Section 17: Psychological support

Although generally after surgery you may have improved mental health, sometimes you may experience some psychological issues. These might include depression, issues around body image, eating due to stress or emotional reasons, low self-esteem, anxiety, disordered eating, altered relationships, another addiction to replace a food addiction or in rare cases, self-harm and suicidal feelings.

If you have had mental health issues in the past, you can become more vulnerable to these issues after surgery. It is important to continue your medication as advised by your GP or psychiatrist (although this may have to be changed to a liquid form initially after surgery) and continue to get psychological support as needed.

If you are self-harming or have suicidal feelings, you should contact your GP without delay. It is important to tell someone how you are feeling – as well as calling your GP for an emergency appointment, sometimes speaking to a friend and/or calling a helpline such as Samaritans can help. See Further Reading and Additional Resources for their and others contact details.

Below, we explore some of the most common issues following surgery and suggest some ways in which you might manage them.

Depression

You may find that you experience feelings of depression prior to surgery at the prospect of potentially not being able to enjoy food in the same way after surgery. In these situations, it can be useful to engage with people who have already had the surgery, perhaps via www.bandboozled.co.uk. They might be able to help you to think about enjoying food in a different way - for instance, enjoying the comfortable sense of satisfaction rather than an over-full ‘stuffed' sensation.

Having unrealistic expectations of what will be achieved with regards to weight loss can be a trigger for depression after surgery, so it’s important to talk about expectations at your pre-operative appointments so you are well-prepared.

Common symptoms for depression are low mood, inability to have interest or pleasure in activity on a day to day basis, lack of sleep, feeling tired and lack of energy, feeling worthless or having low self esteem. It is really important to see your GP if you are experiencing any of these symptoms.

Body image

Issues around body image can be difficult to deal with, as after weight loss surgery some patients may experience loose skin. In these cases, further surgery may be an option. See Cosmetic surgery after weight loss.

Altered relationships

You may find that friendships and relationships change and evolve after surgery. For instance, it might be that after losing weight, you are more inclined to go for a walk in the evening as opposed to watching TV, but your friend/partner may still want to do the latter. Think about using this as an opportunity to allow your relationship to evolve – just because you don’t share this any more, it doesn’t mean you can’t enjoy other activities together. Your partner may find it difficult to deal with the effects that surgery are having on you, even if they are positive. Make time to talk about issues to help them to understand. It is likely that many of these changes will have positive benefits on your relationship.

Non-hungry eating

People have all sorts of reasons for eating, such as social occasions, celebrations, comfort or habit – we don’t only eat to satisfy physical hunger. Before surgery, you may feel that you won’t miss certain foods or that you will be able to resist eating them when you don’t feel hungry. It is often OK to manage this in the short term, but as time passes and life goes on, you may face some challenges. 

Some people overly restrict themselves from eating certain foods, labelling them as ‘naughty’ or ‘wrong’. When you then eat the food, and ‘give in’, you might experience guilt. This can lead to disordered eating such as binge eating, night eating or comfort eating.

In order to tackle these issues, firstly it is important to find a pattern in your behaviour and identify any triggers. These may include:

• Loneliness
• Anger
• Stress
• Perceived appearance
• Disappointment with weight loss
• Feeling guilty of eating a ‘naughty’ food.

Stress can be a significant trigger, and this may have an impact on weight loss. There are two types of stressors: external and internal. External stressors can include a busy lifestyle, work pressure, and the demands of caring for children or relatives – ones that you perhaps can’t easily control. Internal stressors tend to be your own thoughts or behaviours, such as feeling unhappy about your weight or your way of eating. Learning how to manage stress can be a challenge.

When in stressful situations, consider whether there is anything you can do to take control and make it less stressful. How would this make you feel? What is the result?

For other triggers, such as loneliness, reach out for support - maybe speak to a colleague or a family member. Try to find comfort in things you enjoy. Evaluate whether you are contributing to your loneliness, maybe by keeping to yourself, and look at how to overcome this.

