Having Bariatric Surgery: To Tell Or Not To Tell

November 11, 2019

The decision to have bariatric surgery often follows a significant period of struggle with weight and associated health conditions. The allure of “lose weight fast” fad diets have faded. You realize that you have to do something to gain control of your health.

The time you have put into research, discussion with your medical team, and appointments have made you confident and empowered in your life-changing choice. Diet and exercise changes don’t come easy, but you have committed to a lifelong effort in favor of better physical and emotional health.

One of the unforeseen difficulties that come along with weight loss surgery is the response from friends, family, and even complete strangers!

Disease Treatment Versus Disease Prevention

A conversation that I have with most of my patients is this: "The majority of society is much more comfortable with the medical model of disease treatment versus disease prevention." Take, for example, the response of someone who has started to take insulin for their diabetes. While it’s likely very difficult for the patient and their family to accept, they proceed to fill the prescription, make diet changes, and monitor blood sugar without much-unsolicited input from others. After all, we consider that impolite, and they will likely not hear stories of complications of diabetes.

On the contrary, if that same person wanted to eliminate the need for insulin, starting with the elimination of sweets, daily exercise, and eventually weight loss surgery, how would that be perceived? They may hear stories about someone’s relative getting very sick after surgery, or told that they will “get too skinny.” Regardless of the method, the patient would benefit from support, right?

The good news is, you have control over how to manage the conversation. The decision to tell someone about your weight loss journey is YOUR choice.

Nobody is obligated to know about your surgery, but with such noticeable results, it can be difficult to keep it private. A vital point to remember is that you only have to disclose what you feel comfortable with.

Having Bariatric Surgery

Only .4% of patients who qualify proceed to have weight loss surgery, making it not as common as perceived (Dolan et al., 2019). Engagement in your bariatric program can make you feel that it is much more accepted and common.

A frequent misconception is that surgery is “the easy way out.” A number one reason for this stigma is fundamental miseducation. Statements such as “Don’t get too skinny,” “Why not just exercise more?” and “How much weight have you lost?” can feel very stressful. Grappling with the worry that your weight will be the focus can lead you to unintentionally sabotage yourself or lead you to rethink your choice.

Invite family members to watch videos, visit suggested websites, and even attend appointments with you. There are a number of myths out there; this is a good overview by the American Society for Metabolic and Bariatric Surgery (ASMBS).

Before you have this conversation, some helpful questions to ask yourself can be:

1. How will I feel if they have a negative response?
2. Is this someone who is likely to support my choice?
3. Why do I feel that I should disclose my decision?
4. Do I trust this person to keep it to themselves if I ask them to do so?
5. What type of support do I need from this person? What specific examples can I give them?

Some examples of assertive, boundary keeping statements include:

1. I have thought very long and hard about pursuing surgery. I’d be happy to answer any questions you have, as it is really misunderstood. It was a very hard choice for me, and I just need your positive support.
2. I appreciate your concern, but right now, I am focused on my own journey. Hearing of others' difficulties is not helpful. Everyone responds differently.
3. It might seem that this is easy, but let me assure you, it requires a lot of work every day. I’d be happy to tell you more about it.
4. I understand your curiosity. Right now, I am figuring this whole thing out too. It’s not the best time for me to discuss, but maybe visiting my bariatric center program’s website might help.

While patients may have been subjected to criticism when they were overweight, they often feel equally, if not more, under the microscope when undergoing a very noticeable transformation. They often think that they can’t win for losing (pun intended!). But remember, you are not alone!

Support Systems

Evidence shows that social support for surgical weight loss patients has an impact on treatment adherence, and successful outcomes (Sogg, Lauretti, & West-Smith, 2016).

There are a number of online support groups like those found through Obesityhelp.com to aid in your journey. Your treatment team involves a psychologist who can help you navigate through the emotional aspects of your weight loss. Being around peers who have similar goals, struggles, and successes can provide the motivation that you need.

References

• Dolan, P., Afaneh, C., Symer, M., Dakin, G. F., Pomp, A., & Yeo, H. (2019). Assessment of Public Attitudes Toward Weight Loss Surgery in the United States. JAMA Surg, 154(3), 264-266. doi:10.1001/jamasurg.2018.4650
• Sogg, S., Lauretti, J., & West-Smith, L. (2016). Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surgery for Obesity and Related Diseases, 12(4), 731-749. doi:10.1016/j.soard.2016.02.008

ABOUT THE AUTHOR Jennifer M. Duncan is a clinical psychologist in the Weight Management Institute at Summa Health. She provides mental health services to surgical and non-surgical weight management patients. Services include psychological evaluation, psychological testing, and supportive psychotherapy to patients with eating and weight issues. Read more articles from Dr. Duncan!

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