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Are you "eating" emotions and are you afraid that you will continue to do it after bariatric surgery? Only when you eat, do you feel happy and don't want to lose it? Are you depressed or have other mental he alth problems? Or maybe you are afraid of surgery and life after it? Ask for advice from a psychologist. We advise on what a psychologist can help before and after bariatric surgery.

Obesityis a chronic disease that negatively affects many areas of the patient's life. Not only does it prevent him from fully enjoying life: learn, work, and enjoy his social roles. It also disrupts his daily, ordinary personal and home activities as well as his relationships with people. A person suffering from obesity, due to his illness, often avoids contacts, closes himself in his safe world, postpones or does not take important decisions - paradoxically, also the most important one, i.e. the treatment of obesity. Or, after many unsuccessful attempts, for fear of further failures, he gives up new options for therapy. He is looking for his own way to deal with his emotions. Often it is food.

Obesity and emotions

It happens that for an obese patient, food ceases to be a means of satisfying hunger and becomes a reward, a method of coping with stress, escaping problems and difficult situations, or a way to provide pleasure. It can also be a form of showing closeness or meeting many other emotional needs. Of great importance is the education of a patient with obesity and what emotions they feel. Expanding and differentiating this "emotional vocabulary" allows the patient to interpret what he or she is feeling more precisely and not to react by reaching for food whenever he or she feels uncomfortable. But also people who do not have trouble recognizing emotions may find it difficult to control the food they eat when they stop paying attention to what, when and how much they eat. This happens most often, for example, when watching TV, working at the computer, or reading a book, and it is associated with attention and monitoring disorders.

Read also:Losing weight: how to reduce appetite and hunger?

People who are obese often suffer from mood disorders. And it is not entirely clear what is the effect and what is the cause of their development of the diseaseobesity. Is it a depressed mood that stimulates them to eat food from the group of the so-called comfort food (e.g. ice cream, cookies, chocolate) to improve your well-being? Or does excessive and uncontrolled eating lead to a depressed mood? It's kind of a vicious cycle. It shows that the relationship between the patient's psyche and obesity is often complicated, requiring complex diagnosis, searching for the causes and mechanisms that led to the development of excessive body weight and "insight" into what food "does" to the patient and what his needs satisfy. Only then can obesity be treated.

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The most common emotional states and disorders as well as mental illnesses accompanying obesity are:

  • low self-esteem and lack of self-acceptance
  • affective disorders (e.g. depression, bipolar disorder)
  • anxiety disorders
  • night food team
  • compulsive eating syndrome
  • food addiction
  • bulimia nervosa
  • personality disorders

Emotions and bariatric surgery

Bariatric surgery is the most effective method of treating obesity of the 2nd degree (with other diseases that are complications of obesity) and 3rd degree obesity, the so-called morbid obesity. Surgical treatment of obesity, by changing the anatomy of the digestive system, helps an obese patient to reduce body weight, i.e. lose weight, to a level that is safe for he alth. This is a major surgical intervention. When deciding on surgery, the patient should be aware of what awaits him. To this end, psychoeducation is conducted with the patient in the early stages of treatment, checking what he knows about bariatric surgeries and supplementing his knowledge in order to stimulate his awareness and responsibility for action.

Even before bariatric surgery, during preparation, and even more so after surgery, an obese patient will experience a radical change in lifestyle and learning to control the disease. Bariatric surgery is a tool supporting the treatment of obesity, but unfortunately it will not solve emotional problems, cure mental disorders, or change eating habits and behavior. A psychologist will help with this. Its role in supporting obesity varies depending on the stage of bariatric treatment.

Psychological qualification for surgery

Polish and European recommendations regarding the qualification of obese patients for bariatric surgery recommend that each patient undergo a psychological consultation before the procedure. The tasks of a psychologist include:

  • learning about the patient's medical history and life - these are the keyevents that changed the way and style of eating: the amount and quality of food consumed by him and periods of weight gain and weight reduction,
  • diagnosing the psychological mechanisms that guide the patient's behavior, which could have influenced the development of his obesity disease,
  • diagnosing the patient's eating disorders, depression, anxiety and other disorders, which, if left untreated, may sabotage the effects of bariatric surgery,
  • finding out if the patient consciously makes a decision about surgery,
  • stimulating motivation and self-efficacy in weight reduction, i.e. whether the patient is ready to modify his lifestyle and how much he / she assesses whether he / she will cope with this process,
  • find out if the patient understands the necessity to cooperate after the surgery with a bariatric surgeon and other specialists (psychologist, dietitian and physiotherapist),
  • identifying barriers that may hinder the patient's cooperation with the therapeutic team.

