Corey has a decision to make.
Ever since reaching puberty, Corey had struggled with her weight. At first she tried to accept the extra pounds, but a few searing “lard face” comments from schoolmates left her increasingly self-conscious. This self-consciousness multiplied after her second pregnancy, when her weight started to balloon and wasn’t coming off. By the time she reached middle age she was more than 100 pounds overweight, labeled with that subtle phrase MORBIDLY OBESE.
Although Corey’s husband seemed to accept her and she knew intellectually “she wasn’t her weight,” she often felt lousy about herself. Sometimes she felt invisible, as when co-workers didn’t seem to notice her and she was passed over for promotions. Sometimes she wasn’t invisible enough, as she felt judgmental eyes on her when walking in public. At times she felt embarrassed; at times outright shame.
Not that Corey took these weight challenges lying down. She had tried “every diet ever conceived,” estimating she’d lost more than three hundred pounds in her life. She had read books, attended seminars, and exercised whenever possible. But somehow the weight always seemed to come back, and often with a vengeance.
Corey is now approaching 50 and the ramifications of carrying the extra weight is starting to wreak havoc. She is now pre-diabetic, and her blood pressure is up. Her joints ache, her back hurts, and she has chronic pain in one of her knees. To counteract this, she doubles down on her diets, trying out all the latest weight loss fads but coming out with the same results.
At her wits’ end, Corey considers weight loss surgery after seeing a few newspaper ads and watching an episode of Oprah. She does her due diligence, researching the various weight loss options online. She wrestles with the idea, seeing the pros and cons, and tries to envision herself doing what she first considers a drastic measure.
But as she gets ready to embrace the idea, she is surprised and put off by a few family members and co-workers who thinks she’s making a mistake. “Isn’t surgery an easy way out? Where’s your willpower? She also notices the most vociferous objectors tend to have weight issues of their own.
She goes back and forth until one day she has an aha moment when taking her two year old granddaughter to an amusement park. After waiting 20 minutes for the ferris wheel she can’t fit in the seat and her granddaughter’s look of disappointment scorches her soul. “That’s it,” she thinks. “This isn’t about others and their opinions, this is about me and my health and those I love.”
The next morning she calls Puget Sound Bariatric Center, which offers surgery options such as the Gastric Bypass and LAP-BAND but specializes in the popular LapSleeve, where 80-85% of the patient’s stomach is removed. To help make this surgery a success the Center also specializes in comprehensive before and aftercare, which includes multiple visits with the surgeons, nutritionists, exercise physiologists and psychotherapists.
I am privileged to be one of the latter at Puget Sound, and my initial contact with Corey comes with a psychological assessment we do with each of our patients. I ask her about her personal and family background, looking for indicators such as abuse and trauma and other possible precursors for weight gain. Since Corey has never seen a therapist before, she finds these questions challenging but does her best to answer. I also reiterate that the surgery is a tool more than a quick fix, that a lifestyle change will be needed for her to be successful.
Part of the goal of the intake is to get a sense of why the weight was gained in the first place.
Certainly genetic factors come into play with weight challenges, but environmental/psychological factors can also be important. We want to know what our patients gain by gaining weight (Safety? Protection from unwanted relationships and responsibilities?). We want to know how trauma has affected their lives (Low self-esteem? Need to self-sabotage?).
In Corey’s case her unsettled family (her parents divorced when she was 10) coupled with the weight problems with her early onset puberty left her searching for ways to ease the inner turmoil. At this point food became both her problem and her solution, her way to self-medicate and cope with life. This continued as her life progressed, as almost any life challenge triggered her eating. Bored? Eat. Anxious? Eat. Angry? Eat. With all the “payoffs” from this emotional/comfort eating, you can see why Corey says she’s addicted to food.
So Corey has the surgery, not only to lose weight and keep it off, but to establish a new relationship with food. And that she does, but after a few months she finds herself spending a boatload of money on online shopping, and thinks there’s more to it than just outfitting her shrinking physique. In a follow-up session I reiterate the idea of transference addiction (we had talked about it earlier), where people will look for one addiction source when another is taken away. She thinks this is what’s happening with the shopping, and soon finds some perspective.
As Corey’s story reveals, weight loss surgery takes courage, as those involved not only go through the challenges of surgery but need to take a hard look at themselves. But there is also joy and freedom, as the weight which has been a weight slowly but surely recedes. And with this process also comes humor--at our last session Corey mentioned she is planning to show the film of her surgery when hosting this years’s Thanksgiving dinner (dessert?).
And speaking of humor, there is a cute term in the weight loss world for someone who crosses under the 200 pound threshold. It is wonderland, as in onederland, as in you’ve made your way into the under 200 Promised Land and can use a one at the start of your weight (e.g. 197). Goals are a part of the weight loss process, and when you’ve reached a milestone might as well have a fun name for it.
I too am in wonderland working with patients like Corey in that I find it wonderful, as in full of wonder. Courage, honesty, humor--this is not the stuff of those lacking willpower, but of those who want to take a good look at themselves and change their life for the better. Obviously weight loss surgery isn’t for everyone, but for Corey, it was “the best decision I’ve ever made.”
