So Why Don't We Talk About It?

[summerset 5,261]

So someone dug out this thread: https://www.bariatricpal.com/topic/434528-i-am-a-food-addict-and-bypass-isnt-a-cure/

I saw several users wishing for more discussion on this. However, we don't have these discussions. If a thread like this pops up it gets some traffic and then gets buried under other threads until someone might dig it up again.

So... what in your opinion is the reason we're not talking (a bit more) about this? Are people talking about these issues elsewhere? Are we too scared? Ashamed? Do we not really care? Or are we all cured after all?

[Sleeve_Me_Alone 654]

I always, always, always suggest therapy to anyone considering WLS. Personally, doing the mental/emotional work was absolutely necessary for surgery to be beneficial. It is absolutely true that surgery cannot and will not cure binge eating, eating addiction, or any other disordered eating habits. I'm grateful that others suggested it, its been key to my success, so I work hard to talk about it openly and pass along the advice.

I suspect the shame of "diet culture" has a lot to do with is, as does misinformation, sadly.

[ms.sss 14,669]

...probably the same reasons people don't talk about therapy outside of the bariatric universe. i dont think the taboo that is (unfairly) assigned to mental health management is specific to us as a group.

🤷🏻‍♀️

Edited January 3, 2023 by ms.sss

[SpartanMaker 676]

I think we don't talk about it because what is there to say? I'm pretty sure we all recognize that WLS does not fix eating disorders and that therapy is the recommendation. Beyond that, what would we discuss?

I don't agree with this assessment, but for what it's worth, the medical community seems to believe that full blown eating disorders are fairly rare in the obese patient population. This is one of the reasons the clinical recommendation is to screen for eating disorders prior to WLS. If an eating disorder is discovered during the psyc eval, it can be a contraindication for proceeding with WLS, depending on the severity and the behavior in question.

My personal belief is that you just about can't become obese unless you have some level of disordered eating. Perhaps for many of us the level of disordered eating is sub-clinical (in other words, it's not to the point where we would formally be diagnosed with an eating disorder), or perhaps lots of people aren't fully truthful during the psyc eval to avoid being told we don't qualify for surgery. Either way, I think we have a lot of people that complete surgery and have disappointing results because they only treated part of the problem,

[qtdoll 534]

Prior to my surgery I watched a lot of 'VSG Fail' videos & I noticed many of them either hide the addiction, or assume the habits formed during the pre-op diet is enough to over-come the addiction. I'll be honest, my psych assessment consisted of this:

Doctor: "do you have any psychiatric history?"

Me: "Not since high school"

Doctor: "& nothing since then?"

Me: "nope"

& that was it. It made me realize how easy it would have been to just lie my way into getting surgery if I had an addiction. (Luckily, I was being truthful)

Just like most mental health discussions, I feel people would just rather keep things a secret or pretend it doesn't exist. It's such a hard thing to battle. Unfortunately I REGULARLY see people say they think the surgery will be the solution since there's now a physical barrier stopping them from binging. That link you posted is clearly proves it's not enough to fix a person. I wish more people knew this

Edited January 3, 2023 by bbykitty

[Nepenthe44 183]

I don't know that there's a lot to say. Like, the only response to talk about disordered eating is "go to therapy". Which is great for the people for whom therapy is accessible and effective, but for most people it isn't one or the other.

I've been in therapy for literally decades. I've been hospitalized in an ED ward. Still have an eating disorder.

Also, you really don't want to talk about disordered eating on a bariatric forum. What is disordered eating, after all?

Weighing and tracking everything you eat? Getting upset if you break a diet rule? Avoiding social situations where food is going to be present? Exercising no matter what? Refusing to eat food for any reason but the bare minimum necessary to fuel your body?

That's compliance. That's a good bariatric patient. That's a success story.

[smc124 118]

On 01/03/2023 at 17:52, Nepenthe44 said:

I don't know that there's a lot to say. Like, the only response to talk about disordered eating is "go to therapy". Which is great for the people for whom therapy is accessible and effective, but for most people it isn't one or the other.

I've been in therapy for literally decades. I've been hospitalized in an ED ward. Still have an eating disorder.

Also, you really don't want to talk about disordered eating on a bariatric forum. What is disordered eating, after all?

Weighing and tracking everything you eat? Getting upset if you break a diet rule? Avoiding social situations where food is going to be present? Exercising no matter what? Refusing to eat food for any reason but the bare minimum necessary to fuel your body?

That's compliance. That's a good bariatric patient. That's a success story.

As someone who’s also been hospitalized for an ED I’m really surprised to see this kind of false equivalency of what an ED from someone who’s also experienced it.

[Merri Beth 96]

2 hours ago, bbykitty said:

Prior to my surgery I watched a lot of 'VSG Fail' videos & I noticed many of them either hide the addiction, or assume the habits formed during the pre-op diet is enough to over-come the addiction. I'll be honest, my psych assessment consisted of this:

Doctor: "do you have any psychiatric history?"

Me: "Not since high school"

Doctor: "& nothing since then?"

