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Treating the mind first?

lady_myst
on 8/28/12 10:50 am
Recently, the state I live in, Iowa, attempted to stop medicaid from paying for WLS.  That decision was overturned.  Why should it worry everyone that it was attempted?  Well, because if medicaid sets this as the norm, so can YOUR insurance.  Okay, so fast forward.  One of the reasons that they tried to not cover it was because they said it had a high failure rate.  Hmm.  Okay. (not sure i agree but debates rage) So I wondered what could be done to improve the success rate...

Not everyone who has wls has an eating disorder.  I just want to make that clear.  It is my opinion that the majority do have issues with food.  You can take it or leave it but thats my opinion.  WLS treats the body.  It is a tool.  We have hashed it around on this site and most can at least agree to that. 

I would also submit, again my own opinion, that the mind needs treated as well.  I personally sought out treatment for a couple of years before surgery.  I was one of the ones who DID have an eating disorder.  I needed to learn about my disease and more importantly, coping skills other than food to deal with things in life.  It was a personal choice and as I get further out from surgery and things get a little harder weight loss wise, it is a decision I am glad I made. 

With a surgery this expensive, and it being a once in a lifetime shot for me, I wanted to have every opportunity to succeed.  We HAVE to have psych evaluations in most cases.  ANd many insurances also require 6 months of dieting under a doctor.  So, what if, in those 6 months, you also meet with a counselor and gain some tools to deal with stressors or emotions?  I mean, I was so desperate to lose the weight, so hopeless because of failed attempts, I was willing to jump through any hoop they gave me.  Instead of dismissing it across the board and calling it a failure, what if we were willing to set people up to succeed?  WOuld you be willing to do 6 visits with a therapist to get your surgery?  Do you think it would have or will help you?  How do you feel about this as a requirement if it meant that insurance companies would still cover the surgery? 

I am working on a presentation and any of your thoughts and opinions would be appreciated.  Agree, don't agree, hate it or love it.  I want to hear it all.  Please tell me why though!  The more the merrier.  THank you in advance for your time. 
                
Kat1313
on 8/28/12 11:03 am - Jacksonville , FL
RNY on 04/08/13
Yes, I would most definitely be willing to do 6 (or more) visits with a therapist to get my surgery.  I am still preop but have completed all but the 3 month supervised diet required by my insurance.  I have already arranged to have ongoing appts with the therapist who did my psych eval because I KNOW I need help getting my head straight. 

I'm not sure how I feel about this being an insurance requirement.  It would probably be beneficial for most people and hopefully increase the long term success rate for WLS.  However, sometimes I feel that (some) insurance companies have multiple requirements for WLS to possibly discourage patients or even in the hope that patients will fail their "requirements" and they won't have to pay for the surgery.  This may just be my paranoid little mind thinking, but I'm on the fence about this being a requirement. 
FoodAbuser
on 8/28/12 11:20 am - NC
Well I am one of the ones WLS didn't help.
Yes, I lost weight.
Then years later regained almost all of it.
I had a revision and only lost about 50#.
Then I regained all of my original weight plus about 10#
Now I am starting over. No additional surgery but restarting the diet from step one.
Right now I am back on track but I don't know how long that will last.
I am a supporter of psych help prior to and during and after WLS.
Had I had support or psych help I may not have undone all my hard work.
        
MsBatt
on 8/28/12 12:21 pm
On August 28, 2012 at 6:20 PM Pacific Time, FoodAbuser wrote:
Well I am one of the ones WLS didn't help.
Yes, I lost weight.
Then years later regained almost all of it.
I had a revision and only lost about 50#.
Then I regained all of my original weight plus about 10#
Now I am starting over. No additional surgery but restarting the diet from step one.
Right now I am back on track but I don't know how long that will last.
I am a supporter of psych help prior to and during and after WLS.
Had I had support or psych help I may not have undone all my hard work.
Just curious---do you think you would have done better with a different form of WLS?
FoodAbuser
on 8/28/12 2:42 pm - NC
I had an open RNY.
I don't think the type of surgery would have made a difference.
I just think my psych issues and my addictive food behaviors have made me regain.
MsBatt
on 8/28/12 3:21 pm
On August 28, 2012 at 9:42 PM Pacific Time, FoodAbuser wrote:
I had an open RNY.
I don't think the type of surgery would have made a difference.
I just think my psych issues and my addictive food behaviors have made me regain.
Have you read this thread?

