Lynette1962

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When self-induced vomiting becomes habitual it is very dangerous, and, as any bulimic knows, purging is powerfully addictive. If it happens more than twice a week over several weeks you should seek professional help as quickly as possible.

Clothes Shopping
Shopping for clothes is a terrific high for many bariatric surgery patients. Some have never been small enough to buy normal sizes in regular stores, so reaching that goal is momentous. It's important to celebrate such milestones and to buy new clothing that fits well and feels good. Clothing that looks good and makes us feel attractive can provide a helpful boost of confidence for our morphing bodies.

Post-ops should be wary, however, of the potential for overindulgence in clothes shopping and the return to compulsivity that can develop around this behavior.  Overindulging in clothes is a close relative to overindulging in food; both are cover-ups. Newly slim post-ops may be drawn to clothing as a way to prolong the attention their weight loss initially generated and may now be waning. They may feel seduced by the excitement that surrounds the world of fashion and clothing. It's easy to be caught up in this thin obsessed western culture and clothing may feel like an important ticket into that world. Beware! The world of fashion is a world plagued with eating disorders. Weight loss surgery aims to move you toward health. Your love and acceptance for yourself does not depend on your size or the style of your clothing. New clothes seem to provide an emotional fill-up, and as with other behaviors that become compulsive, the temporary relief heightens the need for repeat fill-ups. Dependence is established on that need for more. The real need is for self-acceptance and balance. Using clothes shopping to cope with feelings is a dangerous path back into compulsive behavior. Enjoy your new clothes and size as just one part of the many ways your new body is changing and enjoying better health.

Spending Money
Spending money on anything to cover up your real feelings or problems is another way to substitute for overeating. Overspending, like overeating, seems to sooth us for a short time and temporarily helps us manage our emotions. New toys, electronic gadgets, CDs or DVDs, trinkets from the mall or souvenirs from trips can pile up around us like insulation. What are we trying to cover up? This is the time to figure it out. There can be a very addictive quality to spending money regardless of the items purchased. For big wallets, compulsive spending might mean more furniture, more art, more antiques, newer cars, etc., but any new acquisition that gives us a brief lift or a momentary respite from reality can begin a pattern of spending that becomes compulsive. Spending feels exciting and dangerous at the same time. Sometimes you can feel your heart pounding as you pull out your credit card. Those are powerful feelings, and all that adrenalin makes you feel very alive, but spiraling spending can be devastating to long-term security and financial health. Find your excitement in simpler ways and learn to know and love the new person your WLS has uncovered.

Relationships
Long years of morbid obesity and social ostracism leave many post-ops with powerful feelings of low self-esteem. Even after WLS our old fears of rejection will battle with our longings for acceptance. In the absence of compulsive overeating to sooth such intense and conflicted feelings, the emotional ride into recovery is likely to be rocky. Surgery can help patients acquire a more normal looking body but the transition into better self esteem and real body acceptance is much more complicated.

Adults who were morbidly obese as teens will not easily forget the profound isolation they endured. Anger may assert itself in aggressive ways. Personalities that were unflappable and compliant before surgery seem to rise up in righteous indignation afterwards pushing away anyone who tries to get close. Friends and family will feel this wrath and resent being targets of this rage. Some post-ops will be tempted to throw out old relationships along with their larger clothes and start anew. Sometimes pre-op relationships are toxic enough to warrant this but it?s important to go slow here. Relationships that were rocky before surgery will probably get rockier and may eventually have to be abandoned, but relationships that were solid before surgery will likely weather the transition and be even better in the end. Post-ops need to take their time and be sure to make wise choices. Friends and family are never perfect but they are precious resources; protect them from your swirling emotions until you arrive at a calm and stable place in your recovery. You need to understand your anger and compulsive urges and develop lots of new effective coping strategies. It will take at least two years?or even longer for many. 

