When it comes to my experience as a bariatric patient and a psychologist, the professional is personal.

To that end, I’m currently extending my knowledge, by studying towards a qualification as a “Board Certified Bariatric Counsellor”, through an American institution. I

’m interested in it for me. And I’m interested in it for my bariatric clients.

A module I completed this past week struck me, and I thought to share it with you.

Because it spoke about the need for bariatric doctors, therapists, and dietitians to normalise relapse/regain as part of the process of long-term bariatric success.

Read that again: to normalise relapse/regain as part of success.

The typical scenario might go like this: a person suffering with obesity considers undergoing bariatric surgery, reflects, consults, and contemplates. They proceed, and lose significant weight, maintain for some time, and then, at some point, for whatever reason, start to regain.

They may deduce that all is lost, that they are a failure, that “that didn’t work”, and spiral downwards into crushing shame and defeat, with no further options to exhaust.

If you are familiar, this is aligned to the “transtheoretical model of change”, which suggests that there are various stages in bringing about change in our lives:

• Pre-contemplation – ‘thinking-about-thinking’ about change.
• Contemplation: actively researching, consulting and decision-making.
• Planning.
• Action.
• Maintenance – the change has happened, all is well, and wins are managed and care-taken.

But we know this is kinda bullshit, right...?

There are murky, horrible pieces of the journey, not written into this model.

Relapse, and, hopefully, recovery.

And then maintenance, again.

And then relapse. Reconfiguration. Re-maintenance.

This module I completed argued for more of a focus, in patient education, on the inevitability of relapse after most weight loss surgeries, and the strategies available for recovery.

So that forewarned is forearmed, and shame is avoided when it happens.

They speak of “the 3 stages of relapse” – lapse, relapse, and collapse - and want these incorporated in the “stages of change” model. They also suggest that catching relapse in its infancy, and understanding it, would prevent the utter devastation that some bariatric patients experience when everything unravels.

A lapse is a temporary return to unwanted behaviour. A slip…

A relapse is a complete return to unwanted behaviour. A dip…

And a collapse is a relapse, with the associated regain, shame and hopelessness. A dive.

This makes immense sense to me, 7 years post-surgery.

The first 8 months were a breeze. Then I was shocked, disturbed, and destabilised by increasing hunger, urges, cravings, and compulsions. At that point, I drew on the tools in my toolbox as a psychologist and stepped up my ‘emotion regulation’ and ‘distress tolerance’ game (employing the fundamentals of Dialectical Behaviour Therapy, which I teach in my Bariatric Mind Masters program). 

At some point I re-engaged the services of a dietician. I consulted an endocrinologist and was put on medications to assist (long before the days of Ozempic and Saxenda). I’ve hired therapists and coaches and bought countless courses and books. I’ve journaled through forests (before going digital!).

And, more recently, in the last 2 years, I’ve embraced exercise as a mainstay. In August 2021, I jumped on a trampoline for 5 minutes per day. Recently I completed a half marathon.

But it’s been messy AF in-between.

In agreement with the content of my study material this week, the ‘trick’ for me has been never giving up, and never accepting defeat. I’ve had some horrible days, weeks, and months over the years, bingey and regaining.

But I’ve somehow always clawed my way back, refusing to hit a wall and call it a day.

I’ve always viewed long-term post-surgery life as a journey, with highs and lows, and as a full-time job.

Obesity is a chronic, relapsing condition, and there exists no ‘end point’ where remission is a certainty.

In my Back on Track program, I teach the concept of “A Week of Abstinence”, where my students craft for themselves a plan for their most successful week ever (full of nutritious food choices, quality sleep, hydration, movement, and self-care), and then attempt it. But I built in a fail-safe, aligned with the idea of lapse and relapse, where complications are expected and accounted for.

So, in essence, we win (by staying on track) or we learn, if a day doesn’t go as planned.

We troubleshoot, unpack and strategise for better wins the next day. Because the road to success is littered with slips, dips and dives, lapses, and relapses.

What we ultimately aim to prevent is utter collapse. Collapse, I believe, is the result of a false belief that all is lost, and the shame that this floods us with. When slips, dips and dives are normalised and expected, and bariatric surgery is never viewed as once-and-done, recovery and recalibration are easier to access and accept.