One of the great deceptions, in the immediate aftermath of bariatric surgery, is that people often lose dramatic weight no matter what or how they eat. And get comfortable in that. The physical restriction alone is sufficient to effect quite significant losses. Wonderful as this is, the experience is usually short-lived. In the long term, if unchallenged, this sets a ghastly precedent that is unsustainable. Many patients miss out on what is actually a golden opportunity to overhaul and modify their lifestyles and mindsets, while the cravings and hunger are at bay.

To be fair, many go into surgery well prepared, “shrink’ed-up” and “dietician’ed-up”, full of tools, skills and support to tackle their new life. And the outcomes are thus more likely to be favourable.

Sadly, (and often due to a lack of appropriate information), others only realise the need for this support structure and effort-filled overhaul when it’s (almost) too late.

Understanding the Changes Post Bariatric Surgery

I believe that weight loss surgery is a profoundly effective way to lose weight. I watched a bariatric patient on TikTok recently bemoaning the criticism that “weight loss surgery is the easy way out”. I’m not offended by this assertion in the slightest. 

To the contrary, my understanding is that, for 95% of the significantly obese population, it’s not the easy way out; it’s the only way out. Science has shown that our bodies resist efforts to lose weight, and fervently rebel after some time on a restrictive diet. We experience this as failure and berate ourselves for not having sufficient willpower. But we’re often unaware that the odds are stacked against us, and physiologically our bodies will send up urges, cravings, and compulsions to neutralise any losses achieved. Willpower is futile in this instance. 

Bariatric surgery assists by creating sufficient restriction, coupled with a a sufficient decrease in hunger, to effect rapid and dramatic weight loss. But my sense, as a bariatric patient myself, and a psychologist working in this field, that this is mostly all that it does.

Bariatrics gets the weight off.

We are solely responsible for keeping it off.

And so I veer back to the idea that there’s a golden opportunity provided in the first year after surgery. In the absence of over-eating, compulsive eating, emotional eating, and fixation on dieting, there is time and space to do our mindset overhauls, do our trauma processing, and fervently work towards creating habits, routines, systems and processes that will keep us safe into the future, even if compulsion and hunger returns.

The absence of hunger, and the revolting diet cycle, offers a reprieve, but that reprieve should be well utilised. If we are deceived by the wonder of shedding pounds while eating exactly as we did before, but in smaller quantities,  we run the risk of incurring disappointing regain in the future. When compulsivity sneaks back in, around month 8, along with the ability to eat more, the reality of what has been squandered will become apparent.

(CAVEAT: I’m by NO MEANS a member of the “FOOD POLICE” camp, and you’ll never hear me banging on about abstinence from sugar, or about bread being Satan’s delight, or any such. I believe that each bariatric patient needs to work with their own nutritionist and their own surgical team, and figure out what is appropriate, long-term, for him or her).

The Biggest Post-Surgery Mistake

The biggest mistake that we probably all make, to some extent, post-surgery, is gently entertaining the idea that we might actually be psychologically and emotionally different, now that our anatomy is altered. Because it does often seem that way. But we are wise to learn from those who have the wisdom of experience and scream from the sidelines not to rest on our laurels just because it’s easier than it’s ever been to lose weight.

Certainly, what I learnt, and what my patients and clients confirm, is that losing is mostly easier than it ever was. Getting to goal and maintaining losses remain as difficult as ever they were.

And so, resolve that your surgery can provide a springboard into true healing, by taking the focus off the cruel and relentless diet cycle for the first time ever. And then DO THE WORK, and know that this work is practical, educational, psychological, emotional, even spiritual.  It’s a life overhaul.

This is the golden opportunity to address emotional difficulties, limiting beliefs and to rework nutritional plans, meal plans and LIFE IN GENERAL -

• While you hardly feel like eating at all…
• When physical hunger is at an all-time low…
• When compulsivity and craving is mostly diminished.

This is the golden window of opportunity to actually confront your demons, do the work and sit with your feelings. To sit with your powerful emotions, and learn tools, skills and strategies for coping with life on life's terms, to be in therapy if that’s what you choose, to be in support groups, to source relevant teaching and programs, and to acquire different vocabularies and methods to understand and approach life.

The Result of Doing the Internal Work

This work is invaluable, because, at around the 8-month mark, all of the pre-surgery realities usually rear their ugly heads. And if no life amendments have been made at all, you’ll find yourself up the proverbial creek! It's at that point that many people come knocking on my door absolutely horrified that there's been an almost overnight return of hunger, compulsion, the urge to binge and overwhelming emotion and craving.  It’s not necessarily too late, at this point… The tools will always be the tools, the therapy will always be the therapy, and ‘the work’ will always be ‘the work’. But it’s certainly a lot easier to do it when it’s a lot easier to do it!