How you perceived yourself can affect how you feel on a day to day basis. Self esteem is linked to how you perceive yourself. Try to find ways to feel better about yourself. Avoid weighing yourself every day, try not to compare yourself with other people, reflect on the good things, and be kind to yourself.

Some people may feel guilty about having the ‘wrong’ or ‘naughty’ food. Try to avoid labelling foods, and give yourself permission to have a variety of different foods as part of a healthy balanced diet - maybe even try to practise mindful eating.

Look at your own triggers and try to think of ways you can overcome them. Write down a few ideas, and work out small steps on how to tackle these issues. It might be helpful to set a few goals. Be clear about what you want to achieve, as well as what you will want to do more of when you get there. This might be having some quality ‘me’ time two nights per week to help with relaxation. It’s important to note your achievements and practice self-praise as this will help you feel better and proud of what you have achieved. 

If you have listed emotional eating as one of your triggers, keeping a food and mood diary like the one we have put below might be helpful.

Self-esteem and negative thoughts

Your own thoughts can affect your mood and behaviour. For example, positive thoughts are good for your physical and mental health, whereas negative thoughts are likely to decrease motivation and make you feel helpless. Recognising any negative thoughts is the first step so that you can begin to challenge them.

Low self-esteem is linked to unhelpful thoughts and negative thinking. If you find you are having negative thoughts, this can affect how you feel and bring you down. This may then cause you to dwell on this thinking, which intensifies the feeling and makes it more extreme. If you can change what you are thinking, this can change how you feel.

The examples below show that, by identifying negative thoughts and replacing them with positive statements, you can feel more confident about yourself.

Examples

Challenging your views – when you have a negative thought, think…

What evidence do I have that this thought is correct?

Do these thoughts help or hinder me?

Is there another way of viewing the situation that is more helpful?

What would a friend say in same situation?

…then try to come up with a positive alternative.

Coping strategies

When you are in a difficult situation, it can be hard to cope. You might have feelings of worry or anxiety, and feel helpless or out of control. The following strategies might help you manage better and stay calm in a difficult situation.

Distraction techniques

This is probably the most common way to help you cope better. By using flash cards or sticky notes with examples of pleasant activities, tasks or time on your own, you can encourage yourself to think about something else. By then taking part in that activity, you should soon forget what you were struggling with before.

Examples of things you could do are:

• Having a bath
• Going for a walk
• Reading a good book
• Joining a support group
• Phoning a friend
• Going shopping (not for food!)
• Having a drink of water or other calorie free fluids

Positive affirmations

We all need to think more positively about ourselves to help increase our self-esteem and self-worth. If you feel this is something you don’t already do, you could write down some positive statements or phrases and stick them on your mirror or in your kitchen!

Some examples are :

• Nobody but me decides how I feel
• I choose to be happy
• I believe in myself
• I will be kind to myself
• I am losing weight for me, because I love me
• I use self-care, not self-control
• My challenges help me to grow
• All my problems have solutions
• I forgive myself for my mistakes

Relaxation

You might find that just simply relaxing and practicing mindfulness is an excellent way of coping day-to-day. Breathing techniques, and taking time to be in the present moment, can help you slow down and be more aware of what you are doing.  We have listed a few apps in section 18 that can help you practice these. For information on mindful eating, see Follow-up and general guidelines on healthy eating and living with a band.

Remember…

No one is perfect! We all can have days where we struggle to cope and feel like we aren’t good enough. ‘Failure’ is a part of understanding yourself better and therefore can help to improve your weight loss journey.

Identifying triggers and coping mechanisms before surgery will only aid your success after surgery. Try to move away from perfection, listen to self talk, and learn to challenge it. Be positive!

Try to get support from friends and family as well as professional support.

If you would like to find out more on any of what has been discussed in this section, please see Further Reading and Additional Resources.