There are always studies being done. Sometimes you don't even know exactly what the study includes. I am always looking for data regarding weight loss surgery and it amazes me when "studies" are done and someone who knows little about the life of a WLS patient comes to a conclusion. I'm not complaining...I'm just saying that when I read the results of a story published (see link below) I want to scream that I know something about that!
The study talks about a higher suicide rate after weight loss surgery. They talk about drug overdoses too. Well duh....
I have to speak from my experience and since I have been a member of Obesityhelp.com for over 7 years, I have had many occasions to talk to several hundred members in various stages of their journeys. I totally believe that we are food addicts and guess what happens when you take away our drug of choice? If we are not properly educated we will find another. The other issue to take into account is the honeymoon period. (The year or so after weight loss surgery is the honeymoon period) The first year after weight loss surgery we are on a new "high" because no matter what we do....pretty much.... you are losing weight! WOOOO HOOOOO!!! The party is on. That is a most critical time because if you don't use that time to retrain yourself to eat differently, you will most likely fail. I have a saying...
If you don't learn, you will return.
I have seen many people carry on as usual (no changing of lifestyle) and when the honeymoon party is over they crash. At this point they seem to have a few choices. They can make the lifestyle change that they should have in the beginning and it's a bunch harder at this point....or they can choose another drug of choice or they can go back to the original drug of choice.
I have a real dislike for the term "unrealistic expectations". It is easily confused with how much weight you will lose. After attending a seminar on WLS, I was told by a doctor that I should not expect to get back to the size you were when you married. What if that was only a couple of years ago? For me, that was like telling me "OK fat girl, you are different. You can only make a C on the test because we know that it is unrealistic for you to make an A." First of all you are dealing with the formerly obese who are broken down to a world of being "less than". Tell me that I am only capable of a C and that's what I'll get. Fortunately I didn't hear that until I had a few years of goal weight under my belt. I made a funny!!
Back to the suicide thing....so....if you decide to choose another drug of choice and it's actually drugs, you may very well O.D. If you go back to food and gain the weight back, the feeling of failure may be entirely too much to endure. After all you do it in front of your friends and family and EVERYONE knows you failed. You also might be one of those lucky ones that has a friend or family that will tell you "I told you it wouldn't work".
I believe so much that we have to get the word out about the addiction and next we must learn what it takes to overcome this disease. There is a phenomenal comment on the article about suicide. I'm sorry for the length of this post but there is just so much to share. Here's what a doctor said that (to me) said it all.
As I read these blogs, I am simply floored. Over the past 20 years I have likely conducted more pre-bariatric psychological evaluations (+2000) than any other psychologist that I am aware of. During this past 20 years I have had 2 bariatric patients attempt to take their lives with 0 deaths. I do not know if that makes me an expert, but I can probably be on safe ground being called “experienced in the field.”
First, I strongly believe that we, as a society, must “un-demonize” morbid obesity. To do so we must conceptualize morbid obesity for what it is, a brain-based neurological disorder. For too many years now we have approached morbid obesity as purely a psychiatric or psychological disorder, a lack of will power, or a flawed personality. Instead, we need to look at brain functioning. In the most simplistic terms, we develop “pathways” in our brains. These are very elegant sequences of neurons or brain cells firing in different areas of our brains. The more frequently that pathway is activated, the stronger and more easily it becomes for that pathway to continue firing. In morbid obesity, we have taken a very primitive and necessary pathway that is sometimes called a “primary drive” (hunger and satiation) and expanded into areas of emotional functioning wherein food takes on an emotional meaning or purpose. The pairing of a very powerful primary drive pathway with our equally powerful limbic or emotional pathways creates a very resilient and dysfunctional pathway which exists solely to perpetuate eating. we’re bombarded with advertisements which reinforce the continued firing of this pathway. Our brains have a lot of survival safety measures programmed in. To simply stop the eating creates an incredible level of anxiety and agitation in the morbidly obese individuals brain and often creates frantic attempts to restore food intake. The brain fully realizes that a disruption in food intake is not a superficial event but rather is a threat to its continued existence. Remember, historically, starvation has killed more of our species than any war or pestilence. We are the survivors. Our brains in particular are very sensitive to starvation. When our brain senses rapid weight loss it mobilizes its resources to do almost whatever is necessary to stop the weight loss and regain the weight. This is what makes dieting so difficult. Yo-yo dieting is the ongoing struggle between our physiology and our psychology. Obesity is therefore more in your brain than your belly. These dysfunctional pathways have a label in mental health, we call them “obsessive-compulsive disorders”. (If God were to grant me one wish, it would be to eradicate the obsessive-compulsive disorders from this world.) All obsessive-compulsive disorders (OCD’s) are anxiety or fear-based disorders. These OCD’s are again dysfunctional pathways. Remember however, fear feeds on itself. For example, if you fear not being loved, you do not have to experience rejection for that fear to grow. The simple experience or thought of that fear strengthens that pathway. Unfortunately therefore, this particular pathway feeds on itself and grows without encouragement.
Secondly, morbid obesity should be treated as a neurological disorder. Medications have their place but they will typically only serve to buy time. (Don’t let me undersell time though, it is one of our most precious commodities.) We should treat morbid obesity like we treat epilepsy or diabetes. As a multifaceted disorder, like epilepsy or diabetes, we should treat the medical, the psychological, and the neurological aspects simultaneously. To do any less is to guarantee failure. The prognosis for success is however quite good. Early identification is the key to successful treatment. Prior to the surgery the pre-bariatric candidate should be evaluated by a team of professionals including physicians, dieticians, and psychologists. If disorders of impulse control or judgment are identified, referral to the appropriate professional must occur. Rejection must not occur. After the surgery, the bariatric surgery patient must participate in follow-up services including at minimum individual or group therapy and support groups. Treatment must focus on changing not just physical and psychological functioning, but brain functioning. (Throughout our lives our brains our constantly revising, reinventing, and literally physically changing their structure to adapt to demands in our lives.) To do this, the bariatric patient must work with a professional skilled in changing both psychological and brain functioning. These are very treatable pathways and disorders. There should be individuals in your community with these skills.
