Advertisement

Doing Life Together

Doing Life Together

The Psychological Side of Weight Loss Surgery

Lose it for lifeWhen Governor Chris Christie announced this week that he had weight loss surgery this past February, he made headlines. Christie has often talked about his weight, has been the brunt of late night jokes and seemed to roll with the punches. But Christie, like 220,000 other Americans decided to take action on his personal war on obesity. He had gastric banding surgery, a type of weight loss surgery in which a small band (ring) is placed over the top of the stomach and tightened in order to reduce food intake .

Advertisement

When I read Christie’s reasons for the surgery, I was assured, having conduced pre-surgical psychological evaluations for weight loss surgery patients. The most important thing in terms of mental health is to have the surgery for the right reasons.

Surgical treatment for obesity is often recommended for patients whose obesity is refractory obesity or obesity-related medical conditions that pose serious health consequences. Surgical intervention is reserved for those with a BMI (body mass index) of 40 or greater, or a BMI between 30 and 40 with obesity related health conditions.

The two most used procedures are gastric bypass and gastric restriction. Surgery related death is less than 1% for low-risk patients, and less than 2% for high-risk patients for either procedure. The goal of surgery is to reduce the stomach reservoir so that a sense of fullness is gained from a smaller volume of food. Obviously with less food intake, weight loss occurs.

Advertisement

Surgery can achieve maintainable losses of 40% to 60% of pre-surgery weight. But weight loss is a complicated psychological as well as physical feat. Unfortunately, the psychological state of a patient is not always considered when recommending this option. Increasingly, more surgeons are interested in psychological screenings for medically qualified patients.  Unfortunately, far too many surgeries are still performed without taking this necessary step.

Positive personality changes can accompany weight loss (Stunkard et al., 1986). Patients often report feeling less helpless, more stable, improved mood, etc. Other patients experience negative psychological post-operative changes (Loewig,1993).  It is unsound practice not to screen for possible negative effects.

Advertisement

We know that those who have surgery for medical reasons do better than those who undergo surgery for psychosocial reasons. So we need to ask: What does weight loss mean to a patient? What are his/her expectations? Are there serious pre-operative psychological problems? Will weight loss negatively affect the person’s psychological functioning?

For example, those with severe psychological disturbance may see surgery as the end-all to their problems. When post surgery weight loss occurs and psychological disturbances remain, patients can dive into depression and other psychological disorders.

Some patients have used obesity to cover traumatic events such as sexual abuse. When pounds are dropped, they feel vulnerable and scared. If fear and anxiety were channeled through food and food is no longer available as a coping mechanism, problems can arise.

Advertisement

Obese people who spend years fighting social discrimination, attacks on self-esteem, and rejection may view surgery as a way to gain an acceptable body.  When the physical body conforms to social expectation, the attention can be overwhelming and difficult to handle.

Furthermore, many obese patients do not know how to determine their internal emotional states. They often see all needs as hunger needs. Emotional based eating does not go away with surgical weight loss.

The key, then, is to screen patients for psychological issues prior to surgery and address those issues in an attempt to avoid negative long-term effects. It appears that those who do best with weight reduction via surgical treatment are those who are psychologically healthy.

 

 

Previous Posts

Are Your Tweets Tied to Heart Disease?
#AngryInNYC Another stupid person runs in to me. Sorry doesn’t cut it. Look up from your phone you idiot. This is just one example of Sara’s tweets that regular fill her Twitter account. It doesn’t take much to anger Sara. If someone ...

posted 7:00:10am May. 22, 2015 | read full post »

What To Do When Anger is Triggered
Anger is triggered by expectations, perceptions, and things people say and do. These hot buttons are triggers that cause the feeling to rise. Knowing your hot buttons can prepare you for future conflicts. To deal with hot buttons, think ...

posted 7:00:22am May. 20, 2015 | read full post »

Why You Shouldn't Withhold Sex in a Marriage
Aaron and Jill feels distant in their relationship. Because of the lack of closeness, their sex life has suffered. Aaron came to therapy wondering how to change this dynamic in their relationship. Sex is so important to a man’s emotional ...

posted 7:00:16am May. 18, 2015 | read full post »

Parenting: The Cost of Too High Expectations
Rita, like so many daughters, came to therapy because of a tense relationship with her parents. Rita feels her parents' expectations are too high and she can never measure up. Expectations, when too high or out of line with a child's true ...

posted 6:00:52am May. 13, 2015 | read full post »

Turning A Child Against a Parent
Jerry has no relationship with his children now that he and his wife are divorced. Prior to the divorce, Jerry was very involved in their lives. But the relationships took dramatic turns due to something called Parent Alienation Syndrome ...

posted 6:00:07am May. 12, 2015 | read full post »

Advertisement


Report as Inappropriate

You are reporting this content because it violates the Terms of Service.

All reported content is logged for investigation.