Let me have men about me that are fat, Sleek-headed men and such as sleep a-nights.— Shakespeare
The Journal of the American Medical Association (JAMA) this month was dedicated to the topic of obesity and bariatric surgery. Having spent some time with patients getting them ready for surgery I thought I would take a moment and talk about the topic of obesity, surgery and our cultural response to this topic.
Obesity is quickly becoming a health crisis with rates that affect 40% of adults and 19% of adolescents. I conducted a lot of bariatric surgery evaluations for a local surgical group, and my initial feeling about the work was that this represented another form of shaming the patient for their condition. Like Shakespeare’s Julius Caesar, we often denigrate those suffering from obesity as a form of laziness or lack of effort. There is a tendency to treat surgery as just another quick fix.
We live in a world with endless “quick fixes” for weight problems, and promises of losing weight quickly. Much has been written about diet, exercise and various fad diets like low-carb, low-fat, ketogenic dieting and the like. All of these promise rapid weight loss and the promise of staying trim. One of the problems with this is that we live in a world that promotes obesity. 
It is very difficult to lose weight and keep it off in a society that promotes fast food, processed eating, and a high sugar diet. Patients I have evaluated for bariatric surgery have often tried many things to lose weight and to no avail. Usually, bariatric surgery is a last chance for many people to lose weight. When I would talk with patients about surgery, we would invariably talk about expectations and change. It can be very difficult to take on a new body without acknowledging that there is some kind of relationship with the current body they are trying to get rid of. Without taking some time to process the change that is about to happen, a patient could end up failing with bariatric surgery and not have any idea why.
When I am treating patients with PTSD (a topic I will cover further in another blog), I will see time and time again patients who are not in touch with their bodies. There will be times when anxiety might be confused for hunger, and eating confused with comfort. This same disconnect can be seen in obesity as well. Food can become a coping skill for some to deal with psychological stress, and when it is changed or removed, there is no longer any way of dealing with the underlying stress and anxiety. Over the years I have moved from a position of anger at my colleagues for what I perceived as being bias against patients seeking bariatric surgery, to thinking of bariatric evaluations as a chance to talk about adjustment to change, and what to expect when one is facing the prospect of a rapid, major change in the way they look. Keeping the door open for initiating therapy when undergoing bariatric surgery can help patients transition into their new selves with a greater possibility for success. Weight loss is a real challenge for some, and I find that for many, psychotherapy, in addition to good nutrition, exercise and healthy eating, will help to ensure longer life, and greater success.
— Stephen Taylor, M. D.
Knowing You 