Even those who do not appear to have a weight problem seem to struggle with their weight. People who are only marginally overweight frequently state, "I need to shed a few pounds. I'm going to give that new diet a shot." Then they will ask you, "Would you like to do it with me?" I refer to these individuals as social dieters. They make dieting sound almost enjoyable, particularly if "we" do it together. Almost all morbidly obese individuals are surrounded by social dieters, the majority of whom are close acquaintances or family members. They are well-intentioned, but their perspective on weight loss is vastly different from that of someone who has struggled with their weight for the majority of their lives. Therefore, they cannot comprehend why you cannot lose all of your weight while following their regimen.
People with severe weight issues do not wish to join a dieting group in which everyone is attempting to reduce 10 pounds. They will be the first to lose so much, but nobody seems to notice. In contrast to social dieters, dieting for profoundly obese individuals has always been a solitary endeavor that has inevitably failed. Failure to effectively lose weight is accompanied by feelings of regret and even shame. Once again, these internally programmed behaviors trump rationality and dedication. Is it any mystery that morbidly obese people frequently experience emotional stress? Given this circumstance, the decision to undergo weight-loss surgery is frequently regarded as one of desperation by both the patient and those around them.
I have heard a great deal of internal pressure to succeed in the statements of numerous patients who have said, "This has to work." Family and friends are likely to remark, "I know you can succeed if you just put your mind to it this time," which adds to the pressure to perform. You sense that everyone is observing you, and you silently ponder if their goal is to see you fail once more. All of this typically takes place in the same psychological and social environment that contributed to your obesity in the first place. Something
Clearly, something must be altered! Your success may depend on either your ability to modify your environment (unlikely) or your ability to alter your response to that environment. This does not occur immediately.
During the first few weeks after surgery, when your old friend "food" has been taken away, a transitional period is evident. One of the keys to a successful transition is discovering an alternative source of comfort and satisfaction. For some, this is a much greater obstacle than it is for others, but every band patient I've encountered struggles with this issue to some degree. As you might expect, one of the most effective methods to learn to adapt to this change is to join a community of people who have been in your situation.
To better understand this psychosocial aspect of obesity surgery, we must first recognize the effect that changing our eating patterns has on our interpersonal relationships. We are social beings who partake in social eating. A very prevalent group activity is eating. In fact, dining together is one of the most fundamental social activities, and it has become an integral part of our culture. Why is it that the majority of regimens fail? Eating-related social pressures are simply too intense to resist. Some programs, such as Weight Watchers, endeavor to foster a supportive group dynamic for dieting. Some "diets" are more effective than others, but in the end, they all rely on individual fortitude. In contrast, eating takes on more of a herd mentality.
In contrast, surgery is by its very nature a solitary endeavor. Also, it is a completely passive activity. It is something that has been done to you, and it requires you to give up all control, which is not a particularly comfortable situation. My experience has shown that many people feel less anxious about undergoing surgery if they know one or two others who have undergone or will undergo the same procedure, so they can "share the experience." Isn't it true that life's difficulties are always simpler when we have someone to share them with?
Families or work groups that have all utilized band operations have been the subject of a number of intriguing articles or news reports. The studies indicate that group efforts tend to yield superior results for everyone. The most recent trend in reality television has elevated competitive weight loss to an entirely new level. This exemplifies the essence of group dynamics.
The promise of the band is that it will limit the quantity of food you can consume and suppress your appetite. Unfortunately, it has no effect on your desire to participate in the social scene. Even if you are physically present in a situation where everyone else is consuming but you are unable to partake in the same manner as before, you may feel excluded. Many morbidly obese individuals have inadvertently exacerbated their condition by subconsciously associating with other obese individuals. Typically, they plan the majority of their social activities around the one aspect of dining at which they have always excelled! Is it surprising that, after forming a band, they begin to feel like social outcasts?
Band patients have described their internal dialogue in these situations as follows: "Everyone else is eating and having fun; why can't I?" Here I am eating a 'child's portion,' and everyone is staring at me as if something is amiss. They must believe I do not enjoy the cuisine. Do they recognize my band? Should I attempt to inform them? No, they'd only ask how much weight I've lost, and I'd rather not go there! Maybe I'll just stay home the next time." This is a prevalent occurrence, and I occasionally encounter AGB patients who have self-imposed social isolation.
Isolation is exceedingly detrimental to the psychological recovery of a band patient. Being a part of a group makes us feel more secure, and whenever we feel separated from that sense of security, we experience discomfort and even fear. Why else would so many band patients claim to have spent numerous hours in online chat rooms? They must experience the safety of belonging to a group. Participating in a group that can provide you with support as your confidence grows is crucial to your success, as your sense of safety is a significant factor in determining your level of accomplishment.
