What Working in a Bariatric Surgery Clinic Taught Me About Weight Loss

A couple weeks ago I finished up my dietetic internship rotation at a bariatric surgery clinic. I loved my work there. Getting the opportunity to sit and talk with people one-on-one about their struggles and successes is, in my opinion, the most rewarding aspect of being a (soon to be) dietitian.

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At this clinic, the dietitians were in charge of counseling the patients both before and after surgery. In fact, I soon learned that dietitians were an integral part of the medical team. They needed to "clear" patients for surgery just as the surgeons would, based on a set criteria. In order to be cleared, patients needed to show the medical team (and their insurance company) that they could make healthy behavior and lifestyle changes. Studies have shown that patients who do make these changes experience the greatest amount of success in losing weight and maintaining the weight loss after surgery.

Wait, what?

That was my first thought too! Doesn't weight loss surgery mean you don't have to worry about making those pesky changes? Ah, sadly no. What bariatric surgery does is significantly decreases the size of your stomach. The result is you feeling full faster. BUT...(and there is a but) we all eat past our fullness sometimes, don't we? Think of the upcoming Thanksgiving, holidays, parties, times of emotional duress, eating popcorn mindlessly while watching Stranger Things 2... (you get the picture :)

We eat past our fullness everyday. Many patients came into the initial consultation with the idea that as soon as their stomachs would be made smaller, they would only eat a small amount because they felt full. To that, I would counter that we all eat for reasons other than hunger. Our decision to eat is also emotionally, behaviorally, and environmentally based. 

Losing weight successfully means facing the emotional, behavioral, and environmental barriers and stressors in our lives.

What we weigh is determined far more by these factors than by our hunger cues alone. Sadly, many patients I saw years after their surgery had plateaued or gained much of the weight back. Why? Because, somehow, they had not addressed these factors. But what do these factors look like?

  • When I am blue (or have a case of the mean reds), I sometimes reach for that extra piece of chocolate. This is an emotionally-based decision. I don't feel physically hungry - but my brain wants that pleasurable feeling that eating can bring, so I turn to food. 
  • I tend to clean my plate or bowl, regardless of my level of fullness, because that is how I have always been. My ritualistic behaviors and habits also prevent me from being 100% attuned to my body's specific hunger cues. 
  • Whenever I am in an old neighborhood of mine that has a particularly amazing donut shop, I feel compelled to buy a donut. In that moment, I am not hungry for a donut. But my environmental surroundings are reminding me how great it was to have those donuts and now, boom, a craving is setting in. 

All this is not to say that you should feel guilty or bad about making the decision to eat when you are not hungry. I would argue that this is apart of what being human is - we savor the moments that bring us joy and comfort and oftentimes that involves food. 

What IS important is that we are aware of these external cues. And if you decide you want to lose weight or adopt healthier lifestyle habits, know that these cues have to be addressed in order for you to be successful in the long-term. 

So what can you start doing today to help be more aware of your eating patterns?

I will talk about this more in future posts, but start by writing down common stressors or triggers that lead to you eating for reasons other than hunger. Just writing them down alone is recognizing that they exist and will help you become more aware. 

What strategies do you use to help deal with eating when you're not hungry? Comment below!