Dealing with Disordered Eating After Weight Loss Surgery

By January 31, 2013

I had weight loss surgery (lap band) about six months ago and have lost a substantial amount of weight over the past year so that I am approaching a “healthy” weight. When I was heavier I did not have a lot of body image issues and was not preoccupied with my body/weight/food. But now I am extremely insecure about my body and I feel disgusting all of the time. I constantly feel guilty when I eat because I feel like I am too fat to be eating. Then I feel guilty when I don’t eat because I know that is not healthy and will only mess up my metabolism. I will often just not eat at all or throw up after eating even though I’m eating healthy foods and healthy amounts. I feel like I shouldn’t eat. I am not sure what to do at this point. Every time I eat or don’t eat and every time I get dressed it brings on feelings of guilt and unworthiness. I feel conflicted because part of me recognizes that these negative feelings and behaviors are unhealthy. But there is another part of me that recognizes that I am still fat and that these negative feelings are true and the negative behaviors make sense and are justified. Any advice?

Dear Anonymous,

What a great letter!  Your note beautifully highlights the need for community support and aftercare following weight loss surgery.  Are you participating in a group? Are you able to not only process nutritional information, but emotional information?

You write the following about your life before surgery: “I did not have a lot of body image issues and was not preoccupied with my body/weight/food.”  And yet after surgery you find the following: “I am extremely insecure about my body.”  I think what you may be learning is that prior to surgery you accepted (or at least told yourself that you accepted) your body as it was. Perhaps you were not “preoccupied” in your mind because you had settled on an idea: I am fat, this is me, I am not a girly girl, but just a normal good person, etc.  In other words, you did not deal with your body so you did not notice feeling insecure about the body.

But weight loss is noticeable to others and not just us. And often with weight loss comes the words and stares of people who were previously silent. Given this newfound attention and energy around our body, we “awaken” and begin to pay attention and notice. Our natural instinct is to keep the words and stares coming because they make us feel special, empowered, worth something or better then we felt before. Suddenly, you are dealing with a subject (your body) that you previously paid little heed. And you may begin to have shame or embarrassment or frustration surface toward self about the fact that you did not control your eating or weight sooner.

Some post surgery participants reveal that they become insecure because they realize they were “asleep” to caring and valuing self before surgery and now they have an insecurity or fear that they will not remain “awake” or self controlled. And in a quick attempt to think they have a way to get reassurance and control they begin practicing disordered eating behaviors. These are tools meant to manage their anxiety about what is being revealed to them emotionally with the weight loss—not steps to health.

I hope you have reported to your follow-up practitioner/medical provider that you are struggling and developing habits of disordered eating. You need to understand that there are serious side effects from bulimic activity with a band and/or anorexic/restrictive activities. Do not keep this developing conflict a secret. Let someone help you!  I encourage you to seek a counselor to discuss the body image and eating issues.

I think this is an emerging area that needs response…dealing with post weight loss surgery disordered eating.  We assume the problem was the food and if we put less of that “bad” food in the body we will be “okay.”  The problem was not the food…it was what we wanted from food (nurture/reassurance/love/coping/company).  People still want nurture, reassurance, love, coping and company after surgery. The same triggers (job stress, relationship issues) still exist and we have limited one of our coping tools.

You are stumbling on to a truth. You need more. You have the lap band to assist with feeling full which helps portion sizes. But you need more then just food control. And that is acceptable and makes sense. Please know that you are not alone in adjusting to post surgery weight loss. Carnie Wilson following gastric surgery openly discussed how she began using alcohol to handle her feelings around food and later developed a chewing and spitting habit out of fear of taking in calories. Also, Star Jones is quoted as the following in the July, 2007, issue of People Magazine: ”  “The toughest part of the journey has been forgiving myself for not having the self-control I know I should have had, or admitting I needed help,” she writes…”Every day I am learning to let go of my insecurities and acknowledge that I don’t have all the answers, which is okay,” she writes. Though she still struggles with self-image, she writes that being healthy is what counts. “I’m not saying that in order to be happy, women need to be a certain size, but I am saying that we should all strive to be healthy.”

I encourage you to advocate for aftercare services around body image/disordered eating/and coping with your surgery provider or facility. Request a referral for counseling services with the goal of dealing with the emotional aspects of weight loss. You deserve to live free of rules that are all about controlling you! You deserve to live well following surgery!

Bless you,

Leanne Spencer, LPC, MAMFC, CGE