Friday 5/8/2015 ~ Should there be more emotional/mental prep before bariatric surgery?

    I belong to multiple groups on Facebook and that kind of thing, and so I interact with and see posts from people who are at all different stages of their own “weight loss journey” on a daily basis.  I have to say that on the whole I find people engaging and pleasant and I enjoy hearing and sharing in their success and stumbles along the way.  I also frequently see posts (that I don’t ever comment on because I know I’d be negative) from people that absolutely boggle my mind.  I also know that everyone goes though their own thing, and I’m actually NOT feeling judgmental like in a nasty way ~ but I find myself in “AWE” of the things that I read sometimes.

An example is “I’m 5 days out from my sleeve, when do you think I can try an oreo?”.  In my mind what that tells ME is that this person was not ready to have this surgery.  I know the RNY (which I had) and the other procedures are “different”, but I mean I LITERALLY did not eat any “solid food” for like two months after my procedure.  When I DID it was more like, ohhhhh wow two forkfuls of tuna I’m in heaven.  I am by NO means being “judgmental” of the feelings these posters have, OMG NEVER – I understand that sweet calling of oreo cream better than anyone.  Food addiction has played so many roles in my life I’m pretty sure it’s in fact got first billing on my marquee over even my own name.  To me though, the decision to have had the surgery was a ‘GREAT BIG DEAL’, I mean on a personal level it was a GREAT BIG HAIRY DEAL.  So much so that I put myself into 3-years of therapy once/week to handle it and to NOT allow myself to abuse the opportunity I had been given.  I LITERALLY knew for my OWN success and sanity that I had to deal with my “addiction” and make changes within me that went far beyond the actual surgery.

I guess I worry ~ about the lackadaisical attitude (as I perceive it to be) towards ‘weight loss surgery’ in general.  I mean I understand the BENEFITS by all means I do, I was the recipient of those benefits and I am NOT against the surgery.  I am however against anyone going into it mentally and emotionally unprepared.  I guess I don’t understand what people “think” will happen.  Like do they think that the change to their physical anatomy will just POOF change their entire mental and emotional being as well?  If they have been using food as their coping tool for like 30 years do they REALLY and HONESTLY think that is just going to change?

    Most programs (that I know of) of course require the courtesy “psychiatric visit” for clearance, but I really think that on the whole that is nothing more that an attempt to avoid later backlash.  I really think that bariatric surgery programs should have a MUCH more comprehensive psychological component and requirements prior to anyone being eligible for the surgery itself.  I know that ANYONE and EVERYONE who’s in the bullpen awaiting their approval will be shoving me in front of the next bus for this opinion, but I honestly think it’s necessary.

I also think that some point it will happen, unfortunately I don’t think it will happen for the ‘right reasons”.  To me the “right reasons” would be that the surgical community would see the rates of failure and struggles and continue to improve their “programs” to include more comprehensive psychological considerations for candidates.  That would be the “right path” in my mind, the one that provides for the most overall health (mental and physical), as well as the most successful outcomes.  Instead what I can envision happening down the road is that the insurance industry is going to require “more and more” for approval.  Mind you I am not a “fan of” nor do I “work for” insurance, and my feelings about insurance companies are a blog for a whole different day!  

However, I am a realist and I understand that “business is business” and a for profit business needs to make a profit.  The financial reality for the insurance industry is that they are taking a hit on the unpreparedness of so many of those that are approved for these bariatric procedures.  Over and over I see posts of people who are having their second and third revisions because they gained back half their weight, or all their weight and then some.  Granted, there are instances where it is a “physical or surgical” failure that creates the need for these revisions, but there are JUST as many instances of people continuing to make unhealthy choices post surgery and literally “undoing” all that was done.  

Sure the insurance company saves $$ on long term healthcare of other health issues (like high blood pressure, heart disease, diabetes) if the surgery is successful long term, and most companies already have a staunch physical list of criteria to be met prior to approval.  However most bariatric programs and insurance companies have a pretty SLIM list of criteria for “mental health” in order to qualify, and I believe therein lies the problem.  When a surgery is approved and performed, then all the weight is regained who wins here?

The “patient” is playing hell with their body on every level from the surgical risks, to the regain of the weight along with the potential regain of these other health issues.  The insurance company has now what doubled or tripled THEIR costs because they DID foot the bill ~ hoping for long term gains of health (that in turns saves them $$) and now they are going to pay again?  Let alone the actual mental health of the candidate for that revision ~ and the likelihood of their long term success if “something does not change”.

Honestly it saddens me really because food addiction and dependence is a prison just like all other addictions.  I think personally that bariatric surgery can in fact be a “great tool” in dealing with chronic and severe obesity.  I also think though that the “easy in easy out” culture that bariatric surgery has turned into as it is more widely accepted as the “norm” brings with it a HOST of other issues that we have not “caught up to dealing with yet”.

    Every time I see a post from that post-op patient just LONGING for their first cookie or pizza my heart breaks a little because I know that our system is failing them, and that the road ahead for them is going to be a difficult one.  My best advice is to be your OWN best advocate.  Neither your insurance nor your program require a years worth of therapy to deal with your relationship with food?  Well who CARES!?!?!?!  My advice is put yourself in the drivers seat and realize that realistically after the surgery you will still be you – and take whatever steps necessary to ensure that your own journey is a successful one!  My two-cents on a controversial subject, thanks for stopping by!


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