Don't be afraid of the psychologist!His role is not to judge you. A psychologist will support you in the process of change. The psychologist acquires information about your difficulties during a conversation with you. During the meeting, he or she may use special psychological tools: questionnaires and tests. Thanks to them, it will effectively diagnose the problems you are struggling with and take the best treatment for you.


The diagnosis of mental illnesses and other disorders does not mean that an obese patient will not be able to undergo bariatric surgery. The surgeon will perform the procedure when the patient's mental state is stable, when the patient understands the essence of the treatment and cooperates with the therapeutic team. Therefore, after diagnosing possible psychopathologies, first of all, it is necessary to balance the patient's mental state, and then - treatment of obesity. These are two elements of therapy closely related to each other.

Help of a psychologist in preparation for surgery

At this stage, a psychologist works with an obesity patient to change the way he thinks and his destructive thoughts, beliefs about himself, eating, relationships with people and the world around him. Patients who wish to undergo bariatric surgery often, when they are told that the surgery is not a miracle, and that in order to achieve long-term effects of treatment, they face a period of preparation and lifestyle modification, they experience ambivalence, ie internal conflict. Behavior unfavorable for their he alth is related to the suffering they experience, but also to some kind of benefits, gratification in connection with its continuation, despite the negative consequences.

The role of a psychologist is to explain to the patient the mechanisms that led him to obesity and to show how to effectively change them. The psychologist prepares the patient for potential failures and emotional crises, which are an integral part of the process of change. It tells how the patient can deal with them and who to ask for support. The psychologist helps the patient recover the so-called agency - the feeling that the patient has an influence on their behavior and functioning.

Working with the patient before bariatric surgery, a psychologist uses various techniques adapted to the needs and therapeutic goals. They are, among others :

  • cognitive restructuring,
  • mental stimulation,
  • mindfulness training,
  • breathing exercises,
  • emotion regulation training,
  • constructive reward training,
  • relaxation techniques.

At this stage of psychological preparation, the patient's commitment and motivation to introduce changes are extremely important. The psychologist creates safe conditions for him to learn and improve new skills, eating behaviors, coping with stressful situations and, as a result, to regain control over his actions.

After surgery - what does a psychologist help with?

The time after surgery is special. It is psychologically the most difficult stage, although it might seem the easiest one. High expectations of the patient as to the effects of the surgery, euphoria and optimism very often lead to the exclusion of his vigilance and forgetting about the "obese past". The consequence is often a breakdown of self-control.

This is the period when the psychologist encourages the patient to persevere in following the recommendations on proper nutrition. Patients often find it difficult to adapt to the regime - eating food in the right amount and consistency. The psychologist teaches sensitivity to signals sent by the body, observation of the work of the altered digestive system, and coping with difficulties. It is a period of perfecting new skills in the field of he althy eating and consolidating the correct attitude towards food. Thanks to this, the effects of the surgery will last longer and the obesity disease will not recur.

The article is based on: Sekuła M., Paśnik K. - "The role of a psychologist in the surgical treatment of morbid obesity" - Military Doctor 2016: 95 (3) 298-301.

Where to go for help

There are few bariatric psychologists, i.e. specialists supporting patients before and after bariatric surgeries. But if you need psychological help, you can use the help of another psychologist, e.g. a psychologisteating disorders. It is important that you trust him and establish a good therapeutic relationship with him - remembering that he is there to help you, that is, to give you a "tool box" with appropriate knowledge and skills so that you can handle difficult situations on your own.

Important supports safe treatment and a dignified life of people suffering from obesity. This article does not contain discriminatory and stigmatizing content of people suffering from obesity.

About the authorMagdalena Gajda A specialist in obesity disease and obesity discrimination of people with diseases. President of the OD-WAGA Foundation of People with Obesity, Social Ombudsman for the Rights of People with Obesity in Poland and a representative of Poland in the European Coalition for People Living with Obesity. By profession - a journalist specializing in he alth issues, as well as a PR, social communication, storytelling and CSR specialist. Privately - obesity since childhood, after bariatric surgery in 2010. Starting weight - 136 kg, current weight - 78 kg.

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