What Bariatric Surgery Teaches Us About the Psychology of Weight

What I find fascinating is that even weight loss surgery has surprisingly high failure rates. You would think that if you have surgery that physically limits what you are able to eat, you wouldn't be able to do anything but lose weight. Yet this isn't the case. An estimated one fifth of patients regain more than 15% of their body weight five years post surgery, with some studies suggesting that around three quarters of people experience weight regain within six years.

That strongly suggests that there's something driving people to override their lack of hunger signals when they've had surgery and force themselves to eat. Clearly eating for these people wasn't simply down to hunger but instead had some other purpose that wasn't ameliorated by reducing the size of their stomach. It strongly suggests that it was something psychological rather than physical.

Also interesting is that rates of drug and alcohol problems skyrocket after bariatric surgery. Studies have suggested that rates of alcoholism increase by 33% after surgery, which I would argue is because people look to other things to provide the comfort that food used to provide for them. When you take away someone's source of comfort, they find another.

I have worked with pre and post bariatric surgery patients over the years and seen this firsthand. After the initial elation of starting to lose weight and having the torment of the constant mental battle around food taken away, they are often incredibly distressed as they realise that they were using food as a way of managing their feelings and emotions and they no longer have this as an option.

This often leads them to either try to find an alternative to food, such as drugs, alcohol, shopping, gambling or similar activities which provide a quick, simple rush of feel good hormones in the same way food did for them, or to try to eat anyway despite their surgery.

I had one patient who had undergone bariatric surgery and lost a considerable amount of weight. Soon after surgery she realised that her original problem with her weight was because she would graze all day as a way of distracting herself, rewarding herself and managing her feelings. After surgery she was no longer able to do this and was overwhelmed with her feelings so started eating over 100 bags of cheese puffs a day to give her the same sensation in her mouth. Her hair started to fall out from the lack of nutrients.

These lessons from bariatric surgery are invaluable for understanding how to use GLP-1 medications effectively. Unlike surgery, these medications offer a gentler, more gradual approach that provides time and mental space to develop new coping strategies. The key is to use this window of opportunity wisely, addressing the psychological roots of overeating whilst the medication quietens the noise, so that when you eventually stop, you have the tools you need to maintain your progress.