In my practice, we promote this aggressively by incorporating group sessions into nearly every aspect of our comprehensive weight-management program. We make the most of the positive reinforcement that patients provide one another. This consists of group sessions with our dietitian and psychologist, as well as our monthly support group meetings.
Reestablish Your Friendship Network
It is completely illogical to suggest that, in order to reduce weight, one must form a new "band" of friends. If that were the case, nobody would ever be successful. However, your success will depend in part on how supportive your closest relationships are of your efforts. This is only possible if they comprehend the process you are undergoing. If those around you are continually critical of your efforts, it will be very difficult for you to maintain a positive attitude.
The reality is that the people around you might not know what to say or do. This is not because they are uncaring; rather, they simply do not understand what you are going through. They cannot connect. To avoid this, you must participate actively in their education. One of the reasons we've written this book is to explain to nonpatients what the AGB is and how it functions. Nevertheless, you must recognize that it may be difficult for someone without a band to fully understand what you are going through.
Your closest acquaintances may occasionally say inappropriate things at inappropriate times. If they do, absolve them immediately. It will benefit both of you. It will also help you avoid a situation in which others are afraid to speak up for fear of offending you. Communicate frequently with your peers. Inform them of what is happening and how you feel about the changes in your life. If you do, they will quickly realize that you are still the same person you have always been; you simply cannot consume as you once did. (That, by the way, is a positive thing.) Once they observe your newfound optimism, they will likely approach you for advice on how they, too, can learn to better control their food habits.
Kim's Tale
(Left) Kim, pre-op, 401 pounds.
Kim, four years post-op, has 183
pounds.
I'd always been overweight. I weighed more than 200 pounds in high school. However, I reached a point where I weighed 401 pounds and stood 5 feet and 5 inches tall, so my BMI was 66.7. I had no trouble carrying my weight, and I was always very active. But I decided that my weight was excessive and I needed to take decisive action, so I began researching surgical options.
I attempted weight loss programs like everyone else. I would lose some weight, then regain twice as much. Phen/Fen® was the most effective medication for me, but it was taken off the market. I chose a surgeon who was performing the duodenal switch (DS) at the time. This is more extreme than the RNY. My surgeon told me that DS is reserved for people in the "super obese" category because they fear that people with less severe obesity problems will lose too much weight as a result of the procedure's inferior absorption capacity compared to the gastric bypass. My insurance would cover the DS, so I purchased one.
In the year following my DS surgery in 2003, I lost 150 pounds. It was almost astonishing how quickly I lost weight without exerting a great deal of effort. It was an effortless defeat. However, the DS did not instruct me on how to consume. After about a year and a half, I ceased losing weight. I continued on with my existence, but now weighed 250 pounds instead of 400.
When adhesions coiled around my intestines caused a blockage, I returned to my surgeon. He questioned my weight loss and recommended the band. Eventually, he ceased performing DS surgeries and only performed band surgeries. I discovered that my insurance would cover the entire band, subject to a $5,000 deductible.
In January of 2006, when my surgeon went in to repair the adhesions, he added a band at my suggestion. I now weigh 183 pounds and am still losing weight. I want to weigh about 140 pounds.
If I had to do it again, I would start with the ensemble. I gained no knowledge from possessing a DS. The band has taught me how to select and consume nutritious foods. If I make an error, the sensation of it getting stuck in my throat and making me vomit is unpleasant enough to motivate me to correct it. It's like Pavlov's canines. When this occurs, I tell myself, "I'm not going to keep doing this to myself." As a result, I've learned to make wiser decisions and to eat more slowly. It holds me accountable by providing much faster feedback. For instance, if I desire cake, I consume just a few nibbles. When I only had a DS, I would consume the entire piece of cake. Eventually, I would become ill, and within a few hours, I would have diarrhea.
I also discovered that my body had adjusted to my altered dietary habits following the DS. The second time my surgeon went in to place the band, he informed me that my stomach had extended out and returned to its normal size. Before my band surgery, I was anemic and emaciated, so I was in grave health danger and didn't realize it. Now, I continue to struggle with anemia, but I eat healthier. I now take iron and vitamins daily, which I never did before.
Excitingly, I have a job that I could never have held when I weighed 400 pounds. I serve as the director of youth services at a health spa. I incorporate daily exercise into my workday. This never would have occurred three years ago. I was the director of a chain of education programs at the time, so I was doing quite well in life. However, it is more enjoyable now.