Obesity and self-acceptance 4

Obesity and Self-Acceptance After Weight Loss Surgery

July 15, 2019

Obesity and Self-Acceptance After Weight Loss Surgery: At one time or another, all of us who have struggled with obesity fall victim to the voice of self-doubt and insecurity. This voice takes the form of seemingly automatic and negative self-talk that can be persistent, loud, discouraging, and predictably destructive to our efforts.

In order to develop the self-awareness necessary to effect change in our approach to weight loss, it may be helpful to explore how our self-esteem has been shaped and influenced in our lives and how we can come to grips with obesity and self-acceptance after WLS.

Feedback and Comments About Our Weight

Feedback and comments about our weight begin almost immediately following birth. You can almost hear the well-meaning and platitudinal commentary from loving family members along the corridors of a birth and delivery ward: “What a big, beautiful baby girl!”

Over time, the developing child becomes highly attuned to the feedback from family members and others. Young children become very adept at internalizing praise and criticism. Criticism, in particular, is absorbed deep inside our psyche. Young children become aware of just how important it is to meet the expectations of others. They seek out from others' cues for their self-worth and acceptability. Therefore, self-esteem is developed from feedback from the world around us and our interpretation of it.

Abraham Maslow’s A Theory of Human Motivation (Maslow, 2013) describes the hierarchy of human needs as the following, from most important to least important: physiological needs (food, sleep, sex, shelter), safety needs (security of body, employment, health, property), belonging (love, affection, family, friendship, sexual intimacy), esteem (achievement, confidence, position in a group, status), and self-actualization (achieving individual potential). The psychological needs (i.e., belonging and esteem) are of primary interest when exploring the emotional health of those on a weight-loss journey.

Not only do children crave love, affection, warmth, and caring, but they also actively seek out approval, recognition, and affirmation. This is what shapes and molds our self-esteem. As a developing child’s social sphere is ever-widening over time from family to school to community groups to employment, the feedback and comments come and go. Unfortunately, feedback and comments are often uninvited.

We become more aware of the feedback, both positive and negative, as we grow older and mature. The more positive feedback we receive and internalize, the more secure in ourselves we feel. The more negative the feedback, the more insecure we feel. We can begin to build a wall around ourselves to shield us from excessive criticism or labeling.

Because we internalize the negative feedback and it affects our notion of self-worth, many people who struggle with their weight begin to hate themselves.

How to Respond to Our Emotional and Psychological Experiences

Although we cannot control the often pervasive, unsolicited comments from others, we can control how we respond to these emotional and psychological experiences. Traditional cognitive behavioral interventions highlight the importance of emotion (and thought) regulation as a precursor to effective action.

For example, obese patients often spend the vast majority of their time in bariatric counseling addressing the urgency of reframing negative, depressogenic (or at the very least, unhelpful) thinking into more positive, ego-serving, helpful self-statements. While on the face of it, this sounds reasonable, focusing primarily on the structure and content of internal experiences leaves little psychological and behavioral space to address adaptive behavior change consistent with one’s goals and values. In other words, theoretically, the therapeutic premise would resemble, “To do X will require that I think or feel something different than I am thinking or feeling right now.”

Second generation behavior therapies call into question the very notion that an effective weight loss program (or effective weight loss management protocol following surgery) is predicated upon the control and management of internal experiences. Instead, psychologists approaching psychotherapy from this perspective point to the illusion of control over our thoughts and feelings.

Efforts to suppress unpleasant thoughts and feelings often serve to reinforce themselves on a feedback loop.  Paradoxically, the first step towards healthy emotional regulation is letting go of our attempts to control them. A posture of radical acceptance of unpleasant emotions places us in a much more strategically empowering position to effectively respond to them.

People are often pleasantly surprised to learn that by giving up their efforts to gain control over their thoughts and feelings, they actually reported feeling stronger and more in control.

Not to be confused with “giving up,” acceptance reflects an openness and willingness to make contact with thoughts, emotions, and life experiences fully and without defense. Only in doing so can one fully embrace activities that are deemed important and meaningful outside of one’s preoccupation with evaluative language (from self and others).

Obesity and Self-Acceptance, a Shift in Your Perspective

Self-acceptance requires making a shift in your perspective. You are asked to move from a judgmental stance to a more neutral, objective stance. For example, being overweight brings with it a host of self-evaluative language, most of which only serve to punish ourselves and inhibit our ability to move in a purposeful, values-based direction toward meaningful change.

In order to free yourself from the burden of self-evaluative language, one must make a concerted effort to assess dispassionately the workability of weight loss solutions. Objectively speaking, making behavioral changes consistent with your value of physical health is goal-oriented and calculated. Of course, many patients will inevitably find in their history a fusion of unworkable solutions to weight loss and self-evaluative, self-critical language.

Moving forward, a more objective perspective would acknowledge one’s self-perceived weakness as it relates to weight loss yet, thankfully, and in accordance with reasoned thought, fall well short of extrapolating that to self-hatred and self-loathing. In other words, self-acceptance will invariably be an ongoing, active process.

Learning to love yourself, and therefore demonstrating an openness and acknowledgment of one’s strengths and weaknesses, requires a willingness to connect with who we are as a whole person.

Accept who you are, entirely and completely. Only then will you be ready to identify aspects of yourself and make value-driven changes consistent with your goals.

Ways to Cope with Obesity and Address Your Emotional Health

Talk to a therapist

Obesity treatment is best managed by promoting psychological and experiential flexibility and moving patients in the direction of values-based action. Consequently, the therapist and patient will work together to loosen the dominance of verbal and evaluative forms of behavior while at the same time weakening experiential avoidance and patients’ efforts to reduce or control negative thought and emotions.

Make a list of reasons you don’t feel worthy of self-love

Be honest and write an exhaustive list.  This activity alone will help you become more self-aware of how you are treating yourself so unfairly.

  • Which items could you realistically change? Which items cannot be replaced or altered?
    Make a separate list for each.
  • Of the items you could realistically change, write down one small change you could make, for each, to move yourself in the right direction.
    For example, you may simply park your car in the parking lot of the gym for a few minutes every few days. Continue to make small, incremental changes in the right direction.
  • For the items that cannot be changed or altered, what would it take to accept this aspect of yourself or your life?
    Self-acceptance involves compassion and forgiveness. Self-rejection only creates hopelessness and depression and fuels emotional eating.

Practice self-affirming thoughts every day

You may want to make a habit of saying to yourself on a regular basis self-affirming thoughts such as, “I am worthy of loving self-care,” “I can reach my goals one step at a time,” and “I trust myself to follow through until I meet my goals.,” and “I love and accept myself as a person, and I also accept this difficult journey to lose weight.”

Practice gratitude

Focus on what is “right” in your life.  Be thankful for all that you have.

Obesity and self-acceptance
Collins Hodges


Dr. Collins Hodges is a licensed clinical psychologist who specializes in bariatric behavioral health. He attended Southern Methodist University on a full academic scholarship. Dr. Hodges earned both a masters degree and doctorate in clinical psychology. Dr. Hodges has received additional intensive training in bariatric behavioral health. He is a certified trainer for the ‘Am I Hungry Mindful Eating Program for Bariatric Surgery Patients.’ He is a bariatric psychologist at New You Bariatric Center, My New Beginning at City Hospital at White Rock, and the Bariatric and Metabolic Institute (BMI) at Medical City Plano.