As an eating disorder therapist, I practice from a weight-neutral approach, believing that health does not have a size. That being said, I understand that people make choices to pursue weight loss surgery and that provided they are fully informed, people have complete autonomy in their choices and I have no judgement towards them.
I do feel passionately that many individuals pursuing weight loss surgery need psychological support to help them navigate the process and I will not decline to work with anyone who has chosen medical intervention for weight loss. This blog aims to provide information for those considering surgery or who have had surgery to improve their relationship with food and support sustainable change.
What is bariatric surgery?
Bariatric surgery is a medical procedure that helps individuals lose weight by altering the digestive system. There are various types of bariatric surgeries, such as gastric bypass, gastric sleeve, and laparoscopic adjustable gastric banding.
Who is eligible for bariatric surgery in the UK?
Eligibility for bariatric surgery in the UK depends on factors such as BMI (body mass index), existing health conditions, and previous attempts at weight loss through lifestyle changes. Generally, candidates for surgery have a BMI of 40 or higher or a BMI of 35 or higher with obesity-related health issues.
What assessment is required before bariatric surgery in the UK?
NICE guidelines recommend patients undergo a comprehensive evaluation, including medical, nutritional, and psychological assessments. This process ensures that the individual is a suitable candidate for surgery and is prepared to make the necessary lifestyle changes post-surgery. Although this appears to be fairly standard practice within NHS services for bariatric surgery in the UK, I’m uncertain whether it is standard practice in all private clinics, especially those that facilitate surgery abroad. Aside from that, I’m concerned that psychological support often doesn’t appear to stem beyond assessment.
Bariatric surgery and disordered eating
The prevalence of disordered eating among bariatric surgery patients is of significant concern. Studies have shown that a considerable number of people considering bariatric surgery may already have an eating disorder, which can negatively impact the outcome of the surgery.
Disordered eating behaviors are quite common in this population, with one study (LABS-3) reporting that 40.4% of patients experienced loss-of-control eating, 30.5% reported binge eating, 16.5% reported night eating, and 6.4% reported at least one compensatory behavior during the prior six months.
Binge eating disorder (BED) is particularly prevalent among pre-surgery patients, with approximately 12.7% of them presenting with BED, making it the second most common psychiatric disorder in this population. It is essential to address any disordered eating patterns before undergoing bariatric surgery, as these behaviours may continue or worsen after the procedure. Working with an eating disorder therapist can help identify and treat disordered eating habits and improve the patient’s relationship with food.
How can I improve my relationship with food?
If you are considering bariatric surgery and know that you have a poor relationship with food, here are some areas to work on:
Keep a food journal
Tracking your food intake can help you become more aware of your eating habits and identify patterns that may be contributing to disordered eating behaviours. It can also help you make more informed choices about what you eat and how much you eat, leading to a healthier lifestyle overall. One way to track your food intake is by using a food diary, which allows you to record everything you eat throughout the day.
Get into a regular eating pattern
Establishing a consistent meal schedule can help regulate hunger and fullness cues and reduce the likelihood of overeating. It is also important to pay attention to the types of foods consumed during meals. Incorporating a variety of nutrient-dense foods such as fruits, vegetables, whole grains, lean proteins, and healthy fats can promote overall health and wellbeing. Additionally, drinking plenty of water throughout the day can help keep the body hydrated.
Challenge subconscious rules around eating learned in childhood
Reflect on any beliefs or rules about food that may have been ingrained during childhood, and work to challenge and reframe these thoughts. A common belief that many of my clients will have is that they must not waste food and therefore must clear their plate, leading to consistently eating behind their fullness levels. These are often beliefs passed down to us from our parents which need to be challenged.
Tune into your hunger and fullness cues
Learn to listen to your body’s signals for hunger and fullness, allowing yourself to eat when hungry and stop when satisfied. This may require some practice, as many of us have been conditioned to ignore these natural cues and instead rely on external factors such as social norms or strict diets to dictate our eating habits. However, by tuning into your body’s signals, you can develop a healthier relationship with food and avoid overeating or under eating.
One way to become more aware of your hunger and fullness cues is to rate your level of hunger before and after meals on a scale of 1 to 10, with 1 being extremely hungry and 10 being uncomfortably full. Over time, you may start to notice patterns in your hunger and fullness levels, allowing you to make more informed choices about when and how much to eat. Download my Food journal template here to help you with this.
It’s also important to remember that hunger and fullness are not the only factors that influence our eating habits. Emotions like stress and boredom can all play a role in our relationship with food. By becoming more mindful of these triggers and finding alternative ways to cope with them, such as through exercise or mindfulness practices, you can develop a more balanced approach to eating.
Reframe unhelpful thinking patterns that may trigger overeating
Identify thoughts and beliefs that contribute to disordered eating and work with a therapist to develop healthier thought patterns. Overeating can be triggered by a variety of factors, including stress, boredom, and negative emotions. However, one of the underlying causes of overeating is often unhelpful thinking patterns and beliefs that we hold about ourselves and our relationship with food. To address this issue, it’s important to identify these unhelpful thoughts and reframe them to develop healthier thought patterns.
One common unhelpful thought pattern that can contribute to overeating is all-or-nothing thinking. This type of thinking involves seeing things as black or white, good or bad, with no in-between. For example, if you eat one cookie, you might think that you’ve “blown” your diet and might as well keep eating. This kind of thinking can lead to binge eating and other disordered eating behaviors.
Another unhelpful thought pattern is catastrophising, or assuming the worst-case scenario will happen. For example, you might think that if you don’t eat a whole pizza, you’ll be hungry later and won’t be able to concentrate on anything else. This type of thinking can also lead to overeating and other disordered eating behaviors.
By identifying these unhelpful thinking patterns and reframing to develop healthier thought patterns, you can learn to reframe your thoughts and beliefs about food and eating. This can help you develop a healthier relationship with food and reduce the likelihood of overeating and other disordered eating behaviours.
Bariatric surgery can be a life-changing decision, and it is crucial to address any disordered eating patterns before and after the procedure. If you are pursuing this path and recognize that you have a poor relationship with food, don’t hesitate to get in touch. As an experienced eating disorder therapist, I have worked with clients pre and post-surgery and can provide the support needed to navigate this journey. Together, we can work towards a healthier relationship with food and sustainable change.
In case you missed it you can find my last blog post here – Navigating bariatric surgery risks: Psychological risk factors.