First Social Worker Appointment

Good morning! 

Yesterday, I went to my first support group meeting as well as the required social worker (therapist) appointment.  We had a great talk and she asked me a lot of questions.  At the end of the session, she said "Well, it sounds like you did your research and are physically and mentally ready for this huge change.  My biggest concern is you reverting back to old habits and gaining back the weight after the surgery. This is something we will talk about at our next session."

I didn't know what to say to that.  I have a history, as most of us here do, of losing/gaining, losing/gaining.  That is why I want to do the surgery. 

I explained to her that, for me, it's shear fear.  I don't see myself going back to old habits out of fear that I will hurt my new tummy or have to go back for a revision.  Yikes!

Thoughts? 

I think it's a valid concern for all of us. She probably just wants to talk to you more about making sure you figure out new coping mechanisms (especially if you've ever been an emotional eater). It's one thing to have the fear holding us back but over time that fear does subside and it is crucial we learn new ways of dealing with stress etc.

So I wouldn't read too much into her comment and definitely don't think of it as dooming you to fail. Think of it more as you have someone who wants to work with you to make sure you succeed!

I wouldn't take the comment personally because, as you said, almost all of us have that history of up and down weight loss/gain.  I think this is a concern she must have for all her patients.  I was so worried about the same thing before surgery and I remember someone on OH telling me to focus on actually losing the weight before I worry about gaining it all back!  However, I didn't really deal with my food issues right away so after about 2 years, I started a regain pattern.  However, after I dealt with those food issues and started new habits of coping and facing my disordered and binge eating HEAD ON, I feel like I finally have a better relationship with food. I'm not "cured" by any means; it's still an every day thing but it's not my #1 focus anymore. 

Just keep doing what you're doing and take it one day at a time.  :-) 

Going back to old habits is always the downfall.  I posted a long missive about this on another board, and I think I should put some effort into it and work it up as a full blog post.

The gist of it was this:  WLS fails for the same reason diet/exercise/lifestyle changes fail.  WLS is a great tool, and it gives us an advantage that we don't have with just diet/exercise/lifestyle changes.  But it's still just a tool, and success or failure is based on what we do with it.

I've had friends who were banders who deliberately and consciously ate around their bands with cream-based soups and sugared sodas and ice cream because they (openly admitted, BTW) liked soothing their emotional issues with food.  They weren't interested in therapy, they wanted the surgery to be a magical fix for them without changing their habits.

I've had friends who had bypass, which has been more successful but mainly because they all have pretty severe dumping when they eat foods high in sugar and sometimes fat.  A couple of them have struggled a few years post-op with re-gain, but they sought counseling about their habits and got it reined in.

I only know a couple of people with the sleeve, and one is new enough that I can't tell anything from him.  But my sis is now a few years out from hers.  She had gotten to the point where she was not losing and was starting to gain back, because she refused to step away from sugared sodas.

I am only 5 months out, so the honeymoon effect is still very much there.  I can already see how easy it would be to eat around my sleeve.  I don't have any real food intolerances, so there's little negative reinforcement when I decide I want something I know isn't helping my weight loss.  And even with the fear of blowing what I see as my ONE reset opportunity for my set point, and serious health concerns if I remain obese, I can feel the pull of my old habits and lifestyle.  Those ingrained habits are incredibly hard to pull away from long-term.  Not impossible, but really hard.  Habits tend to trump fear over time.  It doesn't take a huge amount of calories over what you burn each day to start putting the weight back on.  If I don't lock down new habits and a new lifestyle in my honeymoon period, I'll be right back gaining weight as soon as that effect lifts.

So the concern about habits isn't about you personally.  It comes from seeing many patients have limited success or complete failure because the old habits creep back in and it is the biggest detriment to long-term success.

I feel like I beat the therapy drum too much sometimes, but I can't overstate what it's doing for me in my life.  I started therapy before WLS because I knew I had food issues that would need to be resolved for my health whether I had WLS or not.  I credit therapy equally with the surgery in my success so far.  I am finding new ways to fill my emotional needs without turning to food.  I can honestly say I don't numb my emotions with food anymore, and the urge to do so is fading away.  Now I've got a new struggle, with chronic illness I get to feeling horrible physically, and THAT drives me to eat junk food because either I don't have the energy to make good food, or I feel so awful that my brain tells me a sugar or carb infusion will make me feel better.  And it does, short term, but then I feel worse later.

Now I've got a new struggle, with chronic illness I get to feeling horrible physically, and THAT drives me to eat junk food because either I don't have the energy to make good food, or I feel so awful that my brain tells me a sugar or carb infusion will make me feel better.  And it does, short term, but then I feel worse later.  So I need to work on figuring out what my body is really trying to get, because it's not truly wanting carbs or sugar, and feeding what it needs instead of turning to the easy options.

In re-reading this post, I think it sounds terribly depressed.  It's not, really.  While this seems like it's a never-ending struggle, it really isn't.  I'm unravelling knots of issues that have been hurting my health for most of my life.  I get one knot unravelled, and there's another knot.  But this one's smaller than the last one, and easier to detangle because the bigger one is out of the way.  So I know at some point all the string will be straightened out, and then I can REALLY get going with my life.  It's progress that I've never had before, and it's a combination of therapy and the surgery that's given that to me.

Anyway, that's my take on it.  FWIW.  :)

I think it should be a real and valid concern for everyone.  The surgery won't change your brain - you've got to do that yourself.  And so many people don't.  

There is always the possibility that we can revert to our bad old ways.  This stuff is mostly mental.  The surgery just helps.  I've been at this for seven months now, and have had my sleeve for three.  I can tell you that for all my being a noob, I have mended my rotten ways.  I lost 67 lbs before surgery, and have lost 60 more since.  I have not had to deal with cravings at all, which is something I thought would be a big problem for me.  

I've even tried some of the "bad" foods just to see, and they have lost their appeal. There just isn't enough there in them to make it worth wasting the space that could be better used for protein.  A small treat once in a while is fine, and I am doing well with that, but the four Tastykake a day habit is gone for good.  I haven't even been tempted walking past the Tastykake display in the store.  :D  The weight loss and its attendant benefits have far outweighed the fleeting pleasure of various food items that got me to where I needed this.