Four on the Floor: Self-Care After Weight Loss Surgery

January 9, 2013

Four on the Floor: Self-Care After Weight Loss Surgery

My family spent much of my childhood in the kitchen. It is where we ate, but also where we socialized. It is where I did my homework and where we watched television. It was where I attempted to master the art of balancing on only two legs of the kitchen chairs. I can still remember my mother admonishing me to use all the legs. She would say, “The chair has four legs for a reason, use them.” I managed to avoid cracking my head open as she predicted, but I did eventually get hurt.

With this in mind, I have been thinking about how your weight loss team can be seen as four legs of a chair. These four legs are medical, nutritional, fitness, and psychological. They work together to try to make sure that your treatment can be as successful as possible.

Despite pre-operative cautions, many patients continue to believe that permanent weight loss is a certainty following surgery. Today’s weight loss procedures are incredibly powerful and do, at least initially, lead to significant and dramatic weight loss. It is hard in the face of this initial success to remember the cautions offered by the pre-surgical team and even harder to commit the necessary time and resources necessary to insure lasting weight loss. Understanding that the struggle with food and weight will continue throughout your life can be daunting, so the desire to see surgery as the ultimate solution is understandable, but the chair has four legs for a reason.

Your weight loss team can be seen as four legs of a chair. These four legs are medical, nutritional, fitness, and psychological.

- Medical: You must care for the procedure you have chosen. Your surgeon has given you instructions and rules to follow. Our approach is to share with the patient the rationale behind the rules in the hope that with this increased understanding, the patient will make the rule theirs rather than ours. Owning a rule always makes it easier to follow. There will be rules about not drinking when eating and rules about chewing carefully. There will be rules about carbonation and rules about vitamins and supplements, just to mention a few. Ask about these, commit to the reason behind them, and commit to following them. Follow up care is critical. Your weight loss surgeon will be a part of your life for many years to come.

- Nutritional: You have the opportunity to truly reset your nutritional clock after weight loss surgery. While the post-surgical food regimens vary somewhat from surgeon to surgeon, they all require that your diet begin with clear liquids and slowly move towards solid food. There may be some variety with respect to timing, but the pattern of transition is always the same. With this, you have the chance to change your patterns. Remember, it is important to change them for life, so make changes that you are prepared to live with! An occasional consultation with your nutritionist will pay off in pounds lost and goals achieved.

- Fitness: Medical research clearly encourages us to exercise daily. Our recommendation for patients considering or having had weight loss surgery is to walk every day for thirty minutes. Regularity and consistency is more important than intermittent intensity.  So begin today, begin at a slow pace, and don’t walk for too long. Slowly your walking will increase in intensity and duration. Finally, and importantly, record your activity in a diary or wall calendar. This will give you a yardstick other than the scale to measure your improvement. If you find your motivation slipping, a few training sessions may help. Variety in exercise can help prevent boredom. Remember, it is rarely fun to exercise at first, but many patients report that once it becomes part of their life, they look forward to it.

- Psychological: Recognizing how important psychology is to weight loss, your surgeon may have referred you to a psychologist prior to accepting you as a surgical patient. Many insurance companies require that a psychological evaluation be part of the pre-surgery work up. Having a mindset that includes the need for a full understanding of your own role in your obesity is critical to your success.

Food provides physical nurturance, but clearly provides emotional nurturance as well. People eat to sooth and comfort themselves in a variety of emotional states. As examples, some eat when they are tired, bored, angry, frustrated, anxious, or sad… truthfully the list is endless. However, food is best at satisfying hunger, so if you eat because of a fight with your spouse, the calories are unlikely to resolve the interpersonal problem. It is this mismatch between the problem and the solution that can lead to binging as the patient continues to eat in an attempt to resolve a problem other than hunger. Learning to eat for nurturance and learning to cope with other emotions in more direct ways is critical to success with any weight loss program. Learning to do this can be difficult, particularly for individuals who have not focused on their feelings in the past, but it is work worth doing.

I’ve seen many patients act as I did as an adolescent and try to balance their weight loss in a precarious fashion. The patients who do the best over the long term are those who become the most involved in their aftercare. Relying only on the power of the surgical procedure can lead to short-term successes, but never leads to long-term success. Sit on the chair squarely; pay attention to the medical procedure you choose, to nutrition, to fitness, and to psychology and your obesity can be a thing of the past. There are professionals available to help you with each leg, please do not hesitate to seek and accept their help.



James A. R. Glynn, PsyD, is a postdoctoral psychology resident for Sakowitz Counseling, PA, who specializes in the treatment of WLS patients. He can be reached in New Jersey at 973-696-0800.

Michael L. Sakowitz, PhD is a Clinical Psychologist, specializes in the treatment of WLS patients.  He can be reached in New Jersey @ 973-696-0800.