Q. My husband is considering lap-band surgery for weight loss, and he seems unwilling to talk to me about it. What do doctors and psychologist look for in deciding if surgery is a good idea?
A. There are three major factors that physicians and psychologists consider to determine if lap-band or any weight loss surgery is appropriate. First, your husband’s BMI (Body Mass Index) must be between 30 and 40. If the BMI is over 40, he will likely qualify for surgery. If his BMI is between 30 and 40, he must have at least one health-related problem that can be resolved or improved by the procedure. These can include hypertension, type II diabetes, sleep apnea, or heart disease.
Second, most surgeons will insist that your husband has tried various methods to lose weight before they will consider performing surgery. These efforts can include support groups, medications, diets, and other reasonable programs for weight loss. As most of us know, many of these methods are ineffective in the long run because adherence is often difficult, losing weight can be very slow, and some programs are costly.
Third, your husband must understand his responsibilities. He should be aware that the surgery requires a complete lifestyle change. His diet will have to be altered dramatically; he should no longer eat and drink at the same time; and he may undergo psychological changes if he has been using food for comfort.
Lastly, both of you should attend a lapband seminar, so that you understand the risks and changes that must be made. A sudden alteration in eating habits, lifestyle, and appearance of either partner can have an impact on a marriage, and every couple should discuss these issues before moving forward.
Independent reporting for Pine Bluff & Jefferson County since 1879.
Q. My wife had weight loss surgery last year. Her alcohol intake and depression have increased, and we are having marital problems. Is this to be expected?
A. Although many weight loss surgeons require a psychological evaluation and pre and post-surgery counseling, many do not. Ideally, they should. It is essential to the well-being of patients that they know what to expect physically and psychologically. If there is a pre-existing condition, such as depression, it does not mean that weight loss surgery should not be performed; however, it is rarely a cure for a mental health problem.
According to the American Psychiatric Association, some patients who have weight loss surgery may be more vulnerable to alcohol abuse. Therefore, they suggest that someone who has had a procedure have no more than one drink of alcohol per day. If it is impossible for your wife to adhere to that limit, she should stop drinking entirely. Weight loss surgery also alters the metabolism, which means she may be more vulnerable to the effects of alcohol.
In my New York practice, I saw patients both before and after weight loss surgery. I observed psychological changes in some patients, but certainly not all of them. Some of the younger females felt they were never attractive or desirable because of their weight, and they became flirtatious or began to wear revealing clothes. Those who had food addictions sometimes turned to alcohol, gambling, over-spending, or other compulsive behaviors in place of over-eating. Others became more irritable and unreasonable because they could no longer self-medicate with food.
Both of you should meet with a counselor, therapist, or nurse trained in weight loss surgery to discuss these issues. Sometimes interpersonal problems and addictive behaviors hide behind the shields of fat and food and do not surface until those props are removed.
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Nancy Ryburn holds a doctorate degree in psychology. She teaches psychology at Southeast Arkansas College and maintains a limited private practice in Pine Bluff. If you have questions pertaining to mental health, e-mail them to drnryburn@gmail.com. The questions will not be answered personally, but could appear in a future column. There will be no identifying information and all e-mails remain confidential.