Ever since reaching puberty, Corey had struggled with her weight. At first she tried to accept the extra pounds, but a few searing “lard face” comments from schoolmates left her increasingly self-conscious. This self-consciousness multiplied after her second pregnancy, when her weight started to balloon and wasn’t coming off. By the time she reached middle age she was more than 100 pounds overweight, labeled with that subtle phrase MORBIDLY OBESE.
Although Corey’s husband seemed to accept her and she knew intellectually “she wasn’t her weight,” she often felt lousy about herself. Sometimes she felt invisible, as when co-workers didn’t seem to notice her and she was passed over for promotions. Sometimes she wasn’t invisible enough, as she felt judgmental eyes on her when walking in public. At times she felt embarrassed; at times outright shame.
Not that Corey took these weight challenges lying down. She had tried “every diet ever conceived,” estimating she’d lost more than three hundred pounds in her life. She had read books, attended seminars, and exercised whenever possible. But somehow the weight always seemed to come back, and often with a vengeance.
Corey is now approaching 50 and the ramifications of carrying the extra weight is starting to wreak havoc. She is now pre-diabetic, and her blood pressure is up. Her joints ache, her back hurts, and she has chronic pain in one of her knees. To counteract this, she doubles down on her diets, trying out all the latest weight loss fads but coming out with the same results.
At her wits’ end, Corey considers weight loss surgery after seeing a few newspaper ads and watching an episode of Oprah. She does her due diligence, researching the various weight loss options online. She wrestles with the idea, seeing the pros and cons, and tries to envision herself doing what she first considers a drastic measure.
But as she gets ready to embrace the idea, she is surprised and put off by a few family members and co-workers who thinks she’s making a mistake. “Isn’t surgery an easy way out? Where’s your willpower? She also notices the most vociferous objectors tend to have weight issues of their own.
She goes back and forth until one day she has an aha moment when taking her two year old granddaughter to an amusement park. After waiting 20 minutes for the ferris wheel she can’t fit in the seat and her granddaughter’s look of disappointment scorches her soul. “That’s it,” she thinks. “This isn’t about others and their opinions, this is about me and my health and those I love.”
The next morning she calls Puget Sound Bariatric Center, which offers surgery options such as the Gastric Bypass and LAP-BAND but specializes in the popular LapSleeve, where 80-85% of the patient’s stomach is removed. To help make this surgery a success the Center also specializes in comprehensive before and aftercare, which includes multiple visits with the surgeons, nutritionists, exercise physiologists and psychotherapists.
I am privileged to be one of the latter at Puget Sound, and my initial contact with Corey comes with a psychological assessment we do with each of our patients. I ask her about her personal and family background, looking for indicators such as abuse and trauma and other possible precursors for weight gain. Since Corey has never seen a therapist before, she finds these questions challenging but does her best to answer. I also reiterate that the surgery is a tool more than a quick fix, that a lifestyle change will be needed for her to be successful.
Part of the goal of the intake is to get a sense of why the weight was gained in the first place.
Certainly genetic factors come into play with weight challenges, but environmental/psychological factors can also be important. We want to know what our patients gain by gaining weight (Safety? Protection from unwanted relationships and responsibilities?). We want to know how trauma has affected their lives (Low self-esteem? Need to self-sabotage?).
In Corey’s case her unsettled family (her parents divorced when she was 10) coupled with the weight problems with her early onset puberty left her searching for ways to ease the inner turmoil. At this point food became both her problem and her solution, her way to self-medicate and cope with life. This continued as her life progressed, as almost any life challenge triggered her eating. Bored? Eat. Anxious? Eat. Angry? Eat. With all the “payoffs” from this emotional/comfort eating, you can see why Corey says she’s addicted to food.
So Corey has the surgery, not only to lose weight and keep it off, but to establish a new relationship with food. And that she does, but after a few months she finds herself spending a boatload of money on online shopping, and thinks there’s more to it than just outfitting her shrinking physique. In a follow-up session I reiterate the idea of transference addiction (we had talked about it earlier), where people will look for one addiction source when another is taken away. She thinks this is what’s happening with the shopping, and soon finds some perspective.
As Corey’s story reveals, weight loss surgery takes courage, as those involved not only go through the challenges of surgery but need to take a hard look at themselves. But there is also joy and freedom, as the weight which has been a weight slowly but surely recedes. And with this process also comes humor--at our last session Corey mentioned she is planning to show the film of her surgery when hosting this years’s Thanksgiving dinner (dessert?).
And speaking of humor, there is a cute term in the weight loss world for someone who crosses under the 200 pound threshold. It is wonderland, as in onederland, as in you’ve made your way into the under 200 Promised Land and can use a one at the start of your weight (e.g. 197). Goals are a part of the weight loss process, and when you’ve reached a milestone might as well have a fun name for it.
I too am in wonderland working with patients like Corey in that I find it wonderful, as in full of wonder. Courage, honesty, humor--this is not the stuff of those lacking willpower, but of those who want to take a good look at themselves and change their life for the better. Obviously weight loss surgery isn’t for everyone, but for Corey, it was “the best decision I’ve ever made.”
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