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Headwork: Could it be the Missing Piece of a Bariatric Surgery Journey? Part 2

October 7, 2019

Successful obesity treatment must include the missing piece of headwork. Developing and maintaining a healthy mindset is just as important as healthy nutrition and exercise. However, as discussed in my first article of this series, too many bariatric surgery patients are missing this integral part of their treatment plan.

Living as a bariatric surgery patient without headwork tools is like trying to play baseball without a ball.

I look forward today to introducing you to the foundation of all headwork tools: Cognitive Behavioral Therapy (CBT).


Cognitive Behavior Therapy is a time-sensitive and structured talk therapy that is specifically tailored to the current needs of each individual client. “Cognitive” means thinking.

CBT therapists focus on solving clients’ current problems and teaching them skills to change their thinking and behavior.  An important goal of CBT is to teach techniques you can use for the rest of your life.

Thousands of research studies have found that CBT is effective for many different health and mental health disorders and psychological problems. (Retrieved from Beck Institute.)

As you read the definition of CBT, you may be wondering, “Ok, so what does CBT have to do with my bariatric surgery?” In my first article, I introduced you to the concept of Stinkin’ Thinkin.''  All of us have “stinkin' thinkin.”  Stinkin’ Thinkin’ includes thoughts that keep us stuck in unhealthy behavior.  Thoughts like:

  • “Just one won’t hurt “
  • “I’ll start over tomorrow”
  • “I'm stressed. I haven't eaten”
  • “I’ve already blown it so I might as well blow it big”

Many bariatric surgery patients can identify with the above thoughts. They realize that their surgery tool has zero power to work on changing their thoughts. Patients in my practice will often say, “I am learning that I had surgery on my stomach but not my head.”

By incorporating CBT strategies into your bariatric surgery treatment plan, you can decrease the power of your stinkin’ thinkin’, which in turn will change your behavior. EVERY behavior is driven by a thought and emotion.  If one wants to change their behavior, they need to slow down and identify the thought that triggers that behavior. CBT strategies can help you do this.

Let's go through an example:

Headwork Part 2Trigger: Piece of Chocolate Cake

Thought: That looks good. Just one piece won’t hurt

Decision: Permission given to eat cake

Action:  Eat the cake

Can you relate to the above scenario? If so, how fast does that sequence of events happen? I bet you're thinking “in about a nanosecond!''  So many of my patients struggle with slowing down and identifying what triggered them to eat the chocolate cake. If you look at the above example, you will see it was the THOUGHT that triggered the behavior. CBT strategies are tools that can help you “catch the thought” and “change it”

You can see from the above example that the “trigger” does not matter. What matters is what you THINK about the trigger.   We often do not have control over the triggers we encounter but we do have control over our thoughts. This should give you HOPE.

We experience so many triggers when it comes to our eating behavior. Smells of movie popcorn (environmental trigger), memories of grandmothers Christmas cookies (mental trigger), feelings of sadness or joy (emotional triggers), and being offered food at a party (social trigger) are just a few triggers that can precipitate off-plan eating.

Triggers often seem powerful, but I am here to tell you that the trigger does not matter. What matters is what you THINK  about the trigger. For example, how many times have you watched two different people face the same trigger but respond to it in very different ways? Some people face the trigger of a stressful event and cope by exercising or talking about it with a good friend. Others face a stressful event and turn to emotional eating as a way to soothe. The difference in behavior is how each person THOUGHT about the event. Our thinking influences our behavior. Let’s run through the chocolate cake scenario again:

Headwork Part 2Trigger: Piece of  chocolate cake

Thought: That looks good. Just one piece won't hurt

Helpful Response: “ Just one won't hurt” thinking does not get me to my goal. I am learning that ALL BITES COUNT

Decision:  Decide not to eat the cake

Action: Pass on the cake and stick to your eating plan

Cognitive Behavioral Therapy strategies are headwork tools to help you catch your stinkin' thinkin’ and change it to a more helpful thought.

For the past 16 years, I have been teaching CBT skills to bariatric surgery patients in my practice. I hear over and over again this was the “missing piece” they needed to ensure lifelong success post-bariatric surgery. I had the honor of teaching many of these skills to a large audience at the recent ObesityHelp National Conference in Anaheim, California. I now look forward to continuing to teach CBT skills to you.

In the final article of my series, I will  provide you with specific hands-on strategies to “Catch" and “Change” your stinkin' thinkin.”  Until then, I encourage you to take some time to ”catch” your stinkin’ thinkin' and take the time to write it down. You are taking the first steps in building your “headwork toolbox.”  I assure you that you will not be disappointed.

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Lora Grabow


Lora Grabow, LMSW, ACSW, is an obesity medicine behaviorist who partners with medical providers to empower patients to holistically change their lives. Holding a Masters in Social Work, Lora has worked with weight loss patients for over 15 years. She partners with a thriving obesity medicine practice located in Grand Rapids, MI. She is a member of the American Society for Metabolic and Bariatric Surgery and The Obesity Action Coalition.

Read more articles by Lora!