Post-op bariatric patients faced with changing self-image
Christine Bennett was shopping in a resale store near her Itasca home when, out of the corner of her eye, she caught some movement in close proximity.
“I’m walking down the aisle and, thinking I was in someone’s way, I said ‘Oh, excuse me,’” she said. “Then I realized there was a mirrored column and I was looking at my own reflection. It was so embarrassing — I just hope nobody witnessed that. I couldn’t believe that I didn’t recognize myself.”
The episode wasn’t spurred by a ditzy moment or lapse in awareness of her surroundings. Like many other gastric bypass patients, Bennett was faced with a mini identity crisis after shedding 100 pounds.
“There’s a big lag time. Even four or five months after the surgery, I didn’t process what I saw in the bathroom mirror,” she said. “It took that long for my brain to catch up with my body because my self-esteem was in the toilet.”
Bennett never experienced any serious buyer’s remorse since she had the surgery in 2003, although she did admit to a small bout of depression. But bariatric specialists say it’s not uncommon for patients to hit the postoperative panic button when they witness the significant physical and mental changes.
“A lot of people think ‘I just have to get all this weight off, and the grass is going to be greener, the sky will be bluer, the sun will shine every day,’” said Dr. Ehtesham Ghani, a physician board certified in bariatrics and internal medicine on staff at Adventist Hinsdale and La Grange Memorial hospitals. “But it’s not a cure-all, and the transition time can be an emotional rollercoaster with evolving life outlooks and personal and professional relationships developing new dynamics. The patients aren’t always prepared for the aftermath.”
Bennett, who went through LifeWeigh Bariatrics in Downers Grove for her procedure, agreed. She was holding out for a whole new image, but when reconstructive plastic surgery failed to pan out as planned, Bennett had to cope with the letdown.
“You build up so much expectation, and then the rug gets pulled out from under you,” said Bennett, who has since become the medical group’s unofficial poster child for well-adjusted patients. “You’re in this sort of weird limbo. On the one hand, there are the positive health benefits of losing the weight and getting healthy, but you can also be a little scared of the unknown.”
As a clinical psychologist at the Center for Weight Management — which has offices in Hinsdale, Naperville, Brookfield, Berwyn and Oak Brook — Dr. Tracy Robinson often sees patients who “naively” approach the recovery process and don’t know how to handle their dramatically changing exterior.
“If their concepts and schemas all revolve around one body size, that imprint is long-lasting, and you can’t really argue them out of that distorted visage,” said Robinson, who evaluates all prospective patients for risk factors that could derail bariatric efforts. “Even if the scale and the measurements are contradicting what they see in their heads. To be brutally honest, 90 percent of the change that needs to occur is not medical but psychological — both in terms of (willpower for) healthy decision making and self-esteem.”
The superficial identity crisis — fueled by years of ridicule and subsequent attempts to stay invisible — trickles down all the way to wardrobe. Bennett still caught herself heading for the plus-size section for clothes, which were all “frumpy, grandma-looking stuff,” out of habit and subconscious disbelief.
“As I was going from a 16 to a 14 to a 12, I still couldn’t get it through my head that I wasn’t morbidly obese anymore,” she said. “I’d hold up jeans or a shirt and would say ‘Oh, I’ll never be able to get into that.’ But not only can you fit in it, but you can zip it.”
Barb MacTaggart, patient care liaison at LifeWeigh, said patients still migrate to the XL wracks or stores like Big & Tall and Lane Bryant when shopping.
“There’s always a delay,” she said. “It takes at least a good year to get used to your new self and feel comfortable.”
This mental roadblock is often aggravated by social shifts in the way family, friends, co-workers and even strangers interact with patients as the pounds come off — sex drive skyrockets and confidence and motivation levels rise.
“The equilibrium in all of your relationships is vacillating, and post-bariatric patients are sometimes ill-equipped to deal with that,” said Ghani, who also serves as medical director at the Center for Weight Management. “All of a sudden, your connection with spouses, girlfriends or boyfriends and old friends can become precarious because they can’t accept your new attitude and lifestyle. They sometimes resent or feel threatened by your success or worry that you’ll dump them.”
As patients’ support networks disintegrate, there’s a period of time when they yearn for the days of being 350 pounds again, he added.
They also are uncertain how to react to growing attention from the opposite sex, MacTaggart said. Overweight people are used to hearing snickers and malevolent remarks, but compliments are foreign to them, which can make social interaction awkward.
And for patients who were binge eaters, the loss of food as their emotional crutch can be debilitating while navigating the disorienting post-op identity crisis, Robinson said.
“Prior to surgery, they maybe blamed a lot of their problems on their weight, and now this barrier or defense is taken away from them,” he added. “It can be a struggle to find a different vehicle for a coping mechanism.”
Robinson stressed the importance of preparatory and follow-up therapy sessions, which are requirements at the Center for Weight Management, as is participation in support groups to ensure healthy adjusting.
“We want to reach out to those who maybe have psychological risk factors that make them less resilient to change so they can learn the tools to handle the whirlwind consequences of the surgery,” he said. “It’s not an easy road to travel, but we want that previous personality and that person in the mirror to be reconciled.”
Jessica Young can be reached at email@example.com.
Bariatrics: A branch of medicine that deals with the control and treatment of obesity
Gastric bypass: A surgical procedure in which a small pouch is created at the top of the stomach, circumventing the stomach and redirecting food through the small intestine. This limits the patient’s ability to absorb calories
Laparoscopic gastric banding: A minimally invasive restrictive procedure using an inflatable band to partition the stomach into two parts by wrapping the band around the upper stomach. Pulling it tight like a belt, the surgeon creates a tiny channel between the two gastric pouches while the band keeps the opening from expanding and storing more food.