When I read these accounts, it was obvious to me that many bariatric patient were not properly educated, evaluated and treated prior to their surgery and seemingly tossed to the winds post-surgically.
Does bariatric surgery work? Yes, it does but it must be approached with the utmost care, self-evaluation, and good judgment.
For any shortcomings stemming from psychology and neuropsychology, I would like to offer my apology.For those of you still out there “In the wind”, I would encourage you to contact a mental health professional skilled in working with pre and post bariatric surgery patients.
P.S. I don’t have a book published but after reading these blogs I’m thinking maybe I should. What do you think?
Gerard R. Williams Ph.D.
Clinical NeuropsychologistLicensed Psychologist
— Posted by Gerard R. Williams Ph.D.
OK, if this post isn't already long enough, I have to include my comment. So here it is:
Wow….I read in amazement one of the best discussions regarding WLS ever! I wanted to comment on nearly every post. Seven years ago I had weight loss surgery (gastric bypass) and I have been at goal weight since reaching it six years ago. It was a battle that I fought every inch of the way but in the process, I learned a great deal about what is REALLY going on because I live it every day. I have been a member of a large online support group for seven years. I did not have adequate after care… mostly due to the lack of it in 2001. By participating in the support group, I not only learned the very pitfalls of this disease but learned that by participating, I was keeping myself accountable to myself and others. This online group is the largest research study anyone could ask for… a living, breathing, group that grows in power and self education every day but has so much catching up to do.
You who say it is not an addiction have never walked in my obese shoes. An incredible description of addiction: Uncontrolled use despite negative consequences. That certainly described my obesity. I have some of the most profoundly addicted relatives on earth and my addiction was clearly food. The parallels are too numerous. As Mary Jo Rapini said, we are too much in a hurry to get the weight off and we’ll worry about everything else later because we assume the obesity is the only thing in our way. If you are not prepared for the reality that your brain must be fixed, you can crash…to the point of suicide. It’s not like you can just tell them and they are immediately OK. It takes time. You also have many in the field that have yet to even mention the word addiction. As to why after care is not required? There are many reasons. We don’t know to ask, or the doctor doesn’t know, or the insurance doesn’t pay for it. If it is due to lack of insurance coverage, we are all out of luck. It seems every day I hear about yet another company refusing coverage for even the weight loss surgery….even if it is deemed medically necessary.
Every time anyone remotely close to the WLS community hears the words “quick fix” they are repelled. I had RNY open surgery (cut me open) and was in the hospital for five days. As we are speaking about here, the change is extremely difficult and when left to our own devices, we flounder. This rarely constitutes a “quick fix”. Secondly, if I chose any method that takes me from 30 years of obesity to 6 years of goal weight, why does my method matter as long as I am healthy??? I no longer have high blood pressure, sleep apnea or back pain. As many know, it has cured their type 2 diabetes.
You will also offend us every time you say the “old fashioned way”. I am so incredibly impressed with anyone that does it without surgery. I am SO impressed! In fact I did it several times. The only time I was thin for any length of time was in college for 2 years. I STARVED MYSELF to death so I am so proud for anyone that could do it without surgery and keep it off… but I could not…and I tried EVERYTHING.
The other day I realized that I had a tough time picking up a 40 pound sack of bird food but I was expected to be willing to exercise with 130 extra pounds on me. Do this experiment and live in my shoes. For one week, strap on four thirty pound bags of dog food and do everything you have to do. After 30 years like that you’ll be ready to do ANYTHING to get it off…especially the easy way…if there were one.
Dr. Williams you are excellent! I wish there were way more around like you. I have often spoke and written about being one of those “in the wind” and the numbers lost are astounding!! There are a few of us trying with all our might to “pay it forward” to patients coming in behind us because of this exact situation. It is really difficult because we are just post-ops trying to help and many times even some of the professionals are standing in our way because we don’t have a piece of paper. I am beyond grateful for the professionals that consider us valuable. Mary Jo Rapini is one of them. Many long term post-ops certainly know enough from experience that the whole subject of bariatric medicine is vastly misunderstood…even by some of the professionals. What do I have to back this up? Every bit of this is viewable online…the sexual and shopping addiction shortly after being thin for the first time, the new problem with alcohol, the low self esteem issues that never seen to improve, the lack of knowledge about coping mechanisms, and always looking to the future for the happiness we cannot seem to catch. We look for the future to make us happy because we have not learned about living in the now.
Dr. Williams, I have saved your post and I hope you don’t mind if I share it. There are way more “in the wind” than you can imagine. I do know this…what we are doing is not getting the word out fast enough. How do we get everyone in “the know” on some simple basics? It took way too long to get the message out that the surgery is the smallest part of this journey and many don’t realize how much the brain is involved. The lack of education available for patients and pros is scary. As a post-op, I have a limited ability to spread the word. Three of us have started with a website but it is not near enough and there are thousands that need help. Thanks Dr. Williams!
— Posted by Yvonne McCarthy
Enough said on this one.....
Here's a video I did a couple of years ago to put on my profile at obesityhelp.com. It's called "Participating in Life". By the way..the sound you hear when my before picture is seen is a jail door closing. I thought it was more than appropriate.
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