Understanding the Emotional Side of WLSJune 22, 2020
Set Yourself Up for Healthy Coping & Success: the Emotional Side of WLS!
The decision to have WLS is often exciting and intimidating at the same time. There are so many unknowns. Set yourself up for success by understanding the many facets of yourself for the emotional side of WLS in relation to having surgery.
Many insurance companies have a waiting period before they approve surgery that can range from 3 to 12 months. Often patients are discouraged or would like to be on a fast track. On the contrary, use the time to mentally and emotionally prepare for a new life with food.
Factors for the Emotional Side of WLS
Let's take a look at the emotional side of WLS and what is important to know!
The belief everything will be perfect after surgery or that you won’t miss food will set the foundation for failure. Unrealistic beliefs about the changes that are coming only lead to feeling deceived or crushed when the rose-colored glasses come off.
Take the time to sit with your thoughts and outline your beliefs regarding food. Use a journal to write down feelings, use, and the overall relationship you have with food. It takes work and reprogramming your mind.
Habits are hard to break without actively working on them. Remember some of the beliefs about food you hold were developed in childhood, given to you by family, societal teachings, or even a cultural norm you were taught.
What will you miss? Allow yourself to mourn the loss of food as a coping tool, social outlet, or even as a friend. If food or drink is your way of responding to a bad day or celebrating a victory start practicing new responses before surgery.
Identify the thoughts or emotions that could trigger emotional eating. For example, some patients have told me when I’m bored that they need a snack or they need a latte to start their day.
Life is full of surprises. Inevitably, stress is going to happen. Identify current stressors that could hinder your success. Situational stressors or losses will not be reduced by losing weight.
Some patients ignore the stress in their life until post-surgery. Be kind to yourself by addressing those stressors before surgery and not as you are encompassing a huge transition. Work on your marriage, work stress, friendships, finances, and other stressors should be addressed before surgery. The problem may not be completely resolved but at least you're in the process of working on it.
Relationships will be affected by your weight loss and new lifestyle. For many, it will be a positive change, but not for all. Friends may be supportive, some may avoid you, or even unknowing attempt to sabotage your weight loss.
We all have generational habits passed to us. Evaluate what habits you must break that could affect family and other relationships. For example, will you have to change family BBQs, dinner dates, holiday meals, and lunch breaks with coworkers, to name a few.
Family, friends, and loved ones are not having surgery so for them it may be a surprise that you are changing how you interact with them and food. You will find very supportive people, but realistically others will be resentful or sad.
For example, one patient told me her mother would get upset if she did not eat her cooking. For her mother, it was a way to demonstrate motherly love. In your circle of friends you may be the heaviest person, post surgery you will not be. Some may find this new reality unsettling since they may take on that role. Eating differently means some relationships based on meals together will have to be altered and in some cases you may decide they are unhealthy all together.
For many, being overweight means being invisible. If trauma occurred in their life weight could have become a defense or protection from being noticed. Once the weight comes off, anxiety could arise. That is why working on trauma can be beneficial and an aspect of preparation. Another form of visibility some patients describe is related to codependency.
Codependency is a one sided relationship where one person relies on the other to meet their needs.
Some symptoms of codependency include low self-esteem, people-pleasing, poor relationship boundaries, can’t say no, and fear of rejection (there is an extended list of symptoms).
Codependents excessively help family or stay late at the office taking on projects no one else wanted. Their social life is limited. However, once they lost weight they want to participate in life. Often others who expected them to sacrifice their social life do not understand or resent them. Begin to set healthy boundaries and learning to say no if this is an issue.
Gaining attention post-surgery can be exciting but some feel the attention is overwhelming. Self-esteem can fluctuate as one is shedding pounds. Losing a significant amount of weight can come with seeing your body change in weight distribution or excess skin. This can be alarming and anxiety-provoking.
Further, if you experienced low self-esteem prior to surgery, losing weight will not fix it. Explore the issues around the feeling of inadequacy or low confidence in self worth. Find support to work on learning to love your new body.
Post-surgery it is normal to have doubts about your decision. Many patients I see state, “what did I do to myself?” at some point after WLS (usually a few weeks). This is actually a great question, it means the patient is seeing a difference from their past self to a new changing self.
Do not underestimate the stress you will go through as you are in the process of developing the new you. Depression can easily creep in if you tell yourself “I’m not supposed to feel bad or question myself post-surgery.” Rather, have self-compassion during this transition phase.
You are meeting the healthy you for the first time and saying goodbye officially to years of learned behaviors.
Write a list of all the benefits associated with the new you. Have reminders of goals such as a picture of a new adventure you want to try, a new outfit, or a picture of a loved one who inspires you.
Irritability is also common during the first weeks and months post surgery. Your stress level and mood changes will fluctuate. Speak to your loved ones about how to handle your mood changes and what you need (emotionally and physically) so that they understand your process.
After WLS there is a risk of trading one addiction for another. Addiction transfer is when one trades a compulsive eating behavior for other unhealthy behaviors. Food is no longer a source of coping and other behaviors, in turn, are substituted.
One common addiction is obsessing with counting calories and looking at the scale. Some patients fear gaining back weight or losing an unrealistic amount of pounds. Other patients become addicted to exercise for the same reasons. They describe the hypervigilance of food choices or activities. It is as if control is the key and any loss of it will cause anxiety.
There is also the possibility of addiction to drugs, alcohol, or behaviors (shopping, gambling, or sex). Remember you can not use food as coping so it can be tempting to numb emotions other ways.
The Emotional Side of WLS: Conclusion
Perhaps the most important question to ask oneself is “Am I committed to changing my lifestyle?”
Deciding to have WLS is a commitment to a healthier you physically, emotionally, and mentally. Regardless of what type of surgery you decide on, most patients experience a few setbacks. That's why it is important to know and understand the emotional side of WLS.
Setbacks do not mean failure. Set realistic expectations and reflect on what you need to work on. Understanding possible barriers and taking a hard look at how to cope is the key to long-term success.
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ABOUT THE AUTHORBertha Rodarte, MA, PhD is a bilingual (English/Spanish) licensed clinical psychologist, specializing in health psychology. She earned her PhD at the University of Texas at Austin. Dr. Rodarte has over 13 years of experience with bariatric patients. She provides pre-op psychological evaluations for WLS and therapy for patients needing additional support.
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