www.obesityhelp.com/forums/amos/4416773/quotDoes-the-Patient -Fail-the-Procedure-or-Does-the/

It contains an article by a well-known bariatric surgeon who thinks it's very importantto choose the proper procedure type for the individual. I'm certain that this is one area in which counseling could be very significant.
akr9911
on 8/28/12 11:28 am
VSG on 06/20/13
I definitely think that the mind plays a big role in my struggle with weight. Food is a companion (even though I have many other human companions in this life) and a comfort and stress-reliever. And it tastes really good to me too. I am pre-op too but I know that I have to address some of the internal issues as well as the diet plan if I'm going to be long-term successful. I have gotten the weight off before - at least some of it (40-50 pounds). But I don't keep it off. I get lazy, I get tired, I don't prioritize myself enough. So I think I need to spend these 6 months of pre-op nutritional counseling with not only the surgeon's shrink but also with my own. I want to be prepared for what this will mean for me for the rest of my life. And I want to be emotionally prepared for something I've never been: a thin person. I suspect I will uncover more than my hip bones when I lose this weight once and for all. I hope I am comfortable with her but I suspect I will need someone else's counsel to embrace Skinny Me fully.
mollypitcher08
on 8/28/12 12:13 pm
So glad to see something like this for discussion/opinion(s).  I pretty much agree with you in that I do not feel there is enough emphasis on the pschological aspects of WLS PRIOR to the surgery and just exactly your reasons for having it.  I just feel that yes I certainly would go for 4, 5, or 6 counseling sessions if needed.  I mean, it took me pretty much a lifetime to gain all the excess weight what's a few months of sessions to possibly show my why /where my eating problems are coming from?
I think there is a need for more bariatric psychologists or psychologists trained in eating disorders.  Perhaps there are some out there-- I only went to a psycholgist recommended by my bariatric center, and I filled out a questionnaire, he asked me a couple of questions, and bingo, I was cleared for surgery.

I did have to follow a diet but when I only lost about 15# they still ok'd me for surgery.  I am happy I had the surgery.  The surgery in  itself works.   I think required visits to some sort of psychologistcould be a good thing indeed.  I lost 210# total from my highest weight of 450#.  I am now at 275# a 30+lb gain. in 4 years after surgery.  I am not happy but coping as best I can and trying to get back. 

I read and see many re-gains and then revisions to other types of surgeries and wonder if part of the problem isn't that food issues were never dealt with or resolved in the first place.  Oh well, I guess if I knew that I could be alot thinner and richer myself!!!

Thanks for your post.  It made me stop and think.  Psycholgical issues can indeed perhaps be the root cause of so many problems! Treat them and in conjunction with WLS health will be forthcoming.  I am still waiting to get to a size 18!!!
poet_kelly
on 8/28/12 12:19 pm - OH
On August 28, 2012 at 10:50 AM Pacific Time, lady_myst wrote:
Recently, the state I live in, Iowa, attempted to stop medicaid from paying for WLS.  That decision was overturned.  Why should it worry everyone that it was attempted?  Well, because if medicaid sets this as the norm, so can YOUR insurance.  Okay, so fast forward.  One of the reasons that they tried to not cover it was because they said it had a high failure rate.  Hmm.  Okay. (not sure i agree but debates rage) So I wondered what could be done to improve the success rate...

Not everyone who has wls has an eating disorder.  I just want to make that clear.  It is my opinion that the majority do have issues with food.  You can take it or leave it but thats my opinion.  WLS treats the body.  It is a tool.  We have hashed it around on this site and most can at least agree to that. 

I would also submit, again my own opinion, that the mind needs treated as well.  I personally sought out treatment for a couple of years before surgery.  I was one of the ones who DID have an eating disorder.  I needed to learn about my disease and more importantly, coping skills other than food to deal with things in life.  It was a personal choice and as I get further out from surgery and things get a little harder weight loss wise, it is a decision I am glad I made. 

With a surgery this expensive, and it being a once in a lifetime shot for me, I wanted to have every opportunity to succeed.  We HAVE to have psych evaluations in most cases.  ANd many insurances also require 6 months of dieting under a doctor.  So, what if, in those 6 months, you also meet with a counselor and gain some tools to deal with stressors or emotions?  I mean, I was so desperate to lose the weight, so hopeless because of failed attempts, I was willing to jump through any hoop they gave me.  Instead of dismissing it across the board and calling it a failure, what if we were willing to set people up to succeed?  WOuld you be willing to do 6 visits with a therapist to get your surgery?  Do you think it would have or will help you?  How do you feel about this as a requirement if it meant that insurance companies would still cover the surgery? 

