Alfred Trang, MD, and Ann M. Whitehouse, PsyD
When Einstein bariatric surgeon Alfred Trang, MD, tells his patients that they’re going to have to see a psychologist before they have weight loss surgery, he quickly short-circuits their protests. “I tell them ‘it’s not because we think you’re crazy,’” he says. “’It’s to help you deal with issues afterwards that no one expects.’”
Your body isn’t the only thing that changes after weight loss surgery. While the after-effects are largely positive—you’ll be buying smaller clothes, fitting into an airplane seat with room to spare, saying goodbye to chronic conditions such as diabetes and hypertension—you also may be facing some emotional challenges post-op, says Dr. Trang, who has been doing bariatric surgery for eight and a half years, performing thousands of surgeries.
At Einstein, the psychologist you’re likely to see is Ann M. Whitehouse, PsyD., Einstein Behavioral Health. “Having weight loss surgery is a little like having a baby,” explains Whitehouse. “You can’t always anticipate every little thing. It’s like reinventing yourself. It can affect all your relationships. Some people are very surprised at some of the feelings they have.”
Like the woman who came back to Einstein seven years after her surgery for help resolving two unanticipated side effects: anxiety and anger. It wasn’t that she wasn’t thrilled with her weight loss, but the social anxiety and shyness that had dogged her when she was overweight became full blown panic attacks when she reached her goal. To calm herself, she started drinking more—and often found herself inexplicably angry.
The reason: “She was getting more attention because she’d lost weight and she had trouble working through that,” explains Whitehouse. “She was anxious, angry, and even sad because people were being nicer to her—yet, as she pointed out, she was the same person she was before. She was thinking, ‘How dare you judge me based on my weight?’ I referred her to counseling and she’s now doing much better.”
One of the first relationships that undergo a seismic shift is the one you have with yourself—and with food, says Whitehouse. There may be a brand new you staring back at you from the mirror, but you may still see and respond like the old you, the one who never wore form-fitting clothes and always tried to blend into the background.
“Some of the people in our support group have talked about the struggle of getting used to a smaller body,” says Whitehouse. “In your mind you’re still a big girl, shopping in the big girls’ department, even though nothing fits. If being overweight or obese has been lifelong, it becomes part of you. Your whole self-image is what has been reflected to you by other people and it’s not like you can change that overnight.”
If you’ve used food to self-medicate, it’s not always easy to stop reaching for sweets to fix everything, she says. “We like to make sure patients have a handle on that upfront. There’s the potential to gain weight back even after surgery. So we work on coming up with alternatives, like going for a walk or calling a friend when they find themselves reaching for food when they’re feeling stressed.”
The dynamics of your other intimate relationships may also be altered. “You can run into jealousy issues,” says Dr. Trang. “All of a sudden a wife loses weight, feels better about herself, and starts going to the gym and the husband doesn’t like it. He doesn’t want her to go to the gym because he thinks other men are looking at her.”
Sometimes, he says, the person who’s lost weight and adopted a healthier lifestyle “looks at their partner and thinks, ‘Well, when are you going to have the surgery?’”
Friendships may falter. “What do friends do together? Go out to eat,” says Dr. Trang. “Obese people often have obese friends, and you suddenly become the person who is eating off the appetizer or healthy choices menu. Your friends feel awkward; they don’t like feeling awkward, so they eventually stop inviting you out.”
Even your family, who you expected to be overjoyed for you, can let you down. “This is a major life change and can be stressful on the whole family, who are dealing with a decision they didn’t make. They can easily sabotage things, either intentionally or inadvertently, because they want to go back to the way it was,” says Whitehouse.
While all this seems like the world’s most dismal sales pitch for bariatric surgery, being upfront about potential potholes on the road to a slimmer, healthier self has an enormous payoff in the end. “People deal with things so much better when it doesn’t catch them by surprise,” says Dr. Trang.
Learning what might happen beforehand gives you the opportunity to prepare for it, with Einstein’s help.
“For instance,” says Whitehouse, “we can work on developing scripts to help you deal with some of these things so you’re more comfortable with, say, holiday get-togethers or big family dinners. We can go over stress management strategies that will help if you do a lot of stress eating. We can deal with any mood issues, like depression and anxiety, that you have as a co-morbidity. We can talk to your family upfront about how they can get together and support you and each other and think of different ways to relate to one another. If food has been your big activity together, maybe you can have family game nights, go on hikes together.”
Einstein offers monthly support groups for bariatric patients (scheduled on alternate months at either the Elkins Park or Montgomery campuses), as well as a closed Facebook group for patients who may need a compassionate ear or seasoned advice from the program’s dietitians or surgery “graduates.”
And Einstein is always there. “Even if you have it together right off the bat, it’s not unusual to hit rough spots down the road, whether it’s relationship problems or struggling with emotional eating,” says Whitehouse. “Whatever it is, you can always call us. We’ll be there.”For further information about bariatric surgery and to sign up for a free informational session, contact:
- For the Einstein-Elkins Park Bariatrics office: 215-663-6422
- For the Einstein-Montgomery Bariatrics office: 484-622-7700