Counseling Is the Extra Ingredient

Pre- and post-op counseling is vital for both surgical and nonsurgical bariatric patients

LOUISVILLE “It’s not brain surgery; it’s stomach surgery,” says Melissa Moody, LCSW, behavioral weight management specialist at Norton Weight Management Center. Many of her clients and patients, however, have an emotional and mental relationship with food that affects the success — or failure — of their bariatric experience, regardless of whether it’s surgical or nonsurgical.

“The nonsurgical patients actually require more counseling than the surgical because their weight-management is ongoing,” says Moody. She estimates that there are more nonsurgical patients than surgical, about 70% versus 30% in Norton’s Weight Management Center.

“People have thoughts, desires, and cravings for food before and after surgery or when entering our nonsurgical weight management program,” says Moody. “That doesn’t change, but they need to learn how to manage those thoughts about food.” That is where counseling and therapy enter.

According to Moody, most people who are looking for a change in their eating habits and weight management are unprepared for the emotional journey they are embarking upon after bariatric surgery or entering the nonsurgical program. There is often anxiety, especially in the beginning, that can progress to a variety of emotions such as joy, fear, frustration, anger, and shame. She counsels patients to take it one day at a time and advises them that ups and downs are expected and normal. The role of the counselor is “to support our clients during their dark periods and help them normalize their new situation.”

Significant weight loss that is sustainable is not quick. Moody points out, “The weight didn’t go on overnight. It’s not coming off overnight.”

Recognizing Triggers for Success

Moody sees a variety of causes for failure in weight management including medical complications, such as diabetes, thyroid imbalance, and weight-bearing joint problems that inhibit even moderate exercise and activity. Those conditions are challenging for counselors because they affect areas outside of the emotional support system she offers.

“Spotting the difference between ‘head hunger’ and ‘physical hunger’ is critical.”

The majority of her patients, however, face the task of changing their emotional attachment to food. “For many people, food is a friend that they turn to in times of stress for comfort,” says Moody. “In some extreme cases, the friendship with food becomes an addiction. Food is the drug of choice.”

That’s when recognizing the “food hunger” triggers becomes key. Knowing when and how to spot the difference between “head hunger” and “physical hunger.” Moody points out that head hunger can come from stress, boredom, sadness, and external stimuli such as images of food in TV commercials, the aroma of food nearby, or even conversations about food. Moody counsels her patients to “be mindful of the head hunger impulses and make the connection between what the brain is thinking and what the hand and mouth are doing.”

A common recommended response to a head hunger trigger is for a patient to “create their own emotional tool kit to deal with the head hunger triggers,” says Moody. She explains that there’s no one-size-fits-all coping strategy. Individuals must develop a customized response, as well as determining where the head hunger trigger is coming from, i.e., boredom, stress, anxiety. Moody suggests trigger countering behaviors such as “exercise, journaling, doing something artistic like listening to music or reading. Even aromatherapy can be helpful to reduce the stress level that is triggering head hunger. Anything to change what you’re thinking can work.”

Moody points out that patients are also more likely to open up about their fears and feelings of failure when they become mindful of their triggers and behaviors and receive counseling. She encourages all primary care physicians with patients who are considering bariatric surgery or entering a weight loss and management program to seek emotional counseling as a follow-up. “There’s much more involved than just seeing a dietician after weight-loss surgery.”