I am working on a presentation and any of your thoughts and opinions would be appreciated.  Agree, don't agree, hate it or love it.  I want to hear it all.  Please tell me why though!  The more the merrier.  THank you in advance for your time. 
I was in therapy for several years prior to my WLS and continued in therapy after surgery. I was in treatment for depression, PTSD and dissociative identity disorder, but of course it helped me deal with food and weight-related issues, as well.

I don't think six visits with a counslor would be of much help, though, to be honest.  I mean, maybe it would if someone didn't have any type of mental health disorder like depression and if they did not have an addiction to food or an eating disorder and they already had fairly good coping skills.  But in that case, they probably wouldn't really need those six visits.  I don't think six visits is enough time to provide much assistance in terms of dealing with stress or emotions, and it's definitely not enough time to treat an eating disorder or food addiction.

I also object to the idea of insurance companies requiring counseling for all WLS patients.  I don't think we all need it.  I think many of us do, but I think many people that don't have WLS could benefit from some counseling, as well.  But I object to requiring it for everyone, as if all morbidly obese people have the same needs.

And I think that if people saw it as just a few more hoops they had to jump through, they wouldn't benefit that much from it.  Mental health treatment is often not real effective if patients don't want the treatment.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

Ladytazz
on 8/28/12 12:26 pm
As a WLS failure I couldn't agree more.  When I had my first WLS all I had to do was go to the surgeon, verify my insurance and make an appointment.  No pre op education and very little in the way of follow up.  I didn't even require a psych eval.  I knew I was a compulsive overeater and I thought WLS was the answer to my problems.  It didn't help that there were those around me that also bought into that impression.  On the forum I belonged to we exchanged recipes like the Krispy Kreme bread pudding and had social get togethers that included tables of food like desserts, breads and main dishes of pasta.  In 2002 there was a lot to learn about WLS.
I still cringe when I hear about people saying "X pounds lost forever!"  Or "I never have to diet again!"  For me that just wasn't true.  Not that I diet but I can't eat the way I used to or even want to if I want to keep the weight off.  WLS didn't cure my eating problems like I fantasized it would.  It didn't make me like healthier foods or be turned off by my favorites.  It didn't turn me into the normal eater I thought it would.  All it did was make it possible to be satisfied with smaller amounts of food and to curb my previously insatiable appetite.  Everything else is on me.
I am so glad that I was able to be honest with myself, at least to this point.  Nothing is permanent for me.  Tomorrow I could be eating my brains out.  I am very careful not to take things for granted and to always acknowledge my inability to eat like others seem to be able to.  I definitely think WLS should be a lot harder to get then it was for me.  I'm not sure what would be the appropriate protocol since all people are different and we all have different issues and many are good at being deceptive about their food issues, especially with themselves.  I do think the success rate for WLS could be improved if there were better screening and pre op requirements, along with more post op support.

WLS 10/28/2002 Revision 7/23/2010

High Weight  (2002) 240 Revision Weight (2010) 220 Current Weight 110.

jennyrenny
on 8/28/12 12:38 pm - Canada
DS on 08/11/12 with
 I agree with the majority of what you said. A lot of us do have food issues that need to be dealt with. I am a revision and did a lot of self exploration regarding why my first surgery didn't work. I think it was partly because the lapband sucks but I also think it had to do with me thinking the WLS would do the work for me. 

Although I agree that therapy would be beneficial pre and post op but I worry that people would not be able to be totally open if they fear doing so would affect their chances of getting surgery. Perhaps keeping the therapy separate is the best option. I don't know.
            
HW: 365, SW (August 11, 2012): 351
    
Ladytazz
on 8/28/12 2:08 pm
I think that any person who was unwilling to agree to some kind of pre op treatment prior to surgery would probably be a poor candidate for surgery anyway.  There are a lot of things that you have to do after surgery in order to be healthy and successful and if they aren't able to comply prior to surgery then the chances are they won't be much better afterwards.

WLS 10/28/2002 Revision 7/23/2010

High Weight  (2002) 240 Revision Weight (2010) 220 Current Weight 110.

