Are you struggling with obesity?

Are you struggling with obesity? Like millions of Americans, you are not alone. Obesity continues to be a major health epidemic in the United States. In fact, it has been called the ‘disease of the 21st century.’ Defines as an excessive accumulation of body fat, it is a disease that is thought to result from an interaction between genetic, environmental, and behavioral components.

Research indicates that more than one-third of Americans are obese. The prevalence of obesity is rising rapidly in the United States and worldwide. An inactive lifestyle, diet high in fat and energy dense foods, and under consumption of nutrient rich foods has attributed to the increase in prevalence. If the incidence of obesity continues rising, it is estimated that 40% of the U.S. population will be obese by the year 2025.

Obese individuals have a history of repeated failures with traditional weight loss methods including, diet, exercise, and pharmacotherapy. Conventional treatments are usually ineffective in treating extreme obesity in the long-term. Weight loss surgery to treat obesity is known as bariatric surgery. Bariatric surgery refers to the various surgical procedures performed on the stomach and/or intestines to achieve weight loss. The rationale of surgical intervention is either to decrease absorption or the intake of food, leading to weight loss.

After your surgeon determines bariatric surgery is appropriate for you, he or she will refer you for a psychological evaluation. You are probably questioning why you need a pre-surgical psychological evaluation-there are actually two reasons for the evaluation. The first is that it is a requirement based on guidelines established by the National Institute of Health. The second reason is that surgeons as well as insurance companies require the assessment to ensure your health and safety.

What is the purpose of a pre-surgical psychological evaluation and how does it ensure safety? The evaluation is designed to verify that the individual has both an adequate understanding of the necessary lifestyle adjustments and the resources to support healthy change. The assessment will include a face-to-face interview in order to better understand your motivation and expectations for the surgery, as well as gain background information important to the evaluation. In addition, you will complete several measures that will help us assess how we can best help you.

Despite the fact that most people lose a significant amount of weight between 18-24 months following surgery, preliminary studies are suggesting that patients have weight regain and the return of associated comorbidities. Unfortunately, without support and education as to how to modify multiple aspects of one's lifestyle, including exercise and food behaviors, many patients regain significant amounts of weight over time and fail to reach optimal weight loss.

Surgery itself is only one piece of the puzzle. Diet, exercise, and behavior modification are important components to permanent weight loss. Extended contact between patients and health providers is associated with long-term weight maintenance. According to the National Institute of Health, a multidisciplinary team is the most optimal approach in treating bariatric patients, as patients who achieve the best results are well informed and well cared for by their team. Research further indicates that postoperative psychological support is essential in adjusting to life after surgery, as well as learning new coping mechanisms that do not include food for handling underlying psychological, psychosocial, and environmental issues.

Services in the community for postoperative bariatric patients are scarce. It seems as if society regards bariatric surgery as a quick fix to a multifactorial disease. Postoperatively, patients go through more than anatomical changes. Bariatric procedures affect numerous facets of an individual’s life (physical, behavioral, cognitive, and psychological). Multidisciplinary aftercare treatment is needed to support and educate patients through this major life transition, as optimal outcome largely depends on the postoperative patient.

About the author: To address the needs in the community, Dr. Howard developed a program to address aftercare of postoperative bariatric patients that is designed to be multidisciplinary in nature to support weight loss and maintenance, thus impacting the disease process. The program focuses on transitioning patients to healthier lifestyles, increasing compliance with healthcare directive (both medical and behavioral), assumption of responsibility for one’s health, and modification of cognitive distortions and eating behaviors. She offers this research-based program at PBBHW. Once the physical scars of surgery begin to heal, it is time to begin working on the emotional wounds! In an effort to meet the unique needs of the bariatric population, Dr. Howard provides mobile assessment to residents of Palm Beach, Broward, and Dade counties.