When the Truth Hurts

I love to have meetings that require patient involvement. They range from cooking demonstrations to talent shows, fashion shows and patient panels. The exciting part for me is that I have minimal preparation to do. As for the support group I am sure they are glad to hear from their peers from time to time.

I have had a number of patient panels which feature patients from 6 weeks to 10 years post-op. The support group audience is made up of a wide range of new and seasoned patients ranging from 2 weeks to 10 years out of surgery. The questions regard many topics from what was the pain like after surgery to asking if any member of the panel ever regretted having surgery. From my perspective the answers are direct from the professionals who have experienced life after bariatric surgery. If technical questions did arise the panel directed the medical concerns to me for my response. This has always been a very well attended meeting and one I like to do at least twice a year.

I always try and listen to my support group to hear what topics interest them the most. Recently what I have been hearing regards the concerns many are having over weight regain. Perhaps it was 2 lbs. or even 20 lbs. no matter what the regain it sounded an alarm that radiated through the group. Those who had just had surgery were concerned because they heard the long term patients discuss it. Everyone is told that after about 1 ½ - 2 years there could very well be some weight regain but until they hear it from those who are that far from surgery they never seem to believe it. Now there would be a meeting about it. Now they would hear and even wanted to hear what the special panel would have to say.

When I refer to this panel as special I can say my goal was to pick former patients who had been faithful support group participants, were out from surgery farther then 4 years, had lost at least 90 % of their excess weight and would tell it like it is. Sally Hildebrandt, PhD. who has written about the value of support groups reinforces the idea regarding the fact they offer ‘reality checks’. She states that no matter how affirming and comfortable it is in support group it is as important for participants to be significantly enhanced by honest, reality-based feed back. “A good support group will provide benevolently expressed reality checks.” What I wanted from this panel was a big reality check. I wanted this panel to be kind but firm, I needed members who would not downplay the significance of this problem because to everyone who would be in the audience it was an emotionally sensitive and serious issue. We were going to be discussing a problem which many considered their biggest fear. Regaining any weight could be an emotionally wrecking possibility that many considered would make them ultimately feel like failures. The panel that I would select had to be able to address this very tough issue and by the end of the meeting leave everyone with not only the reality checks affirming regain does happen but also with hope and encouragement that if regain does occur they would not be failures but would just have to learn to readjust their daily habits. Our goal would be to empower the audience.

Kelly who was the most recent out from surgery had lost 125 lbs., her surgery was in 2003. After having surgery, Kelly went back to school and became a dietitian who has proven to be one of our most valuable assets to the group by answering patient nutritional concerns. Kelly discussed the period of time that she regained some of her lost weight and that it was a real eye opener. She was in school juggling classes and realized the amount of time she had to spend in class was creating such a rigid schedule ultimately leading to poor food choices and minimal physical activity. Food was quick and not as nutritious as it should have been but most of all she realized her once established daily exercise routine was no longer a part of her life. School was stressful, life wasn’t normal and eventually the dreaded weight regain began to register on the scale. Her regain was approximately 32 lbs. Kelly’s first statement to the group was that, “Yes weight regain does happen but did you have too high of expectations for yourself after surgery? Maybe you wanted your weight to be a specific number that wasn’t realistic and you would not have been healthy at that size. The most important thing is to be happy with were you will be and if you are not then get to a professional who can help you through your struggles. You can always work with a dietitian to help get your weight issues under control and if you need help to get started with exercise then find a friend who will help you. Do something everyday and find someone who will encourage and perhaps even monitor your routine. No matter how many years you are past surgery you can still lose weight. You just have to take responsibility for doing this for you.”

Karen had surgery in 2002 and lost 132 lbs. Karen faithfully attended support group meetings for more then a year until the Michigan economy began a downward spiral and she was laid off from her job. Her next job prevented her from attending group meetings and now once again she was looking for work. Her concern that she addressed to the group was that after she lost her first job she spent hours applying for employment and eating late at night while she worked on the computer, a problem that led to a weight regain of about 25 lbs. Now as she was looking for work once again, her concern was that she would return to daily grazing and regain of the weight she had to work to lose the first time. What she proceeded to tell the group was about the plan that she had to prevent the regain from reoccurring. Karen planned her meals and snacks for the day and worked in an exercise routine. Her goal was to not let the computer consume too many hours of the day.

Dianne’s surgery was in 2001 and after her initial weight loss of 135 lbs. she realized from the stress of her own business that battling the scale and keeping the weight off became a challenge. Her weight regain was approximately 25 lbs. She reported that to be able to lose the regained weight she had to work on her emotional issues more diligently. Dianne encouraged faithful exercise and doing whatever was necessary to help eliminate a stressful life. Dianne faithfully attends support group and encouraged the whole group to also be faithful as the meetings help her stay on track.

Michelle’s surgery was in 2002. She experienced a weight loss of 153lbs0. When she was down to 140 lbs. she told the group that she was very aware her weight was too low. She regained some needed weight and works to maintain by monitoring how her clothes fit. She reports not getting on the scale until she comes in the office. If her clothes are too tight she “readjusts” what she is eating and will exercise more faithfully.

Dave’s surgery was in 1998. He lost a total of 190 lbs. He claims to have put on 10- 20 lbs. at various times but very quickly realized his tight fitting clothes would call for him to back off. He states that he does eat whatever he wants within reason but is very aware he must also readjust his thinking about portion sizes to be able to lose the regained pounds. He has a job that requires constant physical activity, which he says proudly makes his exercise a daily routine. Dave began his presentation to the group by saying, “Some of you in this room will fail. If you think that you can do whatever you want and not regain weight then you will fail. You can control this problem by realizing it is a problem and realizing it is only you who can do something about it. Make up your mind that you will not fail and you won’t.”

It goes without saying how proud I was of this panel. Their message was sometimes painful, often annoying but it was truthful, and it was a reality check. There were words spoken that some did not want to hear but they listened anyway. The following day my emails were flooded with words of appreciation for the meeting that was most empowering. Yes, sometimes the truth does hurt but often it is the only thing that will help us improve our lives.