How Trauma Past and Present Can Sabotage Your WLS SuccessApril 18, 2018
How Trauma Past and Present Can Sabotage Your WLS Success: Trauma describes a person’s emotional reaction to a significantly threatening or devastating event. Although trauma reactions can be different for every person, they often involve feelings of shock, unpredictable or rapidly changing emotions, intrusive memories, difficulties with personal relationships, anxiety, and even physical health symptoms.
Examples of events that can cause lasting trauma include sexual, emotional, and physical abuse. When these events occur in childhood, the impact can often be lifelong.
Trauma Past and Present & WLS
Sadly, up to 61% of patients seeking weight loss surgery report a history of childhood abuse (Salwen et al., 2014), with approximately 16% describing the abuse as sexual in nature (Gustafson et al., 2006). Further, around 30% of patients seeking weight loss surgery report experiencing some type of interpersonal abuse as an adult (Salwen et al., 2014).
These percentage rates are higher than percentages of abuse reported by people in the general population, as well as higher than abuse rates in other medical populations. In fact, both childhood physical and sexual abuse are associated with doubled odds of developing obesity as an adult (Felitti et al., 1998; Rohde et al., 2008).
Researchers and health providers are not fully sure why survivors of abuse, particularly in childhood, are more likely to struggle with obesity as adults, but this relationship persists across study after study. These studies have also shown that bariatric patients with a history of childhood trauma tend to lose less weight after their bariatric surgery than patients without a trauma history (Ray et al. 2003; Steinig et. al, 2012).
Does this mean that if you have experienced abuse or trauma, you are doomed to "fail" at weight loss surgery? Absolutely not! However, in order to be as successful as you possibly can with your weight loss, it might be helpful to spend a little time reflecting on your relationship with food, as well as on your feelings about your body. If this feels overwhelming, your weight loss surgery center may have a psychologist or a counselor who can help.
As you look back, was there any relationship between the occurrence of the trauma and your struggle with weight?
Many patients, when thinking about the past, realize that their weight gain increased more rapidly following a traumatic event. There could be several reasons for this.
Food Can Be A Distraction To Negative Emotions
One reason is that for both children and adults, food can be a source of comfort or distraction from inescapable situations and negative emotions. Eating might be one of the very few things that a hurt or neglected child can control and enjoy. It is a coping strategy that makes sense when limited other resources are available.
However, many folks continue the eating habit long after they have survived the traumatic situation.
A once-effective coping strategy may have developed into a routine behavior that unintentionally sabotages your weight loss efforts. It surely does not help that certain foods, such as carbohydrates and sugars, actually trigger the brain to release chemicals that boost our mood for a very short time.
This makes the habit even harder to break after the abuse has ended. Many patients who struggle with eating in response to negative emotions describe themselves as feeling out of control, ashamed, guilty, or even angry with themselves after the fact.
Another possible reason that folks gain weight after traumatic events is because the weight itself feels protective. Survivors of sexual abuse have talked about their weight feeling like “body armor”, or like a shield that helps them feel invisible. It prevents them from receiving unwanted attention from others. Because of the unfortunate reality of obesity stigma, having extra weight can make it easier to hide and fade into the background in social settings. And if you have been a victim of unwanted, uninvited physical or sexual contact, being able to go unnoticed can be liberating.
Sudden Weight Loss Can Leave Less Time For Adjustments
But what happens when you begin losing this weight shield after surgery? Post-surgical weight loss is more rapid than non-surgical weight loss, leaving you less time to emotionally and mentally adjust to your changing body. Many patients find that this adjustment is difficult, even when coupled with the numerous health benefits of weight loss.
For some, returning to a weight they have not seen on the scale in years can unlock emotions that have long been kept buried. Some patients report mentally feeling taken back to the time when the abuse occurred and facing the distress over again (King, Clark, & Pera, 1996). As a result, old and now problematic coping strategies such as emotional eating may return. It is the return of these coping strategies that can lead to the weight regain that sabotages your weight loss surgery success.
