THE "SKINNY" ON BARIATRIC SURGERY AND OTHER EXTREME WEIGHT LOSS ATTEMPTS
When people hear I am a registered dietitian, the first thing that usually follows is " awesome, can you help me lose weight?"
When I explain to them that my approach, Intuitive Eating, helps foster a healthy relationship with food - they'll answer "Yes, I have a food addiction, I can't stop eating!"
Ok...so let's talk about it....
When do you binge? Why do you binge? When you were younger, what was the subtle messages you received from the environment around you regarding your body and your food choices? I want to know the nitty gritty details...
And then I would usually get a counter response like, “I don’t want to get into that right now. I just need a food plan. Tell me what foods to restrict to eliminate my cravings!” or “what about bariatric surgery?! I saw my friend who had it and she looks amazing!”...
My immediate first thought is "YIKES!" (as I spoke about with Rena Reiser on her podcast "Jewish Intuitive Eating Journeys". https://podcasts.apple.com/us/podcast/jewish-intuitive-eating-journeys/id1403762610?i=1000459006979)
Obviously there are times when bariatric surgery is necessary. But for the average person, I would say; USE WITH CAUTION. Handle with care. Don't try this at home. Some people feel that surgery is their last chance at weight loss, and for them, weight loss = happy. “If I could just lose weight, I'd be happy, I'd feel confident, I'd find love, I'd get a better job”...
So tell me... do you think this weight loss surgery will provide them the happiness they always hoped for?
I can't help but compare this to Dave Ramsey's work on finances. Dave explains that, short-term, you can transfer your debt to a zero-interest credit account, however, if you are not changing the habits that got you into debt in the first place, you will be left worse than you started when the term comes due.
Same thing with body quick-fixes.
If you put a band-aid on your binging problem, and don't get to the route of why you binge, (what does food represent for you, and where did these self soothing behaviors come from), a surgery might help you lose weight in the short term, but the weight will creep back up and it will NOT improve overall happiness.
Did you think those behaviors magically fix themselves? Sorry to burst your bubble. Nope. The surgeon operates on your body, not on your brain. You must put in the hard work to get an outcome as big as a behavior change. It says in the gemara-that it takes a lifetime to change one middah! Change takes effort. Besides for not getting to the root of the issue, taking the easy root, actually creates bigger problems.
As I have learned this year the hard way - our body doesn't forget trauma.
When we have physical trauma, it can also affect our emotional state. When we experience emotional trauma, it can also affect our physical state.
This occurs through the complex process of homeostasis. When something emotionally stresses us out, we may feel a physical reaction like a tightening of the jaw or stomach, but the physical complications and risks associated with weight loss surgery are much more complex than that, and may include (in the short term):
Excessive bleeding
Infection
Adverse reactions to anesthesia
Blood clots
Lung or breathing problems
Leaks in your gastrointestinal system
Death (rare)
Longer term risks and complications of weight-loss surgery vary depending on the type of surgery and can include:
Bowel obstruction
Dumping syndrome, causing diarrhea, nausea or vomiting
Gallstones
Hernias
Low blood sugar (hypoglycemia)
Malnutrition
Stomach perforation
Ulcers
Regular Vomiting
Death (rare) .
And these are just the physical risks! But we know that physical has an impact on emotional.
I have heard of many patients who, even though they have lost weight, no longer engage in social activities because;
They can't eat what everyone else is eating
They have trouble holding down food (this can be extremely embarrassing, at both ends).
They can’t drink socially anymore because they have zero tolerance
THEY HAVE NOT DEALT WITH THE ROOT OF THEIR PROBLEM
After any surgery, the body undergoes trauma.
This past year, I endured my first C-section (with a doctor I had just met) after 2 healthy vaginal births, because my son was breech. The version (trying to turn the baby around) was unsuccessful. My birth plan changed just days before my due date, which was a particularly traumatic experience, because my mother passed away 3 days earlier.
My mother, at the age of 56, was diagnosed suddenly with stage 4 cancer in August 2018.
She died on September 17, 2018.
My son was born on September 20,2018.
Needless to say, the last year was torturous. Interestingly though, one of the worst periods of my life was actually the summer of 2019 - almost a whole year later. I was able to push forward and bury my emotions until that point.
Something my therapist taught me, was that the body doesn't forget trauma. It eventually catches up. At that point, I was physically and emotionally re-living the trauma from the prior year. Although I was so happy that my child was born, and I love him with all my heart, I was still grieving my mother. Trauma is trauma.
So how does this tie in to bariatric surgery?
Let’s imagine a scenario where a husband and wife, let’s call them Jeff and Jen, are having marital issues. They have tremendous baggage, and their relationship looks pretty rocky. They have tried to patch things up, but really, the problems are much deeper than they can work out on their own. They really need some deep therapy, but both have been traumatized by their childhood experiences with therapy. Jen’s parents took her to therapy when she was a child because they felt she was an underachiever and too emotional. Jeff’s parents were unstable and made him go to therapy because he was always the “cause” of their issues. He hated his life growing up. Needless to say, they both HATED therapy. Jen decides that, rather than deal with the root of their marriage issues, she would have a baby. Babies are cute and fun - having a baby would fix everything! (Notice the hint of sarcasm in this sentence).
Jen is all set to have a new baby. This is her chance at a new life with her husband. All their problems will magically dissolve once their cute little angel arrives...
Much like Jen, bariatric surgery candidates are ecstatic to be given the chance at a "new life”. They are even excited to enter into an elective trauma state, believing that their biggest recovery challenge will be keeping to the strict diet before and after the surgery, in order to eliminate uncomfortable symptoms (for example, eating a very small amount of food in order to not disrupt the narrowing of the digestive system).
What they don’t realize though, is that trauma is trauma.
Just as a baby will never be able to resolve the root of the issue, adding a curve-ball to the trauma to try to fix things, just makes the problem worse - not better.
Someone who has been eating 2000 - 4000 calories per day, and has a lifetime of food related trauma, will not be cured with surgery. Not with a cute little baby. Not with a cute little new body.
Sure, they might look great for a few months, maybe a few years… but just like Jen & Jeff’s baby will not solve their marriage problems, bariatric surgery will not solve anyone’s health problems. Trauma is trauma. It needs to be dealt with.
In fact, the physical pain of recovering from surgery, complications from the surgery, and new challenges that arise from this particular surgery, can create a perfect storm for physical trauma to become (more) emotional trauma.
As someone who deals with people in my office crying on a daily basis about their body, and how it hurts them to be this size, I urge you to invest time and energy into exploring why you are so uncomfortable in this body, that you feel you must potentially undergo trauma to "cure it".
Is it because you don’t like how you look?
Is it because you were raised in an environment in which you were “never enough”?
Do you feel like your life is spiraling, and use food as something to control when you can’t control anything else?
Once we have explored the why, we can explore the how. Stay tuned for a follow up post on exploring the how.