Background: Bariatric surgery requires comprehensive aftercare to optimize outcomes. Therapists and dietitians need to implement best practices with weight loss surgery patients in order to prevent relapse with eating disorder behaviors and other complications. Non-compliance, self-sabotage, body image, nutritional deficiencies, weight re-gain, addiction transfer, and post-operative eating disorders will be addressed.
Outline of presentation:
Introduction
- Background/experience of presenters
- How our program is set up
- Importance of eating disorder specialty, importance of multidisciplinary team
Most common psychological complications
- Self-sabotage secondary to psychological issues (depression, unresolved trauma, eating disorders, etc.)
- Body image issues
- Post-operative eating disordered behavior
- Addiction transfer
Most common nutritional complications
- Non-compliance (with exercise, supplements, food records, etc.)
- Nutritional deficiencies
- Weight re-gain
- Poor choices- artificial sweetener abuse, resumption of soda, suboptimal nutritional/protein intake
Interventions for psychological aftercare
- Use of motivational interviewing to address patient resistance/non-compliance
- Addressing underlying psychological issues
- Improving body image
- Relapse prevention for eating disordered behavior
- Therapy group for post-op patients
Interventions for nutritional aftercare
- Use of motivational interviewing to address patient resistance/non-compliance
- Addressing/resolving nutritional deficiencies
- Back on Track nutritional seminar
Case Vignettes and Audience Questions
- Patient #1- severe iron deficiency, insomnia, seizures, undisclosed addiction transfer
- Patient #2- 3yrs post-op, 1-2 glass wine/night, acute pancreatitis
- Patient #3- post-operative anorexia, GI complications, chronic pain, unresolved trauma, unintentional narcotic dependence
- Patient #4- lap-band induced bulimia
Resources and Recommendations for Furthering Your Knowledge of Bariatrics
- WLS for Dummies by Marina S. Kurian MD, Barbara Thompson, Brian K. Davidson
- The Emotional First Aid Kit: A Practical Guide to Life After Bariatric Surgery by Cynthia Alexander, PsyD
- The Weight Loss Surgery Workbook by Doreen Samelson, EdD
- ADA Pocket Guide to Bariatric Surgery, Edited by Christina Biesemeir, RD & Jennifer Garland, RD
- Psychosocial Assessment and Treatment of Bariatric Surgery Patients, Edited by James E. Mitchell & Martina de Zwaan
Psychiatric disorders, including eating disorders, are relatively common in patients presenting for weight loss surgery. Understandably, psychological and behavioral factors seem to influence the results of bariatric surgery and the ability to achieve sustained weight loss and subjective well-being following the operation. We assert that bariatric surgery (to include RNY gastric bypass, lap band, and gastric sleeve) patients require nutritional and psychological aftercare with eating disorder specialists in order to optimize success. Therapists and dietitians need to learn to implement best practices with weight loss surgery patients in order to prevent relapse with eating disorder behaviors and other post-operative complications. Common issues that arise after surgery include non-compliance, self-sabotage secondary to psychological issues, body image dissatisfaction, nutritional deficiencies, weight re-gain, addiction transfer, and eating disordered behavior. This presentation will address these complications and their prevention and treatment. Via didactic material and case discussions, participants will achieve an understanding of the most common post-operative challenges and how to better keep their patients on track. The importance of a team approach to include therapists, dietitians, and surgeons will be highlighted. In addition to outlining specific therapeutic and nutritional interventions for the various types of complications that arise, group-based aftercare will be discussed. Bariatric experts with a successful multidisciplinary program will offer advice on how to develop effective post-operative therapy groups and “Back on Track” nutritional seminars.
Kelly Broadwater is a psychologist, professional counselor, and certified eating disorder specialist with significant training and expertise in bariatrics. She conducts pre-operative psychological evaluations and has facilitated therapy groups for post-surgery patients for over a decade. She also offers pre- and post-operative individual counseling, believing it maximizes results by addressing the underlying issues that may have contributed to eating and weight problems to begin with. She is an expert in post-operative addiction transfer and is passionate about educating others about this potential danger. Ms. Broadwater is an integrated health associate member of the American Society for Metabolic and Bariatric Surgery.
Chaundra Evans is a registered dietitian who focuses on building a healthy relationship with food, body image and improving eating habits using a non-diet approach. She has extensive training and experience in eating disorders and the bariatric population. Certified in Adult Weight Management from the Academy of Nutrition and Dietetics, she is an associate member of ASMBS and the Obesity Action Coalition. Recognized as a Certified Eating Disorder Registered Dietitian, Ms. Evans has been practicing at Chrysalis Center for Counseling and Eating Disorder Treatment for over 10 years and is affiliated with her local Center of Excellence for bariatric surgery.
