‘Mind over stomach’ – bariatric surgery success may have more to do with your mindset than your operation

Bariatric surgery has grown increasingly common over the past few years as the procedure has become a safer, less invasive approach to weight management. This surgery involves making changes to the structure of your stomach and small intestines, which could lead to changes in appetite, feelings of fullness, how the body burns calories and your hormonal signals, specifically those that play a role in weight and eating.

Bariatric surgery becomes an option when diet and exercise alone haven’t worked and when weight leads to other health concerns. However, it’s important to understand that bariatric surgery is only a tool and requires you to follow a healthy diet and exercise plan to experience good results.

Bariatric surgery can help you hit the reset button on your life, but surgeons, dietitians and psychologists all agree the key to success has less to do with what happens in the operating room and more to do with your mindset and behaviors. Lifestyle changes — including addressing mental, emotional and behavioral health — must begin months before surgery. Unhealthy coping strategies and inadequately managed emotional concerns can easily derail the long-term success of bariatric surgery.

The goal of the procedure isn't just to help you achieve weight loss and improve physical health, but also to help you understand behavioral, social and emotional factors that have impacted your eating and weight over the years. Before the procedure, dietitians and psychologists will guide you in developing an understanding of what it means to sustain a healthy lifestyle. They’ll work with you to make healthy changes prior to surgery so that healthy lifestyle behaviors are habit for you and easier to maintain after surgery.

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What are common mental health concerns for patients pursuing weight loss surgery?

A number of patients who seek bariatric surgery struggle with untreated or undertreated mental health concerns, such as depression, anxiety, post-traumatic stress and eating in response to emotions and stress. Individuals with excess weight are more likely to experience concerns of depression and anxiety for several reasons:

• Excess weight can lead to impaired functioning, which can negatively impact quality of life.
• Weight bias and discrimination are prevalent in society, including in our social networks and health care settings, which could negatively impact a person’s self-esteem, body image, quality of health care and social opportunities.
• Excess weight and mental health concerns can create a vicious cycle, with one reinforcing the other.

For these reasons, it’s very common for patients pursuing bariatric surgery to experience psychological concerns. Establishing care with a behavioral health provider, such as a counselor or therapist, to address these concerns and receive professional support is recommended.

When a mental health concern is discovered in a weight management patient, applicants for surgery are asked to treat their concerns concurrently to maximize their chances for success.

What makes bariatric surgery so different from other procedures?

The lifestyle changes required for long-term successful weight loss following surgery are very demanding. The importance of presurgical preparation is imperative since surgery has the potential to lead to complications or weight regain if proper care isn’t taken leading up to and after the operation. The necessary lifestyle changes will lead to optimal long-term outcomes and sustainable success.

Patients pursuing bariatric surgery are required to learn a significant amount about nutrition, exercise, coping strategies and other health behaviors. In the bariatric program at Ohio State, patients are connected with a dietitian, psychologist, advanced practice provider and surgeon to learn those new skills and receive comprehensive care.

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How does mental health fit into long-term success of bariatric surgery?

Before surgery, patients meet with a health psychologist to complete a psychosocial evaluation, which is used to identify risk factors or potential challenges that may arise after surgery and hinder outcomes. Patients may be recommended to meet with the psychologist multiple times to check in on their progress toward goals. The entire presurgical process, which includes working with the different disciplines of the bariatric team, can take upwards of eight to 12 months.

After surgery, the mental, emotional, social and behavioral work with the team is not yet complete. These areas continue to play an important role in terms of lifelong success with the surgery.

Mental health-related experiences AFTER surgery

Every patient is different, but the experiences outlined below are common after bariatric surgery.

1 Bariatric surgery buyer’s remorse

Immediately after the surgery, you may second-guess your decision; postoperative patients have referred to this as “buyer’s remorse.” When it occurs, this is a response to how difficult it can be at first to follow very strict guidelines around eating food and drinking fluids. The newly designed digestive system behaves much differently than the old one, and learning how to eat and drink with a new stomach can be a challenging process. However, this feeling of regret is usually short-lived.

2 Unpleasant feelings and grieving the loss of food

In the weeks and months after bariatric surgery, some negative feelings may boil to the surface. If food was a source of comfort, you may begin to feel emotions that you haven’t felt before, or at least not in a long time. This is part of feeling more ‘alive’ — not just physically but also emotionally — and is an expected part of the healing process.

You may also have an urge to return to eating to cope with unpleasant emotions or stress, or you may grieve the loss of food. We validate these experiences and aim to help you develop healthy ways of coping with stress and emotions and experiencing pleasure that don't involve food, such as physical activity, quality time with your loved ones and other self-care activities.

3Relationship changes after bariatric surgery

You also may experience a mix of negative and positive relationship changes and social interactions after bariatric surgery. Sometimes when patients lose weight, certain people in their lives are not supportive or comfortable with that change, possibly because of their own weight-related concerns. On the other hand, patients may also notice that they receive more positive attention and compliments after weight loss.

We try to prepare our patients for these experiences prior to surgery, but most of the time patients don’t fully understand what the changes will be until they’re experiencing them. These experiences can and will be an ongoing adjustment, which is why we offer support to patients through individual follow-up, support group and group therapy options, both before and after surgery.

4 Challenges after your first year of bariatric surgery

For most patients, the first year is a honeymoon period when most of the weight loss occurs and when weight loss may feel easy. After weight loss slows and is more difficult to maintain, you may experience or re-experience emotional and behavioral health challenges. For example, you may struggle with self-confidence, self-esteem, self-criticism or body image. You may feel that these concerns are solely related to your weight, which usually isn’t the case. We help patients anticipate the possibility of these mental health challenges and hypothesize that additional work through counseling or psychotherapy is often critical to achieve greater self-acceptance.

5 Redefining sense of self

Many patients who have experienced excess weight all their lives have a durable — and often negative — way of viewing themselves. Even after losing a great deal of weight, your sense of self may often still be the same as it was before surgery.

Self-concept and self-image can change, but they do so much more slowly than your reflection in the mirror changes. The process of revising the self-concept can take years, and it’s important for you to be compassionate and flexible with yourself during that time and seek support when needed.