to "eat to live" rather than "live to eat". Food does not need to consume every waking moment in our lives; we should have other interests and activities than always planning our next meal or snack or eating.

For these reasons, I suggest that people find a counselor who specializes in DBT or EMDR. We need to reprogram our thinking and emotions as they relate to food and as they relate to shame, guilt, embarrassment, intimacy and love. That therapy will allow us to strive with the tool of the sleeve. Hope these words have helped. Feel free to PM me if you have futher questions that you do not feel comfortable posting here.:thumbup1:

Edited November 15, 200916 yr by Norma

WildIris,

How you will respond to weight loss is going to be result of how you have learned to relate to food and what not having that same relationship with food/mealtime/ textures and comfort food available to you for the first 6 months or so like it was. If food and meal planning were very time consuming for you prior to surgery and you are no longer hungry (like my experience) you will have to seek out other ways to occupy your time. My fat friends found my quick weightloss and lack of being able to/interest in food threatening. I had some resistance from them of being supportive or including me in things that was surprising. I had to deal with mealtime not having the same appeal to me and my own judgements that people were eating way too much or all the wrong foods. I had to adjust my thinking regarding going out to eat as I didn't like paying for so much food and don't like leftovers so unless someone was along with whom I could share a serving, I considered eating out too expensive and wasteful.

I have lost 92 lbs in 6 months and have never really started regular exercise as I have had knee replacement surgery, a death in the family and kidney stone surgery in that time frame. I have a therapist that I see about every 3 or 4 weeks--we have discussed how people relate to me differently now that I have lost weight, my adjustment to the lessening of importance of food, the overall improvement of my health. The only time that my history of depression returned was right after the knee replacement surgery when I was having trouble with pain management and unable to work for 8 weeks.

So, all of this to say that I think it is a good idea for you to contact your therapist prior to surgery to check in and evaluate what might be your trouble spots on the journey and be mindful after surgery that meds might need to be adjusted for your smaller body size. I believe that you will be able to manage your bipolar issues well if you watch for your trigger signs.

Hi Norma, I'm glad you were able to respond and I'm amazed at how much weight you have lost already! So sorry you have had some bumps in the road but your experiences and advice I find to be helpful. I wish you good health and much happiness. Lis

WildIris,

How you will respond to weight loss is going to be result of how you have learned to relate to food and what not having that same relationship with food/mealtime/ textures and comfort food available to you for the first 6 months or so like it was. If food and meal planning were very time consuming for you prior to surgery and you are no longer hungry (like my experience) you will have to seek out other ways to occupy your time. My fat friends found my quick weightloss and lack of being able to/interest in food threatening. I had some resistance from them of being supportive or including me in things that was surprising. I had to deal with mealtime not having the same appeal to me and my own judgements that people were eating way too much or all the wrong foods. I had to adjust my thinking regarding going out to eat as I didn't like paying for so much food and don't like leftovers so unless someone was along with whom I could share a serving, I considered eating out too expensive and wasteful.

I have lost 92 lbs in 6 months and have never really started regular exercise as I have had knee replacement surgery, a death in the family and kidney stone surgery in that time frame. I have a therapist that I see about every 3 or 4 weeks--we have discussed how people relate to me differently now that I have lost weight, my adjustment to the lessening of importance of food, the overall improvement of my health. The only time that my history of depression returned was right after the knee replacement surgery when I was having trouble with pain management and unable to work for 8 weeks.

So, all of this to say that I think it is a good idea for you to contact your therapist prior to surgery to check in and evaluate what might be your trouble spots on the journey and be mindful after surgery that meds might need to be adjusted for your smaller body size. I believe that you will be able to manage your bipolar issues well if you watch for your trigger signs.

People are obese for different reasons. I think the biggest reason is sedentary lifestyle, car culture, and American food culture. Then there a subset of people who have been sexually abused, traumatized by other people's reactions to obesity, traumatized sexually or emotionally. The mental health community seems obsessed with the idea that all overweight people have been abused, are emotional eaters, or are re-enacting some form of trauma on themselves. There are people like that, and I have sympathy for them as they have double the work to do to get healthy. But I get so tired of the questions from mental health professionals in that direction. I got fat the old fashioned way: I was raised in American food culture, and put on weight until I became insulin resistant and couldn't get it off. I don't hate myself. I don't absorb other people's contempt for fat people. I'm generally optimistic. I don't have eating disorders. In fact, what I probably need is a therapy for dealing with therapists.

