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Bariatric weight loss surgery doesn't solve psychological issues

Lavinia Rodriguez
Published May 1, 2013

Bariatric surgery such as gastric banding and bypass is being used more and more to treat obesity. These procedures lead to rapid weight loss by restricting the amount you can eat comfortably, by reducing the absorption of nutrients or a combination of both.

Such surgery may sound like a panacea, but that's far from the case.

It's understandable why someone who's struggled with obesity for years would place all their hopes on bariatric surgery. Many patients think it's their last resort. (And in some cases, it may be.)

But advertisements gloss over the tough realities of bariatric surgery. And even when the facts are given, many people are so eager to lose weight, they ignore what they don't want to hear.

It's important for those considering bariatric surgery to know these key facts:

1. You can gain back all the weight you lose after surgery.

2. If you have psychological issues connected to disordered eating, bariatric surgery will not eliminate these problems.

When patients regain weight after bariatric surgery, it's usually because of psychological issues. It's not always deep-seated problems that stand in the way of success, but seemingly simple things like perfectionism, attitudes about exercise, and other common issues.

The truth is that bariatric surgery patients must do the same things to lose and manage weight as anyone else — eat moderately and be active daily. Initial weight loss may be more rapid after surgery, but over time, good habits become more important than the surgery itself.

I recently received a letter from a man who learned the hard way about post-bariatric surgery weight gain.

"I've lost considerable weight since my surgery, but I've been gaining a lot of weight over the past year,'' he wrote. "I'm not self-motivated and I hate sacrificing good food and time to exercise. What can I do to get on track, lose weight again, and be healthier?"

Fred's letter tells why he was having trouble:

• He believes in the myth of self motivation: There's no such thing as motivation that magically appears from nowhere. People are motivated when they associate something positive with the action they're contemplating. For example, I'd much rather play in my garden than write this article. When even my deadline isn't quite enough to motivate me, I tell myself that I can garden when I am done writing. Then I feel more motivated to write. It helps to figure out what we like and use it to create motivation.

• He believes his glass is half empty: Fred is creating negatives about his situation instead of reminding himself about the positives. What are the payoffs of exercising and eating well? Feeling better, looking younger, being able to do more — it's a long list and he should be adding to it.

• He thinks only unhealthy foods taste good: If Fred is willing to try new things, he'll realize that there are more good tastes in healthy foods than there are in salty, sugary, greasy "treats."

• He considers exercise a sacrifice: If you think you're wasting time exercising, you won't like it and you won't do it. It's your job to make it fun. Try different activities. Find friends to work out with you. Listen to your favorite music or watch TV while you're sweating. Fred might want to consider that if he doesn't take care of himself, what he's probably sacrificing is years of life.

• He believes there must be a way to be healthy without eating well and exercising: Sorry, there's no magic. However, if you deal with the psychological barriers that are keeping you from doing the right things for yourself, you will understand why eating well and being active are essential.

• He uses self-defeating language: How we talk to ourselves makes the difference between getting ahead and moving backward. If Fred listens to himself, he will understand that his own self-defeating statements are at the root of his weight gain.

Fred's problem is psychological, but fixable. If he addresses these issues he will be on track to losing weight again and becoming healthier.

Dr. Lavinia Rodriguez is a Tampa psychologist and expert in weight management. She is the author of "Mind Over Fat Matters: Conquering Psychological Barriers to Weight Management." Send questions to her at drrod@fatmatters.com.

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