The old saying has always been: “There is no easy way to lose weight”.

Quite often, overweight persons believe if they can “just get a little help in starting to lose weight”, they can then manage to continue steady weight loss. Many join weight loss clubs to learn how to eat and exercise properly. That’s the most effective way to lose weight and keep it off. These persons are changing old habits and hopefully developing new ones in a quest to a healthier life. Others ask their doctor for diet pills or try over the counter diet medications. Then the really desperately overweight will turn to stomach stapling or another bariatric procedure to make them feel fuller while eating less.

It’s true that all good bariatric surgeons carefully screen and counsel patients before surgery, but the underlying reason for a person’s desire to lose weight is rarely simply for health reasons. Most persons who undergo stomach surgery do so thinking that their lives will improve dramatically after surgery. I often hear the excuse their “husband or wife will love them more”, or even “love them again” if they think the love is gone from their relationship. Sometimes, it’s “I’ll be able to get a better job” or “I want to look good in clothes off the rack”. Basically, this means we are really trying to improve our self-image or esteem.

Once stomach surgery has been done, most persons will be so happy and jubilant; they feel on top of the world. That exactly how I described a patient we’ll call “Judy”. Judy had gone through all the pre-surgery counseling sessions, tolerated surgery well, and lost weight steadily for about 10 to 11 months from 251 to 175 pounds. She felt more outgoing and had made a bunch of new friends in the six months following her surgery. Her old friends were patting her on the back and complimenting her weight loss daily. She even fell in love with a guy her age and dreamed of getting married.

Then in the 12th month, she noticed a little weight gain. She was eating just a little more than her diet allowed, but what the heck, she was in love and her surgery would “magically protect her from becoming fat again”. By the end of the 14th month, she was back up to 187 pounds and her weight seemed out of control. She panicked and became moody and depressed. After all, when others are stressed, they usually eat “comfort foods” to help ward off depression. If she ate chocolate and sweets, she knew she would gain weight rapidly and would not be able to justify the expense and pain she suffered for surgery. Talk about a catch 22! The guilt of gaining weight was becoming a huge burden. All of her pain was being internalized.

Once again on a very strict diet and exercise, Judy’s weight gain started to slow, and she even lost back down to 185 pounds. Then it happened; her boyfriend jilted her for one of her best friends. He just couldn’t put up with her mood swings and after all, she was getting fat again. Since Judy had depended on surgery to help lose weight, she just didn’t have the emotional stability and life style changes needed to handle such stress and avoid weight gain. By the end of the 18th month, Judy weighed 252 pounds; one pound more than before surgery!

While it’s true that bariatric surgery and the weight loss it causes seems to be a magical fix on all the problems of life, between 25 and 30% of all persons undergoing stomach reduction procedures will become depressed by the end of the first year. Since they can’t cope by eating, their depression may become very severe. Even worse, as the now depressed person attempts to overeat comfort foods, they may develop vomiting, since their stomach physically can’t hold that much food. Once this cycle of overeating and stretching started, Judy’s stomach slowly started holding more and more and eventually seemed to hold more food than before. She felt as if her life “fell apart before her very eyes”.

Fortunately, Judy had sought help for depression early enough, and antidepressants, dietary help and social counseling prevented progression of depression and further weight gain. The antidepressants bupropion and protriptyline can usually help this type of depression without causing weight gain. Ingestion of a natural amino acid, 5-hydroxytryptamine (5-HT) at bedtime can help reduce sugar cravings even up to three years after surgery.

Judy’s depression went into remission within six months, but in order for her to control her weight and feel self esteem again, we agreed she needed long term social, emotional, stress managing counseling and a dietary support system and exercise program. With all of these lifestyle changes in place, Judy’s weight is back down to 187 pounds and she is much less distressed. She has a new boyfriend and smiles and jokes a lot when she comes to the office now.

On her last visit, she reminded me “There is no easy way to lose weight”. The ideal weight loss plan truly includes a diet and exercise program that burns more calories than calories eaten and a change in habits and lifestyle. Hope your diet is going well!

Dr. Frank