Obesity Surgery: Stories Of Altered Lives

Chapter 7 Through Thick and Thin

chapter 7 Through Thick and Thin Planning for Success If you are not prepared to start fighting some of the fights that happen when you lose the shield of fat, you are going to backslide and have problems. —Frances When individuals opt for obesity surgery, they make a big investment. They have to take time off work, they cannot fulfill family duties for a while, they risk surgical complications, they spend money. Ensuring that this investment will result in good returns is a priority. For most people, that means selecting a good surgeon, getting in physical shape for the surgery (including losing some weight beforehand), and, of course, following the recommended postsurgical diet, exercise, and medication regimen. We think preparing for some of the potential emotional and relational consequences of the surgery might be almost as important as dieting and drugs. We also think that this preoperative preparation can be followed up in the weeks and months after the surgery to guide folks through some of the challenges as they happen. Anticipation is important, but getting help when the rubber meets the road can also be very helpful. So what might this preparation look like? Based on our research, clinical work, and interviews with many obesity surgery patients, we have developed a program. This program aims to guide patients and their counselors through the presurgical preparation and postsurgical process with a specific focus on self-concept, relationships, and skill building, as defined by the 212 “Model of the Post–Obesity Surgery” process we outlined in Chapter 6. We call this program Through Thick and Thin (ttat) in recognition of the fact that even positive developments can be challenging. It consists of a series of steps that can be implemented with the help of a counselor, in the context of a support group, or on an individual basis by following the guide here suggested . Most people we have spoken to claim that counselors and therapists or counselor-guided support groups were tremendously helpful to them in adapting to the changes that followed surgery and weight loss. Most obesity surgery clinics provide these services or give referrals to professionals who do. Although one could do this work individually, it’s harder to do it alone. Most people benefit greatly from peer support and from the guidance of health professionals with experience in this area. The Through Thick and Thin program can thus be used by counselors and support groups to guide their activities and discussions. Although we strongly recommend that individuals considering or undergoing obesity surgery avail themselves of these professional services, we also understand that everybody is different and that access to these services is not universal. Some people favor the solitary approach to working on their issues, whereas others prefer a professionally guided or group-driven effort. For others, these services may not be readily available or affordable. That is why we have tried to design the Through Thick and Thin program so that it can also be followed by individuals, on their own. The point is to be proactive and to reduce the element of surprise in the process of losing weight so that one does not get thrown off-course. The ttat program consists of a series of steps and exercises to help you prepare for the changes to come and to help you cope with them once they start to happen. The Presurgical Module consists primarily of education, identification of issues, and discussion of concerns with significant others. The Postsurgical Module consists primarily of the emotional processing of changes and of skills building. Although the steps are here necessarily outlined in a sequential (one step leads to another) fashion, many of them can be worked on at the same time. Some folks will feel they need to spend more time on some steps than others, but the point is to at least consider each one of them, either briefly or at length. Through Thick and Thin 213 214 O B E S I T Y S U R G E R Y Many people don’t realize they need to do this type of work until they have already had the operation. In that case, the entire ttat program can be followed postsurgically. Although we consider it optimal to go into the surgery with some preparation for the issues that may arise, this does not always happen in the desired order. Some people think they...