shame of weight regain

How To Overcome The Pain and Shame Of Weight Regain

April 18, 2022

After having regained weight after weight loss surgery (WLS), many people may feel shame, guilt, or disappointment. According to Brene Brown, Ph.D., LCSW, shame is “an intensely painful feeling or experience of believing that we are flawed and therefore unworthy of acceptance and belonging,” (2006).

Brown (2006) proposes that some ways people experience shame feel include feeling trapped, powerless, and isolated, which are complex, interactive, and can feel challenging to change. The pain and shame of weight regain are common.

Pain and Shame of Weight Regain

Weight regain after WLS is very common, and maintaining a weight loss is one of the most challenging parts after WLS.  Weight maintenance is influenced by medical, behavioral, biological, and psychological reasons. Some of these factors may include drifting back to old behaviors, decreased awareness of eating patterns, genetics, metabolic and hormonal mechanisms, or experiencing stressors such as changes in jobs or health challenges.

When people regain weight, feelings or thoughts of shame may develop after. Many people may also feel isolated or alone in their experience.

These thoughts and feelings may make it hard to act in ways that support goals for weight loss or a healthy lifestyle. Self-defeating thoughts such as, “I’ve let myself down again,” or “Nothing can help me be healthy” or “I’ll never keep the weight off” may lead to low self-esteem or body image, inadequacy, low mood, anxiousness, and self-criticism.

In considering the cognitive-behavioral therapy (CBT) model, these thoughts then influence our behaviors and feelings. For example, thoughts like “I’ll never keep the weight off” or “It doesn’t matter what I do,” may lead to eating high calorie or fewer nutrient foods, grazing or snacking behaviors, not being physically active, drinking alcohol, missing doctor’s appointments, and avoiding reminders of your weight such as not recording in a food diary or not weighing yourself. Over time, it may feel hard to know where to begin and seem overwhelming or frustrating or lead to feelings of disappointment or guilt.

We Are Capable of Change And Growth

A crucial point to consider is that as humans, we are imperfect and experience pain and suffering, but we are capable of change and growth. When we begin to accept that we are imperfect, we open ourselves up to change! Accepting our imperfection helps reduce feelings of shame and pain. Equally important, is knowing that you are not alone in regaining weight after WLS. Adopting a self-compassion mindset may also help.

Neff (2003) describes self-compassion as a positive self-attitude that encourages treating oneself warmly and acknowledging that making mistakes is human. One of the biggest things to remember about weight maintenance and a healthy lifestyle is that it is a long-term process, which means we have many opportunities to practice making healthier choices.

Consider What Your Thoughts Are

When we begin to look at some of our thoughts, consider if your thoughts are helpful or less helpful. In CBT there are many thought “errors” we can be prone to make that influence our behaviors or feelings such as:

  • All-or-Nothing/Black and White Thinking—Believing that we are not able to change our lifestyle; that we will always fail at making healthier food choices or being active; eating healthy is something we do 100% or 0% of the time.
  • Overgeneralization—Believing that one choice reflects our future choices, such as “I overate today, so why try tomorrow to eat healthier?” or “I’ve never been able to keep weight off.”
  • Jumping to Conclusions or Fortune-Telling—Believing that we can predict the outcome or how others will respond like, “My doctor will tell me there’s nothing else to do for me to get healthier, why go?”
  • Should, could, and would statements—When we create a mindset that does not allow for error or mistake, it may create opportunities to feel shamed or guilty such as “I said I’d never eat a cookie again.” 

Some Of The Reasons We Regain Weight

When we begin to increase awareness of how our thoughts, feelings, and behaviors interact, it helps us realize we are able to change them! Sheets et al. (2015) found that some of the behavioral or psychological reasons people regain weight after WLS include:

  • Decreased adherence to diet recommendations (e.g., eating high-calorie foods, grazing, uncontrolled eating, emotional eating, eating sweets)
  • Physical inactivity
  • Limited support
  • Reduced follow-up with medical providers
  • Anxiety, depression, or substance use

Consider These Steps Of Empowerment

If you have found yourself experiencing shame related to weight regain, consider some of the next ideas or steps to help feel empowered and ready to make changes.

  • Use SMART goal setting to help set Specific, Measurable, Attainable, Realistic, and Time-oriented goals to get back on track. Try setting goals in different areas related to the number of servings of vegetables or fruits to eat per day or goals to meet macronutrients or a way to increase physical activity such as by walking in small chunks throughout the day
  • Check-in with your thoughts! Think about the messages you tell yourself and see if they fall into some of the “thinking errors” described earlier. If they do, try to come up with some other thoughts to tell yourself that are true and kinder.
  • Practice mindful eating. Prior to eating, check in with your physiological hunger before and after eating with goals of eating until feeling comfortable and satisfied versus stuffed or full. If mindless eating is a trigger, consider pursuing an alternative activity such as puzzles or a game on your phone.
  • Keep track of your food intake via an app, a diary, or another means to increase awareness of current eating habits. Use this to help set SMART goals related to eating and aim to cut back on high-calorie and high-sugar foods
  • Remember your “why.” Reflect on your reasons for pursuing weight loss surgery and record your reason somewhere that you can see it each day or when having a tough moment.
  • Follow-up with medical providers. Discuss your concerns with your healthcare provider to help you get back on track or meet with a dietician. Many people regain weight after surgery and working with your team can help.
  • Consider seeing a psychologist or psychotherapist to work at maintaining or resuming healthy lifestyle changes to support your goals.
  • Be accepting of mistakes. By recognizing that we are not perfect and will make errors, it helps us feel less alone and more empowered in our abilities to feel connected and make changes.

Your Take-Away:

If you have found yourself experiencing shame for weight regain, you can feel empowered and ready to make changes!

References

  • Brown, B. (2006). Shame resilience theory: A grounded theory study on women and shame. Families in Society: The Journal of Contemporary Social Services, 87, 47-52.
  • Neff, K. (2003). Self-compassion: An alternative conceptualization of a healthy attitude towards oneself. Self and Identity, 2, 85-101.
  • Sheets, C. S., Peat, C. M., Berg, K. C., White, E. K., Bocchieri-Ricciardi, L., Chen, E. Y., & Mitchell, J. E. (2015). Postoperative psychosocial predictors of outcome in bariatric surgery. Obesity Surgery,25, 330-345.

Danielle Miro, Ph.D., ABPP-Rp is a Psychologist and works with the Nicholson Clinic.

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Danielle Miro

ABOUT THE AUTHOR

Danielle Miro, Ph.D., ABPP-Rp is board certified in Rehabilitation Psychology and licensed in the state of Texas as a Psychologist and works with the Nicholson Clinic. She has held leadership roles at the national level with professional organizations such as the Society for Behavioral Medicine, and remains actively involved in the American Psychological Association Division 22, Rehabilitation Psychology, as well as the Society for Health Psychology.