Me: "nope"

& that was it. It made me realize how easy it would have been to just lie my way into getting surgery if I had an addiction. (Luckily, I was being truthful)

Just like most mental health discussions, I feel people would just rather keep things a secret or pretend it doesn't exist. It's such a hard thing to battle. Unfortunately I REGULARLY see people say they think the surgery will be the solution since there's now a physical barrier stopping them from binging. That link you posted is clearly proves it's not enough to fix a person. I wish more people knew this

I am amazed that the psych assessment was that short. Mine was 300 questions plus an intense interview with psychologist. Then getting the results took a long time so long that i thought i failed.

[SpartanMaker 676]

46 minutes ago, smc124 said:

As someone who’s also been hospitalized for an ED I’m really surprised to see this kind of false equivalency of what an ED from someone who’s also experienced it.

Can you explain what you mean by false equivalency? A lot of the things @Nepenthe44 mentioned seem to be listed as warning signs for ED:

https://www.nationaleatingdisorders.org/warning-signs-and-symptoms

https://www.allianceforeatingdisorders.com/8-signs-you-may-have-an-eating-disorder/

https://www.healthline.com/nutrition/common-eating-disorders#signs

It's plain to see that some of the things bariatric programs (and this forum), encourage are also listed on those pages. Certainly those things alone don't equal an ED diagnosis, but I do think some of them may cross the line into disordered eating, especially if they lead to or cause issues in other parts of our lives. For example:

• Do you worry about "messing up" on your bariatric program to the extent that it's causing severe anxiety issues?
• Alternately, if you do eat off plan, do you express self-disgust and make plans for how to "make-up" for what you ate through extreme exercise or fasting?
• Are you constantly worried about "going over" your calories and/or macros and do you spend hours every day (to the exclusion of work or family), tracking these things?
• Do you actively avoid eating or drinking in public because you don't or can't eat like a "normal" person?
• Do you compulsively weigh and measure yourself and freak out when something is off a bit?

To me, these are just a few possible examples of how "what's expected of a good bariatric patient" may just cross the line into an eating disorder. Regardless of the reason or intent, when our relationship with food or our bodies becomes an obsession, we have an issue.

[qtdoll 534]

1 hour ago, Merri Beth said:

I am amazed that the psych assessment was that short. Mine was 300 questions plus an intense interview with psychologist. Then getting the results took a long time so long that i thought i failed.

Yep that's exactly what I was expecting when I went to see the Doctor but he just took my word for it. No clue if all of Kaiser does it that way but this specific doctor was too relaxed

[BriarRose 432]

I am a mental health professional. I DO therapy along with other things... I got my VSG in 2010. MY mental health appointment with a therapist was this:

Her: Oh you must be so excited, soon you will be slim like me ! But you need to save a ton a money to get plastic surgery afterwards because this *** won't pay for it.

Me: Blinking. Well, you look great; but I am about 25 years older than you, and I think our perspectives may be different.

Her: So, I went to Mexico, do you want the information ? Its like surgery and a spa. Blah blah Blah kept on talking...

Me: ( holy crap, I need this recommendation I guess I play her game ) Oh I would love that, thank you so much, so tell me about your weight loss journey because I can see how wonderful you are doing.

Her: 40 minutes of telling me all about her weight loss and dating. ( I was very newly divorced, and no she never asked).

I was terrified that she would not recommend me.... because she knew NOTHING about me at all. I called her three days later on a fishing expedition ...... and she told me she put in her recommendation for me. I waited until AFTER my surgery to send MY notes to the clinic supervisor.

DO I know that my childhood had molded my eating behaviors ? Of course. My grandmother and mother lived in Europe during the Holocaust. They managed to escape - but not before surviving on scraps of bread. Healthy meant being chubby. I had to re learn as an adult what HEALTHY was, then to connect all that and re learn so many things. Did that therapist ever know that ? of course not. she never glanced at my autobiography because if she had, it would have made it into the report. Which I requested afterwards.

It does not mean your experience will be like that. Find a good therapist. Do not rely on one session to make or break your desire to have a personal tool to help with your weight loss.

[summerset 5,261]

8 hours ago, Nepenthe44 said:

That's compliance. That's a good bariatric patient. That's a success story.

Sarcasm?

[Nepenthe44 183]

To some extent, sarcasm, but to some extent not.

One of the issues discussed in the sparse literature on post-bariatric restrictive eating disorders is that it's difficult to distinguish someone complying with bariatric program behavioral advice and someone with atypical anorexia nervosa on the basis of behavior.

New standards need to be set for post-bariatric patients because just because someone is cutting everything on their plate into bean-sized bites, taking two minutes between bites, counting the number of times they chew, and only eating a few ounces of food through a full meal doesn't mean they have AAN. They could just be a very good bariatric patient, who will definitely be counted among the surgeon's success stories.

[summerset 5,261]

Let me quote Blythe Baird:

Quote

If you develop an eating disorder when you are already thin to begin with, you go to the hospital. If you develop an eating disorder when you are not thin to begin with, you are a success story.

Nowhere this seems to be more true than in the WLS community. That's why I asked about sarcasm. ("Good bariatric patient" sounds too much like "good boy/girl" to be. That's something I would say to my dog when I pat him on the head.)

[Nepenthe44 183]

Everyone is so much happier with me now that my eating disorder isn't the wrong eating disorder.