long term wls success

7 Psychological Barriers to Long-Term WLS Success

December 8, 2016

Bariatric Surgery, or “weight loss surgery,” is an effective tool to help you reach your weight loss goals. But weight loss surgery is just that, a tool. As part of your preparatory regimen before you had surgery, you may have met with a physician, dietitian, and a psychologist to help you prepare for all of the complex changes you are required to make before and after surgery. You may have wondered, “Why do I need to meet with a psychologist?” as part of your pre-operative preparation.

It has been shown that those patients who address emotional factors pre-operatively have better success with weight loss maintenance (Toussi et al., 2009).

Many patients begin to realize that having the surgery is more than just changing eating habits. It requires you to change your lifestyle, old habits and your emotional relationship with food. Psychologists that specialize in health behaviors, namely weight loss, can help you identify and anticipate emotional factors that are or can become barriers to long-term weight loss success.  As a mental health professional, I’ve identified the top 7 barriers that get in the way of long-term WLS success.

7 Barriers That Get In The Way of Long-Term WLS Success

  1. Forget that the old habits are what led to weight gain
    It can be very exciting to see the amount of weight you lose after surgery. However, patients must realize that weight loss is one facet of long-term weight loss success. I often see patients allow old habits such as dessert after dinner, grazing, reintroducing “slider” foods, or increasing portions sizes to creep back into daily eating habits. Heading down this slippery slope can lead to weight regain—which can leave you feeling defeated and in the cycle of yo-yo dieting that you may have been in the past.
  1. Stray from the Basics
    Your bariatric dietitian likely provided you with a handbook of post-operative diet basics. It’s easy to feel bored with some of the same foods, but they provide the vital nutrition that will help you to reach long-term goals. Any time patients feel like they are straying too far from their diet, I remind them to take a look at their surgery handbook and keep their diet simple. This reminder can lead to feeling a sense of empowerment, control, and encouragement.
  1. Miss Post-Operative Follow-Up Appointments
    Whether you have regained some weight, are stuck, or are doing great, attending all post-operative appointments is vital to long-term success. You may think that it’s been a long enough time in months or even years and that you are doing fine, but our bodies change over time. At these appointments, your bariatric care team can help to address issues related to physical and psychological well-being.
  1. Don’t Use Support
    While your friends and family are imperative in providing a post-operative support system, remember that your bariatric center likely offers peer support groups. Peer groups can be a valuable resource to help you over any hurdles and keep you from feeling isolated post-operatively.
  1. Allow Stress to Get the Best of You
    Stress has detrimental effects on our body (Chao et al., 2015). It can often cascade into poor eating choices, less activity, and weight gain. Finding healthy coping strategies or practicing stress prevention techniques can help you to overcome stress-related weight gain.
  1. Make Health Less of a Priority
    We’ve all heard them— the reasons (or excuses) — such as lack of time, family obligations, cost, etc. Before we know it, we’ve regained weight, are burned out and feel defeated. In the process of preparing for surgery, you made time for appointments, tests and changing your eating/exercise habits. All of your other obligations were met with some adjustment. Take some time to re-prioritize your health.
  1. Succumb to Emotional Eating
    Weight loss surgery changes how much you can eat, what you can eat and how you eat. However, it will not necessarily change the relationship you have with food. Emotional eating is a complex behavior that we all engage in sometimes to some degree. You may be suppressing negative emotions (i.e.: I’m feeling sad, this treat will help me to feel better) or enhancing positive emotions (i.e.: It’s time to celebrate, I am going to indulge). Recognizing these eating behaviors and adjusting your habits is critical to long-term weight loss success.


Toussi, R., Fujioka, K. and Coleman, K. J. (2009), Pre- and Postsurgery Behavioral Compliance, Patient Health, and Postbariatric Surgical Weight Loss. Obesity, 17: 996–1002. doi:10.1038/oby.2008.628

Chao, A., Grilo, C. M., White, M. A., & Sinha, R. (2015). Food cravings mediate the relationship between chronic stress and body mass index. Journal of health psychology, 20(6), 721-729. doi:10.1177/1359105315573448

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Jennifer M. Duncan is a clinical psychologist in the Weight Management Institute at Summa Health. She provides mental health services to surgical and non-surgical weight management patients. Services include psychological evaluation, psychological testing, and supportive psychotherapy to patients with eating and weight issues.

Read more articles from Dr. Duncan!