By Sheri Sellars, BSN, RN
Bariatric Nurse Educator, Nicholson Clinic
Almost every patient has secret (or not so secret) pictures in our heads of how life would be if only weight were not an issue. Often these dreams fuel at least some part of the desire for weight loss surgery and can provide wonderful motivation as changes in eating habits and activity level take place. Like most dreams though, the reality can be a bit different than we thought. While the body is changing rapidly, the mind can take longer to get caught up. Sometimes these changes, while positive, carry baggage of their own and leave us reaching for coping skills we have not had to find before. Here are a few common psychological issues bariatric surgery patients report as their bodies rapidly change.
Body Perception Issues — Our surgery patients often report a sense of surrealism when it comes to personal perception of body size. Shopping takes on a whole new challenge and often patients report standing in a clothing store with no idea what size to try on. Glimpses in the mirror can yield a sense of shock or a feeling of “otherness” as they struggle to identify ownership of the image they see. Compliments from friends and family can be difficult to accept gracefully and may even trigger suspicion, embarrassment or feelings of shame.
Loss of Security — Morbid obesity remains a very marginalized population in our image-oriented society. Many people who battle this disease report a history of abuse, assault or other physical or emotional trauma, with obesity giving them safe harbor through a reduction of “visibility” or attention. The increase in noticeability that comes from rapid weight loss can result in a wide range of emotions, not all of which are positive. Learning to deal with attention from others who may not have paid attention before can trigger resentment and anger along with pleasure or validation. For some, it may even trigger shame, anxiety or fear.
Relationship Changes — The person we have been throughout morbid obesity is not the same after bariatric surgery. Learning to live a different relationship with food and exercise opens doors to new levels of confidence and a different way of seeing the world. While these changes are positive and empowering, sometimes through the journey of becoming we discover that relationships that have made up our lives also undergo changes. Friendships, familial relationships and marriages can be very challenged by our weight loss and our evolving relationship with ourselves and the world. Newfound confidence can undermine or completely eradicate the basis for relationships we had counted on up to this point. Adjusting to those who cannot make this journey with us can be emotionally painful and can challenge our inner strength.
Mourning Food — This is the one that seems to take most people by surprise. It rears its head early after surgery and can strike during times when food may have offered more than mere sustenance in the past. The inability to eat in large volumes and the elimination of food as a primary means of celebration, bonding, mourning or even just boredom can be shocking to the psyche. Many who suffer from morbid obesity have a long history of disordered eating. Losing the ability of food to feed us beyond mere hunger can trigger a very real sense of loss.
Addictions — Studies in populations who have undergone weight loss surgery are increasingly yielding information demonstrating an increase in addictions after surgery takes place. Alcoholism in particular occurs at a higher rate in patients who have had gastric bypass surgery than that of the general population. Other addictions also have been noted, including addictions to gambling, prescription or street drugs, shopping and sex addiction. The reasons for this remain educated speculation at this point, but the data is clear. Weight loss surgery patients are at higher risk for addictive behavior.
Anxiety — This emotion rears its ugly head after surgery for all sorts of reasons. The surgery itself is major, as are the changes that come with it. The availability of information on the Internet, while helpful at times, can contribute to this sense of concern. Few people take this surgery lightly and most all wish to do things “right,” which can lead to excessive, almost obsessive Internet searching, most of which causes more questions than it answers due to a plethora of surgeons and postoperative protocols. Additionally, former habits do not fade away easily or quietly. The surgery itself is simply a tool and most patients go through a period of shock in finding the habits, behaviors, cravings and hunger that was present prior to surgery is still present to some degree afterward. There is a fear of failure, unrealistic expectations to grapple with and the process of learning to change habits to battle through. Most patients report a sense of anxiety about everything from what to eat to deep-seated fears of regain or surgeon censure if weight loss is slow.
All of these issues can be present at any given point after surgery. Fortunately, here at Nicholson Clinic we are experienced in helping patients through the minefield of adjustment that comes with postoperative emotional changes as well as the physical ones. We partner with dieticians, licensed psychologists and keep a nurse educator on staff to help our patients over these hurdles and into the life that awaits them. Patient awareness that these issues can happen after surgery is important; knowing we are here and prepared to help even more so. If you are postoperative and struggling, the most important thing you can do for yourself is reach out for help to those who understand. We are with you all the way.