Substance Abuse
Alcohol is a high-risk substance for all bariatric patients. Most discover the change in their tolerance for alcohol early in their recoveries. Patients who have persistent dumping syndrome will find it uncomfortable and unpleasant to drink at all. Others may enjoy a new and pleasant sensation of intoxication that they have not experienced before. Post-ops need to exercise extreme caution with alcohol.

Alcohol and other drugs can anesthetize some of the powerful feelings that patients notice after surgery; these substances also reduce normal inhibitions. This is a dangerous combination for people who are trying to get used to life without their old and best coping mechanism: overeating. Recovering patients need to feel, and cope in healthy ways, without covering up. Even a small portion of alcohol can cover up important feelings, obscure danger and induce a very vulnerable and impaired state after surgery.

Alcohol intoxication is short lived for most post-ops. A small drink has a big impact but can disappear quickly. Post-op drinkers have trouble adjusting to these new parameters. Some patients may try to drink small amounts over longer periods of time in order to sustain the new feeling of intoxication they are enjoying.

Driving risks will be magnified more than normal for post-ops under the influence of alcohol. People who are used to feeling safe after one or two drinks at a meal will no longer be able to operate their cars safely using that formula. At the same time it is easy to underestimate these risks because the amount of alcohol consumed seems so small.

Sex
Most people dream that after WLS they will finally realize the love and happiness their morbid obesity and disfiguring weights denied them before. Some patients are keenly disappointed when broken marriages don't revive after surgery and romance is more elusive than they imagined. A cautionary word about dating and sex is especially important. 

Adolescence and young adulthood are the times when most people explore their sexuality and look for life partners. But as we noted earlier, post-ops who were morbidly obese during adolescence are apt to be very inexperienced in matters of sex and dating, and may have very weak or inadequate social skills when it comes to sharing intimacy.

New daters often misread the cues and signals of their peers. They may unknowingly reach out to inappropriate partners when seeking physical and sexual acceptance. They didn't learn how and weren't taught the rules at the normal developmental stage of life. It's awkward and difficult to try to learn these skills later in life when everyone else already knows them. It would not be surprising to find adult post-ops engaged in dating scenarios more common to teens than adults. Risk-taking increases when sexually stimulated people experiment carelessly without their old coping strategies.

For a person who has had little positive sexual experience, the sense of suddenly being sexually alluring to another can be very exciting, seductive, and terrifying all at once. Powerful needs that have gone unmet for years will cause enormous pressure and may propel people into sexual experiences they are not prepared to have. New sexual appetites and behaviors are best explored slowly and carefully. If sex is used as a way to satisfy empty feelings and unmet longings it can easily become a compulsive substitute for overeating and block the formation of a wider, healthy range of coping skills. Promiscuity can develop and jeopardize the formation of healthy intimate relationships. In extreme situations a recovering patient may unwittingly place themselves in the very real danger of becoming the victim of an assault or a sexually transmitted disease.

Compulsive Computer Use
The internet is a natural pitfall for post-ops because they use it so extensively when researching their surgery and establishing their post-op support networks. It sometimes becomes a new best friend, or a habit-forming substitute for food and eating. Recovering overeaters also fall into excessive computer use to zone out or to cover up their feelings of loss or stress just as they did with food before surgery. The computer can be a lifeline for patients who are isolated or live in rural areas and many patients will want to take advantage of the enormous array of help available online but it's important to put appropriate boundaries around the time spent on the computer. It's possible to get so caught up in the online world that the real one slips away. Computer use becomes excessive when it interferes with business at work or with family at home or when it keeps us insulated from being fully present in our new lives. Instead of learning and practicing new coping strategies we substitute compulsive word processing, emailing and chatting for compulsive overeating. The first time the substitute fails to be effective overeating will be waiting to return. 

