Weighing a Lifelong Decision
By Rhonda Mann
Beth Israel Deaconess Medical Center Staff
It's Suzanne Walker's job to figure out if someone is mentally ready to undergo weight loss surgery-and the total change of life that follows.
Sometimes it's the ring of a cell phone that gives her an important clue.
"During a serious interview with me, if this truly is one of their last vestiges of hope, they should not be taking calls from their friends," says Walker, a licensed social worker at Beth Israel Deaconess Medical Center. "It's an indicator that the person just doesn't get it."
Walker is part of a team that evaluates obese applicants who have been unable to drop pounds and sustain a healthy weight despite trying multiple diet and exercise regiments. To be considered for the
weight loss surgery program at BIDMC, patients fill out an application, then meet with a specialized medical internist, nurse educators, a psychotherapist, and a dietitian. They must also attend two information sessions-all before even being seen by a surgeon.
"Most people have done their research and know there's a lot of work involved," says Bariatric Surgeon
Ben Schneider. "After they undergo our team evaluation, we have them sign a contract that shows they do understand it's a lifelong commitment and they need to follow up with us, take their vitamins and adhere to a healthy lifestyle."
For some, adopting that healthy lifestyle can be tough, especially when it comes to changing eating habits.
"Your stomach is going from the size of a football to a golf ball and that will impact the way you eat and drink," says Kelly Moore, a registered dietitian with the program.
Moore says when she screens applicants, she asks about their weight and diet history, if they exercise every day, who buys the groceries in their home, and if he or she likes to cook. She also asks about work schedules.
"A teacher, for example, may get only 20 minutes for lunch and have to cram it all in." she says.
Moore says the biggest challenge facing patients who undergo the surgery is that often times old eating habits creep back in. One patient, she recalls, started relying on fast food with her busy schedule instead of taking the time to make a healthy meal. Most battle through the temptations, she says, but she's seen a few who have actually dropped weight post-surgery just to put it all back on.
"The surgery isn't a magic bullet," she says. "You can still eat a little bit of the things you love, like chocolate, but you have to learn how to balance it-take something else away."
This balancing act can be particularly difficult for those who routinely turn to food when they get depressed or anxious. Walker says some may have a food addiction, and this addiction can sometimes manifest itself in other dangerous behaviors.
"They can't eat that way anymore, so some people switch their addictions to gambling, even shopping," she says.
As part of the psychological screening, Walker asks prospective patients what they know about the surgery and its risks, if they take any psychiatric drugs (the body can't tolerate certain psychiatric medications after surgery), and what they hope the surgery will do for them.
"Some people imagine it will help them win the love of their life--the kind of turnaround people fantasize about," she says.
After performing their individual assessments of the patient, the evaluation team meets to discuss any concerns. A small percentage of those who apply are denied surgery for reasons ranging from being medically unfit to having drug or alcohol issues.
Walker sometimes recommends patients seek pre-counseling-putting a hold on their surgical plans until they are more mentally prepared.
"They (prospective patients) look at me as someone who is judging them," says Walker. "Honestly, my job is not to eliminate them from surgery but to get them ready for surgery if that's the right thing, so they can do it successfully."
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Posted March 2009