Education

Psychological Aspects of Bariatric Surgery

Lori Sperling Nevins, L.C.S.W.
Program Coordinator
New York Bariatrics
White Plains, Westchester County, New York

People who suffer from the disease of morbid obesity do so in immeasurable ways, from the daily stress of not feeling well physically to the indignities and humiliations of a "fat phobic" culture to the internalization of others' criticisms as low self-esteem and shame. Those who struggle with this disease have often developed a "disordered relationship with food" that works hand-in-hand with genetic and metabolic influences to form the disease of morbid obesity.

Many issues face the pre-operative bariatric patient including portion adjustments, slow and mindful eating and separation of fluids and solids at mealtime. In a parallel fashion, there are numerous psychological issues that are apparent as a patient prepares for bariatric surgery. We often speak in these terms when describing a patient's struggle with morbid obesity -

• emotional eating nor "head hunger"
• addiction to high glycemic carbohydrates, or the "white foods" and
• mourning the loss of food" and our relationship with food as we have come to know it.

as well as the emotions that correspond to them such as:

• anger
• sadness
• anxiety
• boredom
• fear and anticipation of change

The continuity of the above points is potentially a significant undermining force to any patient who is considering bariatric surgery. Therefore, it is crucial that these issues be addressed prior to the surgery date, as part of the patient's pre-operative evaluation and education process. In conjunction with the identification and exploration of the above mentioned issues, it is essential for a pre-operative patient to start to locate, identify and evaluate support systems, as a part of a structured aftercare program that will maximize the patient's potential post-surgery outcomes. Patients must create and implement alternate coping skills, other than eating, in their lives to satisfy emotional responses to daily life stressors. Such skills as:

• Individual and /or group therapeutic participation
• Meditation, yoga and visualization soothe anxiety and fear
• Walking and other aerobic exercise to combat anger, sadness and boredom
• Journaling/recording one's own weight loss experiences can be very motivational

When psychological factors have been identified along with physical factors, as both have probably contributed to a patient's struggle with morbid obesity, one can then begin to structure their plan for recovery in both the immediate and longer term post-operative healing period. The healing of the mind and spirit maximizes the patient's opportunity for an optimal post-surgery outcome as a bariatric surgery patient.

Lori Sperling Nevins, MSW, LCSW, is a clinical social worker and Bariatric Program Coordinator, with New York Bariatrics. She assisted Dr. William Homan, along with Valerie Ross Homan, LCSW, in developing a holistic team approach to pre-operative surgery preparation. Her team prepares bariatric patients for surgery and maintains patient follow-up in a supportive medical, nutritional and psychosocial aftercare program meant to maximize surgical outcomes.

WLS Lifestyles - www.wlslifestyles.com - Copyright 2007