What I need is support for the changes in lifestyle habits, making new habit patterns, getting things done--practical stuff. Just a little support on making the transition from bad eating habits to good eating habits. I wish I could find a therapist who understood that.

I wish I could find a therapist that truly knew more than I do. At the end of the day I have spent lots of money only to watch someone nod their head and tell me what I already know!

Well, it's post-surgery three weeks for me today. So far I haven't had any serious issues with emotional stuff, except being really, really cranky a couple of days, mainly just from fatigue. Any 'down' time is cured by taking a bit of a break and enjoying a few quiet minutes with a glass of ice Water. But, I keep worrying that I've hit a plateau with weight-loss. I know it's kind of ridiculous; I AM only three weeks post-op. But, how often is worrying logical, anyhow?

Anyway, one thing I did do was go talk to my primary care doc, and arranged to have him prescribe all my psychiatric medications, because at this point it's just maintenance, no fiddling with the dose, and I don't see the point in spending more on my co-pay to see my psychiatrist 3 or 4 times a year for a grand total of 15 minutes per visit.

Also, I am on a different sleep medication that's working great! It's actually a tricyclic antidepressant called doxepin (generic name), and not only is it dirt-cheap, there's no eternal hassle with my insurance company over refilling it only after such-and-such a date. No prior authorizations. No nothing, except getting the prescription to my mail-order pharmacy. I love it!!! The three-month co-pay is one-tenth for this medication versus what it is for Lunesta. Less stress, same quality of sleep, and I'm good. I've found over the last five years that if I just get my rest, things go really well for me.

Maybe I just need to lie down for awhile and my feelings of anxiety about the pause in weight loss will simply ... go away.

Mental health is how we think, feel and act as we cope with life. It also helps determine how we handle stress, relate to others and make choices. Like physical health, mental health is important at every stage of life, from childhood and adolescence through adulthood.

What I need is support for the changes in lifestyle habits, making new habit patterns, getting things done--practical stuff. Just a little support on making the transition from bad eating habits to good eating habits. I wish I could find a therapist who understood that.

Donna, sounds like you need a nutritionist.

I love this thread. Thanks Norma and everyone else.

I think it is true that not everyone who is obese is that way because they over eat. The convenience of addictive/junk/fast food at every corner and sedentary workplaces absolutely contribute to the problem. In my case however' date=' I have been an excessive or over eater since I can remember. I ate more than the average person or more than I needed. My stomach always felt stretched and as time went on (by about age 14 my body caught up and I got fat. Being heavy caused me to slow down. After coming home from school, left to my own devises-- both parents at work, I would pull out a loaf of soft fake white bread and slather on the Peanut Butter and jelly and eat one sandwich after another until I tired of the taste. After that I'd be so lethargic I'd take a nap. Then dinner with family then whatever I felt like eating....this for me was not normal and I knew it but hadn't the self control. As I got older I became educated hence I made healthier food choices but I still ate too much. I am definitely a compulsive over-eater so having this surgery is only part of my cure. Since sleeved 6 months ago, my appetite has grown and though I am not able to eat as I used to, I'm seeing my obsession with food as an issue or disorder that needs to be addressed. Now I'm sorting things out, and open to the 12 step program for "Over Eaters" (OA) and psychological counseling. I guess I'm an exception.[/quote']

PLEASE VISIT: toomuchonherplate.com they offer excellent advice and free audio therapy sessions. They also deal with the emotional effects after weight loss surgery. All of us that had or is going to have GS must realize that the surgery does not cure emotional eating. We must address the underlying factors. You can lose 200 lbs. and still me miserable, unhappy, and depressed. Now that you have taken care of yourself physically, take care of your emotional health. Extremely important for us ladies!