If you are a trauma survivor, one of the best things that you can do before surgery to increase your success after surgery is to make sure that you have a good support system in place. Check with your weight loss surgery center to see what kind of patient support groups are available. Find out if you can attend these groups before surgery so that you can learn more about what life is like after surgery and begin anticipating your personal journey. Hearing other patients discuss their struggles might help you prepare for how you would cope with similar obstacles yourself.
Talk To A Counselor Or Therapist
If you are not currently talking to a counselor or therapist, this would be a great time to begin establishing a relationship with a provider that you trust. A behavioral health clinician can help you work through any emotions that arise as you are losing weight. They can also help you better understand your personal relationship with food, and if needed, develop new coping strategies for emotional stress. If your weight loss surgery center does not have behavioral health providers, you can still ask them for a referral. You could also contact your insurance company and request a list of covered providers that specialize in trauma-related counseling.
One mistake that patients make is to wait too long before seeking help. They may feel overwhelmed with existing medical appointments or think that the surgery will motivate them to make changes. They may also be afraid to talk about their struggles out of fear that they will not “pass” the psychological evaluation for the weight loss surgery.
Research has shown that the more behavioral health appointments a patient has before surgery, the better weight loss outcomes they have after surgery (Van Hout, Verschure, & van Heck, 2005). In other words, the more effort you put in pre-surgery, the greater the pay-off post-surgery.
As some insightful patients say – “they operate on your stomach, not your brain.” Making a permanent lifestyle change is difficult and requires consideration of the whole person – body, mind, and spirit. Asking for help can seem overwhelming, but it is one of the greatest gifts you can give yourself.
For more information on trauma, visit http://www.apa.org/topics/trauma/.
For more information on the impact of adverse childhood experiences and health, visit https://www.cdc.gov/violenceprevention/acestudy/about.html.
- Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V. … Marks, J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventative Medicine, 14, 245-258.
- Gustafson, T.B., Gibbons, L.M., Sarwer, D.B., Crerand, C.E., Fabricatore, A.N., Wadden, T.A. … Williams, N.N. (2006). History of sexual abuse among bariatric surgery candidates. Surgery for Obesity and Related Diseases, 2, 369-374.
- King, T.K., Clark, M.M., & Pera, V. (1996). History of sexual abuse and obesity treatment outcome. Addictive Behavior, 21, 283-290.
- Ray, E.C., Nickels, M.W., Sayeed, S., & Sax, H.C. (2003). Predicting success after gastric bypass: the role of psychosocial and behavioral factors. Surgery, 134, 555-563.
- Rohde, P., Chikawa, L., Simon, G.E., Ludman, E.J., Linde, J.A., Jeffery, R.W., & Operskalski, B.H. (2008). Associations of child sexual and physical abuse with obesity and depression in middle-aged women. Child Abuse & Neglect, 32, 878-887.
- Salwen, J.K., Hymowitz, G.F., Vivian, D., & O’Leary, D. (2014). Childhood abuse, adult interpersonal abuse, and depression in individuals with extreme obesity. Child Abuse & Neglect, 38, 425-433.
- Steinig, J., Wagner, B., Shang, E., Dölemeyer, R., & Kersting, A. (2012). Sexual abuse in bariatric surgery candidates – Impact on weight loss after surgery: A systematic review. Obesity Reviews, 13, 892-901.
- Van Hout, Verschure, & van Heck (2005). Psychosocial Predictors of Success Following Bariatric Surgery. Obesity Surgery, 15, 552-560.
ABOUT THE AUTHORChristina Rowan is a clinical psychologist in the Weight Management Institute at Summa Health. She received her Ph.D. in Counseling Psychology at The University of Akron and completed a post-doctoral fellowship in health psychology with a specialization in bariatrics at Cleveland Clinic. She provides individual and group counseling, assessment, and support services to patients struggling with weight or eating-related concerns.
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