Most people who make the decision to have bariatric surgery to enable them to lose weight have thought long and hard about what this entails. Of these people, very few have addressed the psychological aspects of their eating pattern. They are provided with all the necessary information and they know it will be a challenge but the thought of being able to move around freely, to re-engage with life and to feel as if they ‘fit in’ outweighs the concerns they have about adapting to a new eating regime or the pain of surgery. I have heard many people say that the surgery will provide them with a ‘new start’.
I can definitely see the benefits of this new start as, apart from anything else, I have seen the despair, anxiety and depression that obesity can bring. A new start is a good way to jump start motivation and increase self esteem. However, if the weight was caused by depression and anxiety it’s highly possible that this will remain after the surgery. Imagine how frightening it can feel when the weight has come off but the low mood and desire to comfort eat remain? After all, surgery success depends on being able to change and maintain changes in dietary habits. Something that for many was too difficult to do prior to surgery.
I frequently run a bariatric cognitive therapy group to help people to address this problem. Some of the group have had the surgery, some are waiting for it. All of them desperate to ensure the weight does not return. Many of the people in the bariatric groups I talk to say that they recognise that their unhelpful eating patterns started in childhood.
Some people say it was children at school who first made comments about their weight, some were bullied and this drove them to find comfort in food. I have had clients bring photographs in of themselves when they were young. They look at these photographs and say “I thought I was fat, but I look at this photograph now and I wasn’t, I was perfectly fine.” “Why did my Mum put me on a diet?” “Why did I think I was fat?” This causes so much pain as each person recalls a life spent going from one diet to another and feeling a sense of failure when they put the weight back on, when there wasn’t really a problem in the first place. What caused the problems for them was the practice of ‘dieting’ which involved starving the body of food for long periods, a real test of resistance. Resistance was and will always be key to these diets. The misinformed belief that going without food for long periods is good and any break from this is bad; and a sign of weakness, keeps the cycle going. These kinds of diets are bound up in failure.
During the course of the group session I usually ask for a show of hands for how many people have been on a diet. Every hand goes up. Then I ask who has been on two different types of diet, hands stay in the air, more than two? More than ten? Most hands still in the air and getting tired. More than twenty? More than fifty?! Unbelievably some hands remain.
‘Dieting’ is a slippery slope, I believe it’s the gateway behaviour that leads to obesity. The more I hear about diets the more suspicious I have become of them. They lead to negative thinking about yourself “I am a failure.” “I can’t do this.” “I’m different.” “I have no willpower.”
If you had taken your driving test ten times and failed how high would your belief in your ability to drive be? Each time you began your test how positive would you feel that you would pass? You might change your instructor but with each failure self belief is eroded. Over the years people who have been on diets have carried this sense of failure with them. Each time the weight is regained the sense of failure is compounded. “I’m a failure” feels like a fact. Surgery can understandably feel like the final option, as self belief in weight loss through any other method is at ground zero
The current advice being given for weight loss is to eat regularly [up to 6 times a day if you include snacks]. This advice goes against all of the dieting rules that people have been trying to adhere to for years and can be difficult to hear – Eat regularly to lose weight? I don’t think so!
I once saw a gentleman who told me he was ‘craving’ fish and chips and knew he would soon break his rule not to eat them anymore. During therapy we had drawn out his pattern of weight loss and weight gain. He had identified that ‘breaking dieting rules’ was part of his cycle of failure. If he broke a rule he would give up and think “What’s the point?” His behaviour would then be to eat anything that he had previously banned. When I suggested that a way to break the cycle might be to buy some and share them with his family he was horrified. This went against all of the dietary beliefs that he had and he told me so. I asked him how his dietary beliefs had been working for him so far? The following week he came back to therapy and reported that he had eaten some fish and chips, and he had used thought challenges to ensure had not fallen into the trap of believing he was a failure.
Following completion of his CBT sessions this gentleman went on to have bariatric surgery and told me that he felt more prepared and less fearful of failure.
For those people who have been on numerous diets take heart, it is not you who have failed. Diets have failed you. They don’t work. Use this information to help to challenge those negative thoughts you have about your ability to maintain weight loss. Remember that years of thinking you are a failure will be activated at this time. Ask yourself what I always ask my clients in therapy. Is a thought a fact? Is a belief a fact? If they are not facts what are they? - They are just thoughts - and you can challenge them.