Eggface
on 8/28/12 2:25 pm - Sunny Southern, CA
6 therapy visits would/could help but really... this is a lifetime battle. The "head stuff" is the hardest and most important component to WLS and it doesn't end. The day after you reach that magic goal weight # on the scale... no balloons fall from the sky it's just more of the same... rinse, lather, repeat, FOREVER. Life will happen. It could be a family party or a trauma or just a frustrating day with kids or work or.... something will come up that will send you seeking your old frienemy food.

So IMHO we'll always be a work in progress (this is not a bad thing) and we need to take each day one day at a time with support (friends, family, forums, support groups, therapists, medication whatever YOU need), try to figure out our "stuff" and the why's of why we became obese and work on it. Some days we'll succeed (healthy choices, moving the body, being kind to ourselves in body & mind, knowing our triggers and avoiding them, slaying old demons, etc.) some days the enemy will get the upper hand... we've got to just keep moving forward.

Just my 2.5 cents ;) (inflation)

~Michelle "Shelly"


Weight Loss Surgery Friendly Recipes & Rambling
 www.theworldaccordingtoeggface.com 

mcrowder
on 8/29/12 3:25 pm - NC
RNY on 05/03/13
I too agree with you on the psych. I feel that some do not realize that the need help myself included. It was offered to me during my WLS journey. I think I will double check with my doctor this time and whatever help is available to succeed this time.
bigbadjon
on 8/31/12 2:59 pm - OH
Thank you for bringing this up. First, to answer your question... I think a comprehensive psych eval should be one of the first things to occur when a patient expresses the desire for WLS. I do not agree, however, that counseling be mandated in order for insurance approval - not everyone needs it.

I was looking for this exact topic on the forum because I dropped out of one program due to my emotional issues; and am now seriously considering getting back into another program. My greatest fear is that I will have surgery, but will not lose or will gain back my weight. I've lost before on diets. Seven years ago, I lost 200 pounds on a dr. supervised diet. I have since gained back 250 lbs. It isn't the diet itself that scares me. It is the fact that I suffer from clinical depression; and often use/abuse food as a coping mechanism. The first time I entered a WLS program, my NUT and I talked about my emotional eating. She questioned how I was going to be able to change that after WLS. At the time, I answered that I hoped the WLS itself would force a lifestyle change. I didn't believe my answer at the time. The NUT's frank questioning scared me to the point of dropping out. I knew that I did not have my head straight. I could see myself falling into a deep depression and drinking a bottle of Karo syrup.

So, now once again, I'm scared that I could have WLS because I feel desperate. But I'm not prepared to deal with the emotional issues I've had my entire life. I do believe I will require myself to go through extensive counseling prior to entering a program.
MsBatt
on 8/31/12 4:24 pm
On August 31, 2012 at 2:59 PM Pacific Time, bigbadjon wrote:
Thank you for bringing this up. First, to answer your question... I think a comprehensive psych eval should be one of the first things to occur when a patient expresses the desire for WLS. I do not agree, however, that counseling be mandated in order for insurance approval - not everyone needs it.

I was looking for this exact topic on the forum because I dropped out of one program due to my emotional issues; and am now seriously considering getting back into another program. My greatest fear is that I will have surgery, but will not lose or will gain back my weight. I've lost before on diets. Seven years ago, I lost 200 pounds on a dr. supervised diet. I have since gained back 250 lbs. It isn't the diet itself that scares me. It is the fact that I suffer from clinical depression; and often use/abuse food as a coping mechanism. The first time I entered a WLS program, my NUT and I talked about my emotional eating. She questioned how I was going to be able to change that after WLS. At the time, I answered that I hoped the WLS itself would force a lifestyle change. I didn't believe my answer at the time. The NUT's frank questioning scared me to the point of dropping out. I knew that I did not have my head straight. I could see myself falling into a deep depression and drinking a bottle of Karo syrup.

So, now once again, I'm scared that I could have WLS because I feel desperate. But I'm not prepared to deal with the emotional issues I've had my entire life. I do believe I will require myself to go through extensive counseling prior to entering a program.
http://www.obesityhelp.com/forums/amos/4416773/quotDoes-the- Patient-Fail-the-Procedure-or-Does-the/

I strongly urge you to read this thread---I think you'll find a lot of good info there.