Many in the eating disorder community are adamantly opposed to this surgery. They view with suspicion physicians who are quick to promote the procedure as the Holy Grail of weight loss rather than viewing it as a last resort. And while insurance companies may insist on six months of pre-operative nutritional counseling, they do not insist on (and often balk at paying for) pre-operative psychotherapy.
It’s hard for me to take a hard-line stand on the surgery itself. I know people who’ve destroyed their health, developed eating disorders and alcoholism, gained back all the lost weight and even died following gastric bypass surgery. I also know people who’ve lost weight and kept it off, and whose quality of life has improved 1000 percent following surgery. They have no regrets and tout it as a life-saving operation.
Get Thee to a Therapist!
I met a bariatric surgeon who’d conducted his own extensive pre-surgery assessments of his patients. He was shocked to find that 80 percent of his patients who were about to undergo surgery reported being sexually abused as children.
I wasn’t shocked at all. It’s widely accepted in the psychology community that sexual abuse survivors often develop problems with overeating. An abuse survivor may use food to numb her feelings or punish herself. She may try to make herself less attractive by gaining weight. Over the years, eating can become a default way of coping with negative emotions, while being overweight becomes self-defining.
Now imagine this woman gets gastric bypass surgery to “fix” her weight problem, without stepping a foot in a therapist’s office. Post-surgery she may be ill-equipped to cope with negative feelings since her default mechanism has been taken away. As her body changes and men start noticing, she may be unprepared for the sense of anxiety that she cannot identify or manage.
This is the patient who may turn to alcohol, cigarettes or shopping for emotional anesthesia. Or she may just eat her way around that tiny stomach pouch. Once I met a woman who lost and then gained back 250 pounds post-surgery.
More tragically, ERs have a short-hand for the post-surgery patient who’s binged and burst through the tiny stomach-pouch. “GBGB.” Gastric Bypass Gone Bad. GBGB can be deadly.
“Those who do not learn from history are bound to repeat it.”
Doesn’t it make sense that a person who is 100 pounds overweight should address his or her “food issues” before getting gastric bypass? Here’s a story to illustrate the work that needs to happen between your ears before someone opens your gut.
Brad is a bright, vivacious and extremely likable guy. A successful man in a long-term relationship, when he arrived for pre-surgery psychotherapy he weighed 386 pounds. Here are just a few of the themes that we addressed during our year together.
Early family messages
When we explored why Brad had ignored his health, he stated that he believed he was not worth the effort. So we dug deeper.
Brad was adopted. He never felt like he “belonged” to his parents. His mother was obsessed with her own fitness but rarely cooked or cared for her son. Brad always sensed that his mother felt burdened by his needs. Brad’s father was a harsh disciplinarian. A controlling military man, he’d measure the hangers in Brad’s closet to be sure they were one-inch apart. Sharing these stories helped Brad realize that his parents did not love him in the way that he needed to be loved. This insight was accompanied by deep sadness. This “grief work” helped him let go of his old self-perception. Acknowledging that their treatment of him was more about their short-comings than his value as a son, he recognized that he was worthy of the effort it took to take care of himself.
Self-talk
Brad had internalized his father’s perfectionism along with an equally powerful rebelliousness. If you’re surprised to think of someone weighing over 380 pounds as a perfectionist, here’s how it works: If I can’t be Perfect, why bother?
Perfectionism and Complacency are flip sides of the same coin.
In therapy Brad recognized that his harsh self-talk not only didn’t make him a better person, it actually contributed to his weight gain. Brad recalled a high school gym teacher who had believed in him and pushed him to get fit. With her encouragement, he started to feel good about his body. Realizing that her positive approach had helped him get in shape years ago, he started speaking to himself in kinder tones, rather than listening to – and rebelling against – his internalized father.
Current Relationship Issues
Brad’s partner was a caretaker. He loved to feed Brad, but a bit too well! Brad suspected his partner might be sabotaging him since he’d gained 100 pounds in the time they’d been together. We anticipated ways that Brad’s weight loss might alter the dynamics of the relationship. Brad’s new confidence would likely make him more assertive, which would add stress and conflict.
Brad’s partner decided to get in therapy to work through some of his own issues. This helped prepare them both for a new post-surgery relationship, especially with regards to food, love, power and control.
The Update
Following his surgery, Brad accepted a job in a new city. It’s been a year. Here are his words:
“As far as the surgery itself, it was actually better than expected. The doctors…made sure I understood any potential complications, discomforts, recovery times...The side effects were exactly as expected…The positive effects far FAR outweighed any of the negatives…It’s been 12 months and I’ve lost 170 pounds…Within 2 weeks…my blood pressure was completely normal…
Within 7 months, my sleep apnea had improved... My energy levels soared and are consistent throughout the day. Food went from being something I was completely obsessed with to almost an afterthought – who knew I had to remind myself to eat...I had not realized how limited I had made my life, avoiding all the anxieties like air travel, small chairs, parties, social activities…I am more social, throwing parties, going to clubs, going dancing, hiking…I started at 386 pounds. Today I weigh 216 lbs. If I didn’t lose another pound, I would be content…
And the take-away:
“I feel like (our) therapy was extremely beneficial in dealing with the issues of satiety (emotional versus physical), the feeding of the emotional stuff, acknowledging what my triggers were, and more. I really attribute my success to the therapy I had before surgery, and the lessons I learned from it that I have brought forward post-surgery. I know other bariatric patients that had little to no therapy, and their success has been very limited. My recommendation would be get some serious therapy before you embark on a surgical solution.”
Amen Brother.
Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for ShareWiK.com and mindfullivingnetwork.com. You can visit her on the web at dinazeckhausen.com and MyEdin.org
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