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Surgical treatment for obesity is often recommended for patients whose obesity is refractory or have obesity-related conditions that pose serious health consequences. Surgical intervention is reserved for those with a BMI (body mass index) of 40 or greater, or a BMI of at least 35 with obesity related health conditions.

The two most used procedures are gastric bypass and gastric restriction. Surgery related death is less than 1% for low-risk patients, and less than 2% for high-risk patients for either procedure. The goal of surgery is to reduce the stomach reservoir so that a sense of fullness is gained from a smaller volume of food. Obviously with less food intake, weight loss occurs.

Surgery can achieve maintainable losses of 40% to 60% of pre-surgery weight. But weight loss is a complicated psychological as well as physical feat. Unfortunately, the psychological state of a patient is not always considered when recommending this option. Increasingly, more surgeons are interested in psychological screenings for medically qualified patients. Far too many surgeries are still performed without taking this necessary step.

Positive personality changes can accompany weight loss (Stunkard et al., 1986). Patients often report feeling less helpless, more stable, improved mood, etc. Other patients experience negative psychological post-operative changes (Loewig,1993). It is unsound practice not to screen for possible negative effects.

We know that those who have surgery for medical reasons do better than those who undergo surgery for psychosocial reasons.

So we need to ask:
What does weight loss mean to a patient?
What are his/her expectations?
Are there serious pre-operative psychological problems?
Will weight loss negatively affect the person’s psychological functioning?

For example, those with severe psychological disturbance may see surgery as the end-all to their problems. When post surgery weight loss occurs and psychological disturbances remain, patients can dive into depression and other psychological disorders.

Some patients have used obesity to cover traumatic events such as sexual abuse. When pounds are dropped, they feel vulnerable and scared. If fear and anxiety were channeled through food and food is no longer available as a coping mechanism, problems can arise.

Obese people who spend years fighting social discrimination, attacks on self-esteem, and rejection may view surgery as a way to gain an acceptable body. When the physical body conforms to social expectation, the attention can be overwhelming and difficult to handle.

Furthermore, many obese patients do not know how to determine their internal emotional states. They often see all needs as hunger needs. Emotional based eating does not go away with surgical weight loss.

The key, then, is to screen patients for psychological issues prior to surgery and address those issues in an attempt to avoid negative long-term effects. It appears that those who do best with weight reduction via surgical treatment are those who are psychologically healthy.

Stunkard, A. et al. (1986) Psychological and social aspects of surgical treatment of obesity. American Journal of Psychiatry. 143: 4, 417-429.

Loewig, T. et al. (1993). Gastric banding for morbid obesity. International Journal

Jessica Simpson made a bold move by allowing herself to be photographed for the cover of Marie Claire’s May issue. The photo is untouched, showing what a normal person looks like without all the glamour.

The pressure to look as good as the ionic Barbie is constant in our culture and needs to be opposed or we’ll continue to see record rates of eating disorders, cosmetic surgeries, and body dissatisfaction. Make no mistake. The numbers are rising. And while our nation experiences record rates of obesity, personal happiness is still tied to thinness. As a result, body image, our mental picture of ourselves, grows more negative as reality fails to match the body idealism we embrace.

The repeated exposure of unrealistic body perfection does a number on any healthy developing female. Girls who are five years old talk of dieting, and middle age women are now developing eating disorders. Something has to change. We have to be purposely challenging what girls and women see and believe to be true.

I‘m calling for a body acceptance movement to be led by those who know and experience the transforming power of the Gospel. While it’s great that the Dove Foundation and Jessica Simpson are beginning to combat our narrowing definitions of beauty, the church needs a wake-up call on this issue. Most of us need to examine our thoughts about our bodies and make changes in our thoughts, emotions, relationships, and in the culture with which we surround ourselves.

For years, I hated my red hair, glow in the dark white skin, and lumpy-bumpy thighs. Somehow, I was able to disconnect the truth of God’s word when it came to accepting my body. I could renew my mind in other areas of my Christian walk, but when it came to my body, dissatisfaction was the status quo. No one in the church talked about liking your body and accepting what was perceived as physical flaws. So, the cultural messages to improve, fix, and remain chronically dissatisfied were constantly swimming in my head. I truly believe the insecurities that accompanied my long and tiring journey towards body acceptance were unnecessary had I had a better understanding and application of God’s word to my everyday life.

Jesus didn’t come as Adonis, but Adonai. He did not draw crowds because He was drop-dead gorgeous. People were drawn to Him because of who He was. Our children need to know the source of true beauty, and that identity is not found in how much they weigh, but to whom they belong.

What are you doing to combat cultural prescriptions for beauty?

~ Dr. Linda

P.S. Dr. Linda’s book Making Peace With Your Thighs helps women and teens accept their bodies and secure their identities in Christ.