If you’re struggling with obesity, losing weight is a lifelong proposition. And it’s not something you can do alone.
“Studies show that a combination of peer support and counseling helps patients meet their long-term weight loss goals,” says Lauren Skolnick, a licensed clinical social worker who helped build the behavioral health program at Columbia’s Center for Metabolic and Weight Loss Surgery. We recently spoke with her about the psychological issues that arise before and after a weight loss procedure—and why having a place to talk honestly and openly about these challenges is so important.
What role does attitude play in a patient’s efforts to adopt healthy eating habits?
It’s a critical element of sustainable weight loss. Your mind matters just as much as your body.
Since 2016, I’ve been working closely with the Center’s Director, Dr. Marc Bessler and the bariatric surgery team. Over time, I’ve learned a lot about our patients, what their emotional struggles are, and what interventions work best for them.
During our initial evaluation, I ask about the times when they have gained weight in the past, and if they have used food for comfort. This helps to identify the triggers they may face in the months ahead.
Our team also uses the Yale Food Addiction Scale to our assess patients’ eating habits. If individuals meet the criteria for food addiction we focus on their specific areas of vulnerability and help them develop new eating patterns.
What is your main focus as a counselor?
Getting patients to understand the when, why, and how of eating. We talk a lot about the history of their relationship to food. How were you raised to eat? What does food mean in your culture or your family? Are there times that you turn to food for solace because you feel lonely or disappointed? Has grabbing a candy bar or a bag of chips turned into a daily ritual?
Once people understand the why, when and how, they can adopt healthier coping mechanisms. One patient had no idea why he was gaining weight until we reviewed his eating habits. It turned out he was snacking on junk food when he sat in front of the TV at night. We encouraged him to find an alternative activity so he now goes for a walk with his brother after dinner. He’s also started exercising and going to the gym.
We also explored other incentives to help him change his behavior, like putting money that he normally spent on snack food into a fund for entertainment. In addition, we set up an alert on his cell phone, reminding him to eat enough during the day, so he wouldn’t be hungry late at night.
When is the best time to join a support group?
We offer ongoing support groups here at the hospital and also refer people to organizations like Overeaters Anonymous or to online forums for long-term weight management. We’ve also started a mentorship program, connecting patients in the pre-op phase with those who’ve already had weight loss surgery.
In most cases, insurance mandates that patients complete a medically supervised weight loss program, with their primary care providers before a weight loss procedure. This is a useful time to prepare for the lifestyle shift they will have to make.
What psychological issues are likely to arise after weight loss surgery?
Research shows that patients who struggled with depression in the past may develop new or worsening symptoms after surgery. We do our best to prevent this and make sure those people have the right support, referring them, as needed, to mental health professionals.
Most people do really well in the months after weight loss surgery but a year or more out from surgery they may and start putting on the pounds. This usually happens after a major life event like moving or changing jobs, getting married or divorced, having a baby or dealing with the loss of a loved one. When things get difficult, it’s natural to fall back onto old eating patterns. We help our patients to press the reset button and get back on track.
Sometimes patients get injured at the gym because they overdo. Or they might suffer an accident or injury that sets them back. Counseling and support groups are very important then. Everyone needs a safe place to talk about their challenges. It’s profoundly comforting and empowering to be reminded that you’re not the only one struggling to keep the weight off.
This morning, one woman had an important breakthrough in our support group. She realized she was having dessert with dinner much more often, because she was feeling lonely. That helped another member of the group zero in on why she had started eating more at a certain time of day as well.
Supportive friendships are often built on these “aha” moments. While everything shared in the group remains confidential, many people exchange phone numbers and plan to meet up on their own.
How are family relationships affected by the patient’s change in eating habits?
Partners and spouses may worry that they will be left behind once a patient starts making healthy lifestyle changes. Sometimes jealousy issues come up.
Certain friendships may dissolve if they are centered mainly around eating. I tell patients, “It’s important to talk about your relationships prior to surgery, and learn how to communicate your desire for a healthier lifestyle.”
Food also equals love in many families. Sometimes a parent will say to a candidate for weight loss surgery, “Does this mean you won’t be able to eat my Christmas cookies or join us at the table for Thanksgiving dinner?” My message is this: “You can still go to these family events and enjoy yourself. Just go prepared. Have a healthy meal beforehand, and have a plan for the type of food and the portions you will eat. That way you’ll be less likely to overdo or make choices you’ll regret.”
How long do people attend support groups?
We encourage our patients to come when they start planning for weight loss surgery—and to keep coming after their procedure is to build a network of supportive relationships.
We also encourage them to keep coming back, no matter how long it’s been since their weight loss surgery. There is no time limit on support.
What keeps people motivated in the long-term?
Not just the difference in how they look but how they feel. Many of their health outcomes improve. They may have less pain and their diabetes may go into remission. They get out more socially and are fit enough to run around and keep up with their kids. These are all huge wins.