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Bariatric Surgery: A Crock of Weight

Meredith Cariski Writes:

Right now, there is a fire of anger and a swell of disappointment inside of me. I had a conversation that revealed something upsetting I would have never expected.

I was calmly drinking my coffee with almond milk and monk fruit at a local cafe when I ran into a friend’s husband who came sauntering towards my table. There was a sadness to him that I could not quite put my finger on until he began to speak. After a bit of mindless chit chat, I questioned him, “What’s going on? Is something wrong?” I knew there was something wrong so I dug into him. It didn’t take much because his feelings were barely below the surface.

With a heavy heart, he responded, “Bariatric surgery is what’s wrong.”

He began to narrate the saga of his wife’s experience with bariatric surgery. The couple thought that the surgery would be a miracle at work: the platinum standard of weight loss that would last forever. A costly miracle, but worth every penny because the surgery would be effective and life changing. After having done extensive research, the concept of a doctor taking out most of his wife’s stomach should shock her digestive system into maintaining long term weight loss.

However, as they soon discovered, when the weight came back, that the doctors’ claims of permanent weight loss, seemed almost criminal. They were performing a very invasive procedure with the halo of a guarantee of long-term weight loss. However, the reality is quite different – to the point where my friend and his wife felt like they were “taken” by promises that simply could not be met.

More specifically my friend’s wife gained ALL of her weight back, and she was back on her diabetes medications and has resumed using her CPAP machine. He shared that they had some fear that this would happen, but that they had addressed her issues with food and exercise before the surgery to confront the possibility of the fat returning. It was a winning battle. With most of her stomach gone, it made sense that this would be a non issue. She would say that she is not going to end up on the heavy side of the statistic. Yet, she was so wrong.

My friend’s husband was not only upset because ALL the fat came back. That was the symptom of a deeper, scarier problem: the psychological and emotional impact of the weight’s return and the crappy support systems available to relieve the stress from this traumatic situation. Doctor’s have tried to tell them that medicine can help, but they don’t trust the doctor’s anymore. Most of these medications provide short term solutions anyway! What was the point of the surgery then? Another doctor suggested an endoscopic approach. Why undergo another medical procedure after bariatric surgery? Is it too much to ask for it to just work?

His wife feels devastated, depressed and stressed. Chubbiness was back and her body is supporting it, but the worst of it is the couple sought support groups and they were awfully “bad.” That is the word he used: bad. The quality of the groups and suggested apps are Grade F. The lack of standards creates an unsafe environment during group sessions. The stress from weight gain combined with hopelessness to find a solution propelled the couple to find next steps.

The husband understood clearly what the problem was. He compared the situation to having an issue and moving away to another state to fix it. The problem is that wherever you go, you take yourself with you. This was the perfect analogy because the psychological factors and relationship with food that his wife had still exist post bariatric surgery. Her unhealthy relationship with food had not been consistently treated before so when she gained weight after the surgery, her mindset stayed the same and bulked as the disappointment plumped from within. Her husband notices that emotions like her anxiety, low self esteem, self loathing, guilt, and shame seem permanent because he knows she feels them when she eats which causes her to eat more.

I responded, “that’s a fattening Catch 22.”

My poor friend and her husband felt that they had nowhere to turn. I told the sad, yet determined narrator that I can sympathize and that I had an idea.

I told him, whenever I am searching for answers, I have to go to someone more educated than I am, I just have to. The intricacies of disordered eating and addiction to food are not only complex, but a subject of sensitivity. I told the husband to seek out someone unbiased for his wife who can analyze his wife’s medical history, hydration, diet, and will keep her accountable. Someone who can listen to why her motivation, evergy, and exercise has stalled post surgery. A specialized therapist in disorders and addiction to food can provide understanding, support, coping skills, and solutions that apparently cannot be found anywhere else.

I feel badly for them and for anyone who is trying to deal with their weight gain after bariatric surgery. Mostly, I’m pissed off. What kind of world is this where money and surgery can’t solve a problem? I wish this whole situation had an easy solution. Is there a solution at all?

Brian Baumal Responds:

Stories like this are unfortunately common, Meredith. My understanding of bariatric surgery is that it works more by altering hormonal responses in the body, than it does by decreasing the amount of calories one consumes. Regardless, I speak a fair bit with individuals who are experiencing weight regain after surgery, and I think the experience of your friend's spouse shines a light on a few key issues.

First, I think there is a better need to set-up people for success prior to surgery. If an individual has disordered eating, eating disorders or food addictions, those issues must be addressed prior to surgery. All too often, I find that these issues need further treatment after the surgery has occurred. Second, specifically related to disordered eating and eating disorders, the stress of weight regain often causes further disordered eating and weight gain, further compounded by the sense of "failing" at the last alternative one has in regard to weight loss.

I find that people experiencing weight regain after bariatric surgery have a high level of anxiety because of these two factors. My goal in working with these individuals is to do the same as I would with individuals who do not have bariatric surgery. I look at life stressors, history of body and weight issues, as well as one's relationship to food. I find that those who are post-bariatric surgery recognize that they have to still manage these issues, and need the support to help them through these issues. The specific focus of therapy also tends to focus on the emotions involved in the weight regain and how to reconnect to the reasons for bariatric surgery to begin with.

If there is one wish that I had is that hospitals, providers, nurses, doctors and broader circles of care fully understand eating disorders and food addictions an that psychoeducation occur for patients on these issues before surgery occurs. The purpose of this education would be to have patients understand some of the psychological reasons for weight regain so that they know that they can, and should seek help when weight gain reoccurs after surgery.

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