It’s been nearly 6 years since I had my sleeve gastrectomy.

For context, I lost just short of 100lbs, quite quickly.

I settled into a maintenance range about 15lbs heavier than my lowest weight.

The first year was easy-ish.

The second year less so.

Every successive year thereafter has required significant ‘level-ups’ in lifestyle, diet, emotion regulation and thought-work to sustain my ‘wins’. (And sometimes I’ve needed medical/pharmaceutical assistance).

I was also a “1%-er”, who had severe complications, immediately post-surgery, and more recently.

And I’m a psychologist who works with many bariatric patients, mostly from a compulsive eating, trauma history, regain and long-term support perspective. I also write about these issues on my digital platform, “The Shrink on Your Couch”. I have an online program called “Bariatric Mind Masters”, which applies psychology principles to the emotional and mental component of long-term success.

I’m currently completing a certification with the American Association of Bariatric Counsellors.

Should you have weight loss surgery?

I’m preparing this article in response to the very dominant question from prospective patients on social media, “Should I Have Weight Loss Surgery?”.

In my experience, a person should not pursue weight loss surgery until and unless they fully grasp the following medical fact:

Obesity is a chronic, incurable, progressive, relapsing disease, with multifactorial causation.

And bariatric surgery is a treatment, not a cure.

For many (myself included), surgery felt like a relief. Finally, there was hope. There was something available that could provide freedom from the relentless struggle.

You’ll only understand what I mean by ‘struggle’ if you’ve been there: the relentless cycle of restriction and deprivation to reduce size and ‘get a grip’, only for that restriction to catapult you into uncontrolled binges, and further rampant weight gain. The self-loathing and social diminution that comes from failing daily, and publicly. And the futility of every successive effort because the odds are stacked against you, hormonally, biologically, and societally.

Many of my bariatric peers are offended by the notion that surgery is “the easy way out”. I’m actually at peace with this concept, because, in the initial honeymoon phase when the weight falls off, and urges, cravings and compulsions appear to have disappeared, the experience does feel somewhat miraculous.

It’s the easy way out at first.

In the sense that it’s the simplest, most predictable way I know of for a person to get their weight off.

I know my bariatric peers argue that it isn’t ‘easy’ because it involves major surgery, winning with medical insurance companies, pain, recovery, incessant nausea, vomiting, reflux, radical lifestyle change, social judgement, and stigma, shifts in relationships, etcetera.

All of these are true.

I even had life-threatening complications.

My argument is simply that it’s the most effective way I know to drive a wedge into the struggle and get significant weight off, and in so doing, to disrupt the disease path for a while. This disruption allows a window of opportunity in which grand-scale lifestyle changes can be implemented, to render the intervention ultimately effective in the long-term.

Surgery gets the weight off, but I don’t believe it keeps it off.

And herein is the dilemma one must resolve when contemplating surgery.

Obesity is chronic and incurable. Progressive and relapsing.

Surgery is a treatment, and on that level, it’s wildly effective.

But it’s not a cure.

And for this reason, it needs to be embraced as one (mighty) weapon in an artillery against obesity.

But once it’s done its physiological, hormonal work, each bariatric patient must accept the baton of their own contribution to its long-term success.

I know a psychiatrist, for example, who speaks about their patients’ role in improving their mental illnesses; that pills and potions can only take them so far… They need to bring their part with effective lifestyle management (sleep hygiene, exercise, mindfulness practices, psychotherapy, etc.), without which the meds won’t appear to help, in the long term.

Bariatric surgery is no different.

I often joke that at any point, I could inhale my kitchen and regain every ounce I lost. Bodies still seek to defend their highest weights, and there is still the physiological, mental, emotional, evolutionary impulse to overeat and get back to triple digits on the scale. And these impulses come in the form of cravings, hunger, perseveration on food, etc.

Friends, family, and clients see a slim, fit person, who used to be significantly overweight.

And so, it would be logical to assume that the surgery did its job, and all is well.

Here’s what they don’t necessarily see:

(And remember, I had surgery nearly 6 years ago).

1. I wake long before dawn, every single morning, to be still, with myself. To meditate, journal, read. And to plan my day’s eating, as well as to assess the day prior. In that assessment, I look to understand where I’ve done well, and also where I may have been ‘eating my feelings’ or using food to regulate my nervous system. And what unhelpful habits might be at work. I challenge myself to do better. I also scan for risks and triggers on the horizon that may compromise my peace, and plan for how to approach these. Please believe: I overeat nearly every day, and course correct every morning. But my superpower is that I never render myself a failure, nor throw in the towel. I just keep slogging, every single dawn.
2. I am in long-term, weekly therapy. I accept that life is hard, and I take time each week to unpack and process my experiences with a professional. It helps me to do my best in my relationships and in my work. And it certainly helps me to reduce how much I might use food to medicate overwhelm, and to take the edge off life complexities.
3. I have found a few authors and podcasters who I love and relate to, and I engage with their material almost daily. I’ve found it’s critical to infuse and percolate one’s mind in solid teaching, because it’s such pearls of wisdom that speak louldy when a craving hits.
4. I weigh myself every day and log every morsel I eat on MyFitnessPal. I care about macros, balanced blood sugar and protein intake. I track sleep quality and steps on my FitBit. These are personal choices that serve me, that I find valuable on the level of personal accountability. They can however, for some, create obsessiveness, and each person needs to figure out their sweet spot with apps and metrics. I find data meaningful and helpful.
5. I exercise 5-6 days per week, HARD. I personally fell in love with ‘rebounding’; a combination of aerobic work and weightlifting on a mini trampoline. And I do it on days that I feel like it, and also on days that I’d rather stick pins in my eyes than jump, lunge, squat and lift. I push myself, and have grown to really care about physical health and vitality, lean muscle mass, long-term mobility etc. I’m currently adding a running component, with a first goal of being able to run 5km.
6. I work with a dietician, who I meet with at least monthly. A dietician is so much more than a provider of a meal plan. They are highly skilled and scientifically trained accountability partners who have line of sight into things lay people don’t know. I have come to understand the role of balanced blood sugar in controlling cravings, compulsions, and mood. In my pre-surgery life, I may have eaten the odd vegetable as a garnish, here and there. Years on, I aim to eat 2lbs of veg per day. Like exercise, I see nutrition as a progressive and goal-oriented pursuit that I’m always dynamically leaning into.

And that’s the thing: obesity is chronic, progressive, and relapsing.

But a lifestyle of Bariatric Mind Mastery can also be chronic and progressive and liberating.

And I have embraced my post-surgery life on this level.

I don’t see my surgery as a ‘once and done’ happening of yesteryear.

Rather, that theatre-call was the beginning of an ever-changing lifestyle, with which I am deeply engaged, and for which I am (at this point) entirely responsible.

If you are considering weight loss surgery, you by no means need to commit to my lifestyle. But you do need to fully understand how much yours will change, and gently lean into creating that new way of being, day by day, month-by-month, years into the future.

I wish you well on your pursuit.

WORK WITH ME?

Should you wish to work more directly with me, or engage with my programs, you are welcome to email me - info@theshrinkonyourcouch.com

Here are links to some of my programs, for your perusal:

BARIATRIC MIND MASTERS

BACK ON TRACK MASTERPLAN MINI COURSE

WORKSHOP: STOP NIGHT TIME SNACKING SELF-SABOTAGE