Emotional Preparation

There is no “one size fits all” advice for emotionally preparing for weight loss surgery.  People’s motivations for choosing weight loss surgery vary tremendously and any emotional planning must take these underlying factors that are driving your decision into account.  I’ve listed some of the most common reasons that people choose weight loss surgery below with some words of advice if these words strike an emotional chord.

“I’m sick of being judged because I’m overweight”

Many people decide to have the surgery simply because they just don’t want to spend the rest of their life 100 lbs. overweight.  Society judges those who suffer weight problems harshly and there is ample evidence that people with obesity are less successful at work, have less self esteem and are judged harshly by their peers and even their doctors.  Weight loss surgery offers an opportunity to be judged fairly by society without the unfortunate negative bias that pervades our society.

For those of you who elect surgery to remedy this discrimination, it is important to fully consider all of the factors that could be causing “discrimination.”  My experience is that surgery does little to change your professional or close personal relationships.  Those who are struggling at work may be quick to blame their lack of promotion on their boss’s discrimination, but it’s more likely it’s their job performance that’s holding them back.  Bad marriages often become worse after one partner undergoes weight loss surgery, while good marriages become stronger.  Friends who also struggle with their weight are often threatened by others who undergo weight loss surgery.  Often those who suffer from obesity use close friends or family who are heavier to rationalize their own weight problems.  Without you knowing it, these people in your life may use you as a standard for their own weight, telling themselves that it’s not a concerning problem since they’re smaller than you.  When you undergo surgery and lose weight quickly, they may no longer be able to explain away their weight problems and be forced to make some difficult assessments of their own struggles.  In short, undergoing weight loss surgery to change someone other than yourself is a bad decision and unlikely to pay off.

What often does change for the better after surgery is your relationship with the rest of society.  Many people tell me they notice that others are much friendlier after surgery and, at times, postoperative patients begin to receive attention from the opposite sex.  Often times, this is a welcome change, but many post-surgical patients report that they feel that the new attention is superficial and shallow and is based entirely on their physical appearance, not who they really are.  

I’ve found that many patients who are primarily motivated to have weight loss surgery to avoid discrimination are often let down by the end results.  Personal and professional relationships are complex and are just as likely to end up in worse shape after one side undergoes weight loss surgery.  Those patients who look to surgery to help improve their relationship with others rarely recognize this goal.  Instead, what improves much more frequently is your relationship with yourself.

“I want to have more self-esteem”

It is easy to quantify the health benefits of weight loss surgery, while the emotional gains are much harder to measure, but no less important.  Patients frequently report greater confidence and happiness after surgery.  However, these effects vary tremendously from person to person and are hard to predict.  

The difference between a desire to no longer be judged, as described above, and a desire for greater self esteem is subtle, but very important.  The motivation for this surgery should come from a desire to improve yourself, not to improve how others view you.  The only thing that we can control is how we view ourself – we cannot force others to think of us in a certain way.  If you want to be a better husband or wife by being able to participate in activities that your spouse enjoys, but you can’t because of your weight, you are likely to be very happy with your postoperative results.  If you want to develop more self confidence so you can finally leave your unhealthy marriage, surgery will likely give you the boost you need to finally make this difficult decision.  However, if you think weight loss surgery will make your spouse love you or respect you more, you are very likely to be let down.

These surgeries can result in a dramatic increase in your self confidence and will likely change the way you view the world.  Often this leads to a better, happier life, but other times, it reveals issues that you’ve used your weight as an excuse for not addressing it.  While most programs require an evaluation by a psychologist prior to surgery, a single evaluation is often inadequate to identify future emotional pitfalls.  In my practice, I look at the initial psychological evaluation as an introduction to a trusted therapist who understands what post-weight loss surgery patients go through.  While the initial evaluation is helpful, more importantly, it sets the stage for a future relationship if patients are struggling emotionally.  For those patients who already have a relationship with a psychologist, it is imperative that you discuss your motivation for surgery with your therapist and analyze your reasons for your decision.

“I’m sick of feeling sick”

If you struggle with basic daily activities like climbing steps, walking for more than a few minutes or getting on the ground to play with your children or grandchildren, you are not alone.  Nearly all of my pre-operative patients report these limitations to their ability to be an active participant in their life.  The good news is that weight loss surgery will dramatically improve your ability to walk, exercise, eat well, climb steps and play with your children or grandchildren.

Also, for those of you who know your local pharmacist by name and take many different pills or injections every day, weight loss surgery will change everything for you.  Very few patients continue to take insulin after surgery and nearly 75% of gastric bypass patients never take another shot of insulin for the rest of their life after surgery.  Most of my patients cut the number of pills that they take on a daily basis to less than a quarter of what they were taken preoperatively.  On more than one occasion, I’ve seen a post surgical patient pare the number of pills they take daily from over 20 to only a daily vitamin.  These changes are remarkable and add many years to your life, and, as importantly, result in a much more enjoyable life.  Many of the things that you couldn’t do before surgery because of your health, like travel, walking distances, swimming, living independently and spending time outdoors become possible again after surgery.

As a physician, participating in these health transformations is intensely rewarding.  Every day, I am able to help patients accomplish things that I was taught in medical school were impossible.  Twenty years ago, I was taught that disease like diabetes, high blood pressure, sleep apnea, acid reflux and heart disease could only be managed with medications, but never cured.  Today, I am able to prove this teaching wrong many times a week in my office.

“I don’t want to die early”

Many patients make the decision to undergo weight loss surgery out of a fear that their obesity will shorten their life.  While obesity can certainly shorten your life, this isn’t true for everyone who is overweight.  Often times, I’ll meet with a perfectly healthy woman in her 40’s who is 100 lbs. overweight with no family history of diabetes or heart disease and no medical problems other than occasionally sore joints.  Although this woman is overweight, it is very likely that her obesity will not shorten her life.  Alternatively, a man in his 40’s who is only 50 pounds overweight, all of it in his belly and suffers from diabetes, high blood pressure, high cholesterol and has already had one heart attack is at great risk for a shortened life due to his obesity.  Body weight or BMI as an independent measure of your risk of an early death is not a perfect measure.  For some, weight loss surgery offers a significant prolongation of your health, while for others, the benefits are minimal or even non-existent.  For those who already suffer from obesity related medical conditions like heart disease, diabetes, high blood pressure and high cholesterol, weight loss surgery significantly reduces your risk of early death, while those who are overweight without health conditions already have a very small risk of early death that will not be affected by a decision to undergo weight loss surgery.

Often times, I find that patients will use their fear of an early death as their explanation to others for their reasoning behind their decision, while, in reality, their decisions are much more emotional and personal.  This is a perfectly reasonable tact.  Just as you should never choose to undergo this surgery for someone else, you also should never feel as if you have to rationalize your decision to others.  If you are questioned by others about your decision, it’s important to be open minded about the reasoning behind the questions.

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