Emotional Issues

Emotional Considerations

Bariatric surgery has both physical and psychological effects. Please do not take these changes lightly. All patients need to consider this before and after surgery. Some of the feelings that you may experience include depression, frustration, anxiety, anger, disappointment, loss, helplessness, euphoria, excitement, joy and others. Many of these feelings have their foundation in physiological changes. Short term, the immediate sense of loss of food is often a cause for distress. Along with the rapid reduction in estrogen levels you may experience symptoms of depression, not unlike the “baby blues” Long term, you may be experiencing changes in body image and further awareness of the social implications of obesity.

Bariatric surgery is not a fix for your everyday problems with your spouse, friends, or family members, employment, or social life. This surgery will allow you to begin to gain control over one aspect in your life: your weight.

Although you have elected to have weight loss surgery to resolve your obesity, weight loss also changes the lifestyle you knew so well. Even with its problems and tensions, obesity was comfortable, simply because it was known. Now, that life is gone. When the reality of the new situation confronts you, it is natural to begin a longing for your old way of life.

This expresses itself in several stages. These stages include denial, anger, bargaining, depression, and finally, acceptance. Different people go through these stages differently. It is natural for some patients to experience denial before they have surgery, because they focus on the positive. They seem to understand the risks and complications, but often do not recall hearing about the emotional and physical stress that follows. After surgery is performed, some patients try to bargain for extra space in their stomach pouches. They overeat, experience the painful consequences, and may become angry for getting into this situation. This anger may also surface when other discomforts or complications develop throughout the recovery period. These feelings are difficult to accept or express openly, and depression may follow. Feelings of sadness and crying episodes can be common occurrences.

These emotional responses to surgery are completely understandable. They cannot be eliminated, but must be experienced and worked through. Adapting to the changes taking place in your body and your relationship to food can take many months. The final stage of acceptance will occur when you feel at peace with the changes brought about by surgery.

In the past, one of the best methods for you to cope with life stress may have been for you to eat. This method will no longer be useful, especially while your new stomach pouch is at its smallest. One of the keys to success of this surgery is to learn to replace those comforts with healthy activities. Replacement methods for coping will need to be learned, but this will take time. Try not to sabotage yourself. The experience of such rapid bodily change will likely be accompanied by many emotional ups and downs, depending on your age and sex.

There are many things that you can do to help yourself through the recovery and adjustment period. One of the most important aspects is the recognition and understanding of the experience of loss. Expect to have ups and downs as the weeks go by. If you are feeling teary and depressed, have a good cry. Do not suppress your emotions. They will surface again anyway. Use the journal in this guide to get you started. Going for a walk or adding other physical activities will help you manage this changing phase of your life.

Your adjustment and acceptance will also be eased by the realization that bariatric surgery, with resultant weight loss, will not solve your personal or relationship problems by itself. You cannot expect a perfect body or a perfect life after the weight loss. In fact, many new problems will develop because of the many new opportunities. These will need to be recognized and attended to. Try to be as positive as possible. As new challenges pop up, recognize them and develop a problem-solving approach.

Adjust your expectations. Set realistic goals and stay occupied with work, hobbies and exercise. You will also feel more positive if you look your best. Pay attention to hygiene, hairstyle, clothes – women may want to experiment with make-up. T a ake walk, listen to music, meditate or pray. Do things you always wanted to do. Enjoy the process of rediscovery. T alk to your spouse, family doctor, friends, other patients for support.

We are here to support you through the changes with personal consultations, support groups and workshops. Use your Pocket Journal and the Journal section in this guide to help you express your experience. If, at any time, you feel overwhelmed or otherwise need more assistance, please contact us. We will be glad to take the necessary steps to refer you to the best possible resolution.

Counseling

Occasionally, personal adjustment or relationship problems will persist after surgery. These should be addressed in professional counseling. Emotional counseling may be needed during the phase of adjusting to the new physique and the many changes that follow the surgery for clinically severe obesity. We can help recommend counselors who are qualified and experienced in working with people who have had weight reduction surgery. Do not hesitate to request this. Major changes can cause new problems to emerge or old ones to intensify. Our experience has shown us that in the period of stress, starvation and weight loss that occurs following surgery, mild to severe depression is common. You and your support person should look for the signs of depression: persistent sad, anxious or empty mood, loss of interest or pleasure in activities (including sex), restlessness, irritability or excessive crying, feelings of guilt, worthlessness, helplessness, hopelessness, changes in sleep patterns, decreased energy, fatigue, “feeling slowed down” thoughts of death and suicide, difficulty concentrating, remembering or making decisions, persistent physical symptoms that do not respond to usual treatment. Effective drug and psychological treatments are available.

With treatment, patients can improve and return to normal quickly. Unfortunately, most depressed persons do not recognize their depression. You and your support person need to be aware of the risks of depression in the recovery period and if present, we need to discuss possible treatment. Professional counseling can be a positive step toward a healthier adjustment.

Family and Friends

You can expect your family and friends to have varying reactions to your surgical experience and to the weight loss that follows. Although you hope y our loved ones will be supportive and helpful during your ups and downs, this may not always be the case. First of all, your partner or spouse has become adjusted to you and your obesity. This may result in a resistance to the change, taking the form of disagreement, mood swings, or refusal to support your dietary or exercise regimen. Keep communication channels open, recognize signs of distress in your partner, who is adjusting to the changes in your body and behavior. These changes will require your partner to relate in new ways to you. This takes time, effort and patience. If you are experiencing serious ongoing problems in your relationships, some short-term professional counseling may be helpful. Friends and extended family members also must adjust. Many of them will be positive and genuinely delighted for you. They will stick with you through highs and lows, and relate to you as the lovable, unique person they have grown to appreciate. Others have become secure in your obesity and will have difficulty adjusting to the new body you are developing. If they are also obese, they will be constantly reminded of their continuing problem as you lose weight. They may be quick to point out sagging skin, wrinkles and other disadvantages. They may envy your courage or physical health. Be open about your appreciation of them and their concerns for you. Recognize their ambivalence and talk with them about their own feelings. And finally, let people pull away if they need to for a while. Some time may need to pass before they sort it out for themselves. Your main responsibility is to care for yourself. Others are responsible for their own feelings and actions. Hopefully, most close family members and friends will eventually adjust.