Exercise
Exercise is important for post-ops, as everyone should know, but exercise should be part of a thoughtful plan with moderation, consistency, and an appropriate goal in mind. I emphasize appropriate because exercise is about better fitness and health, not about losing weight. Unfortunately it is easy for compulsive overeaters to set unrealistic expectations for exercise, especially in the first few months after surgery. The set-up is very dangerous. The novelty of surgery generates high levels of excitement early in recovery, but failing to stay with an unrealistic exercise regime can throw a tender new life style far off course. Our old patterns of behavior with food resurface quickly almost as if they have been waiting in the wings. Failing at over-exercising translates quickly into failing at all exercise and eventually failing at recovery altogether. If we fail at extreme exercising we must be one of the hard-core losers who just can't do it. We throw our baby surgical tool out with the exercise bathwater and then wonder why surgery didn't work.

Another concern is the bounce-back regain. Some patients who engage in a strenuous exercise routine over the first post-op year will lose more weight than their body is able to maintain. As soon as the strenuous exercise routine ends (and it almost always does) patients experience a 10 or 15 or even 20 pound bounce back. The bounce back precipitates a crisis of faith in surgery and a panic about regain. Dieting and yo-yo restricting begin out of habit and patients find themselves in the familiar territory that fueled their morbid obesity in the first place.

When establishing a post-op exercise routine, emphasize how great exercising makes you feel. It should make you feel good! It?s hard to find the time for this important part of life but exercise shouldn't hurt?and it shouldn't ruin the day if we do or don't do it. Exercise can become a very cruel overseer if we espouse the no pain, no gain philosophy. That kind of exercise begs us to quit.  It also sets a very negative tone for the day if it feels like an obligation instead of a contribution we make willingly. It's a little like excessive-compulsive weighing on the scale. It's important to keep an eye on the scale on a regular basis, but if your day is completely colored by the numbers on the scale or the number of reps or sit-ups, then something is out of kilter.

Some would argue that compulsive exercise is healthy better than compulsive eating. They fantasize about cultivating exercise as a new and healthy addiction. Don't fall for that trap. Obsessions and addictions are never healthy and anyone who thinks they are has never seen the pain in the eyes of a young anorexic running in place, alone in her darkened room at night, or the frenzy of a binge-eater with no more ice cream.

Compulsivity doesn't disappear
Compulsivity is a main ingredient in the morbidly obese person?s lifestyle. Surgery doesn?t make it go away. We need to learn to manage our compulsiveness in healthy, constructive ways. Compulsivity is likely to linger for most post-ops. It will be very tempting to substitute other compulsive behaviors to fill the space over-eating occupied before surgery. We will have to learn to recognize our pressing urges, and plan effective ways to deal with them and with the feelings associated with them. Compulsive and addictive behavior is not healthy. When any activity or substance becomes compulsive or excessive we need to figure out why. When compulsivity begins intruding on our normal routines or begins stealing time and money that belongs to our work, our families, and our friends, then something's wrong.

Gastric bypass surgery gives us a tool to battle back and makes it possible to triumph over obesity, probably for the first time, but we must learn to use it well.

What will fill you up?
So you and I and Lucy will still need to deal with our compulsive behaviors after surgery. The answer to her excellent question about where all that compulsivity goes after surgery is clear. Nowhere! I told her that her recovery time is the time to develop a better understanding of what things and behaviors really fill her and are healthy for her. I urged her to be realistic about her own compulsivity and needs. I suggested she make lists of the dependable joys in her life. I suggested she pay closer attention to the times she felt happy and fulfilled. Her friends and loved ones could help her identify them too. I told her to write down these small joyous moments. We all need to see more of our good and celebrate it. We need to plan to change the things that need changing and get started. Catalogue specific things that have helped you to ward off anxious moments or get through food-filled obligations in the past without losing control. Write your own book of 101 things to do instead of overeating. Weight loss surgery can inspire your efforts but effort will still be needed. Use your precious post-op honeymoon to put your recovery first and make it solid. Get the help you need to do it right. Fill yourself with love and hard work and success. 

Just a little food for thought!