Education

The Importance of Behavior Modification and the Role of Personal Accountability

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

In order to ensure a successful post-operative outcome following bariatric surgery, the patient must draw a "road map" for themselves on the path to post-surgery healing and recovery. There is tremendous value in recording one's journey through the bariatric surgery process both pre- and post-operatively. Patients can benefit immensely from the power of experiential feedback as a reference guide for future challenges in the longer term post-surgery period. These proactive efforts and use of self are effective tools only if they are put forth with honesty and courage. Being truthful is a patient's main defense against relapse to old food behaviors and triggers. Old lifestyle patterns only undermine and negate all the positive achievements of weight loss surgery patients. Bariatric surgery provides a powerful tool that should be utilized to its fullest potential; this tool needs to be respected and used thoughtfully by anyone who chooses to enter the realm of an enhanced quality of life and a valued sense of self.

As a professional in the area of bariatric patient care, my team promotes the following mindset with patients from all surgery time frames and life situations:

• Lifelong commitment to pursuing a healthier lifestyle,
• Compliance to the guidelines of behavior modification outlined by your program's team and
• Addressing and grappling with challenges that are life long

Self awareness and personal accountability are two areas that are often minimally apparent when assessing one's own part in their struggle with morbid obesity. We are aware of genetics, family history, medical co-morbidities and life stress issues that impact a patient's history of their personal struggle with obesity. So how can a patient obtain the necessary mental and emotional tools to support the physical presence of bariatric surgery? Through engaging in a solution to the past disappointments of weight loss efforts that are already so familiar.

Many patients report that paths to insight and reflection often reveal mental justifications, old bargaining behaviors and frustrations that fuel negativity and the inappropriate attachments to and uses of food. Although it is easy to lay blame for our lot in life, self deception only facilitates the repetitive cycle of anger and disappointment. In the professional arena, we often discuss the addictive quality of food and how food has a parallel function in the same way that other behaviors do i.e. shopping, drugs and alcohol, sex, gambling and the like. The need for emotional escape and mental distance can encourage us to use food as "anesthesia", a way of shutting down and shutting out the world around you. We are careful to watch for cross-addictive behaviors following bariatric surgery and recommend support services and resources that provide a safe and secure place to investigate and discuss personal issues that are relevant and central to a patient's sense of success following bariatric surgery.

The role of a supportive aftercare program, including individual therapy, can be a valuable tool on the road to recovery and facilitate a smooth transition and adaptation to new food behaviors and lifestyle changes. The ability to share a parallel experience with patients at a certain stage of recovery provides a potential for engagement and bonding with other patients. On an individual note, psychotherapy can expand one's self awareness and promote a greater degree of personal accountability once the genesis of old behavior patterns have been deciphered. A patient can then restructure their responses and actions to issues and challenges that may have proved inadequate prior to surgery. Activities that promote reflection and insight may include:

• Write your story of living life with morbid obesity. Detail the features that have impacted you the most and how you attempted to cope with your past struggles.
• Compose a goodbye letter to the burden of obesity and the highlight the reasons for a new and more positive commitment to a healthier life.
• Keep a food journal and record emotions and thought patterns as a part of your examination of the use of food. It may illustrate some of the feelings that you have had difficulty putting into words.
• Make an inspirational chart/collage of pictures, phrases and joys that outline your goals and successes; this usually reinforces further inspiration and compliance to a new life.

As patients embark on the road to recovery and have engaged in the physical, as well as emotional, healing process, the element of discovery and the pride in making better, well-informed choices is contagious. Not only are patients able to experience improved health, more energy and an increasingly positive attitude, the possibility of calmness, balance and peace is an often pervasive occurrence. Once personal discoveries have been made, in a supportive group setting or in an individual treatment session, bariatric patients can begin to feel more in control of the path in front of them. Commitment and compliance are two of the key elements to post surgery success. When patients utilize new found tools and wisdom consistently, patient life choices are infinite and profoundly rewarding.

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.

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