Grief is best defined as the internal emotional response to loss. Although most people associate grieving with the loss of a loved one, the term has evolved to include multiple types of loss, including loss of a physical abilities, loss of a relationships, loss of opportunities and loss of ideals. In fact, any longstanding loss of life as it has been known to us can be seen as a catalyst for grieving. Bariatric surgery is no exception.
“But Bariatric Surgery is a Good Thing…”
We tend to think about bariatric surgery as a gain. Patients are receiving an opportunity to live longer, be healthier and feel better. As an elective procedure, bariatric surgery is seen as a choice, an option for those who wish to lose weight and are ready to make changes in their lives. While there is truth to all of these assumptions, the reality of bariatric surgery is much more complicated. There is a differences between choosing something because it sounds enjoyable and choosing something because if you don’t, your quality and length of life are at risk. Being ready to make lifestyle changes does not mean that making those changes is going to be easy. No matter how well prepared you are, nobody can really know what life after surgery will be like for them until they are experiencing life after their surgery with their body. Finally, just because there are critical things to be gained from an experience does not mean that experience does not contain losses, some of which may feel just as significant.
Patients who undergo bariatric surgery have multiple losses to grieve. For surgery to be safe as well as successful, patients must give up favorite foods, sugar, nicotine products, alcohol consumption, carbonated beverages and excessive caffeine. Additionally, many of the social, pleasurable and comforting aspects of eating are lost as patients strive to change longstanding patterns to regain their health. For many patients, having bariatric surgery forces an acknowledgement of the fact that they are living with the chronic illness of morbid obesity, and that like any other chronic illness, longevity and quality of life will depend on making multiple and enduring lifestyle changes that consistently force the patient to go above and beyond what others have to. This realization that bariatric surgery is just the beginning of the solution and that the patient will have to give up many of the things that his or her peers take for granted can feel like defeat. If these patients do not give themselves the opportunity to grieve for these changes, they may become mired in their losses and unable to ever fully accept or make use of their gains.
The Stages of Grief
In 1969, psychiatrist Elisabeth Kübler-Ross published her seminal work On Death and Dying in which she posited a five stage pattern of adjustment to impending death. Since then, the model, known as the Kübler-Ross Model or Five Stages of Grief, has been extended to up to 10 stages by some sources, and is used to conceptualize adjustment to any type of loss. While the stages suggest a linear progression, it is important to remember that people do not always go through all of them, nor do they always follow the given order. Additionally, people may find themselves revisiting certain stages at different times, or even experiencing multiple stages at once. By convention, we will discuss them in their traditional order. It is important to remain open, however, to a different experience of grief.
Denial: This is typically the first stage of the grieving process. During denial, the person refuses to acknowledge the presence or severity of a problem. Examples include
• I don’t have a problem with my weight
• Bariatric Surgery will fix my weight problem without my having to make major changes
• I will be so happy that I am losing weight, that it will be easy to diet and exercise
• I could do it on my own if I really tried
• I can have better/faster results than most people
• If I can only get this surgery, I will do anything it takes to make it work
Anger: This stage hinges upon acknowledging that there is a problem, but getting caught up on the lack of fairness that the problem exists. Patients in this stage often struggle with “why is this happening to me?” type questions and will often externalize responsibility, blaming others. Example include:
• Why should I have to make changes others don’t have to make?
• Why can’t I get more fill?
• Why won’t the dietitian tell me exactly what to eat?
• Why did I get a complication?
• It shouldn’t be so hard
• My loved one’s don’t “get it” so why should I bother?
Bargaining: During this stage, the person is beginning to come to terms with the essence of the situation, but is still searching for a way to “fix” the problem or postpone the inevitable lifestyle change. If a patient is trying “too hard” to find an alternative way to get the weight off while avoiding diet or exercise changes, they may be in the bargaining stage. Examples Include:
• Having had bariatric surgery will make me want to exercise
• If I take all these weight-loss supplements from the health food store, I won’t have to exercise
• I’ll just work really hard until the wedding, then I can ease up
• If I exercise every day, I won’t have to alter my eating
• If I can just lose the weight, I will never let myself regain it
Depression: This stage is the beginning of recognizing that weight-loss and weight maintenance are going to be a lifelong endeavor. During this phase, the person comes face to face with the full reality of what he or she is going to have to deal with. It can be overwhelming and result in isolation, sadness and feelings of hopelessness. Examples include:
• I’m not going in for follow-up because there’s nothing they can do to help me. After all, I know what I need to do.
• This is too hard
• Why bother?
• Nobody else could possibly understand
• I brought this on myself
Acceptance: At this stage, the person starts to figure out what needs to happen to build a life worth living despite their loss. The loss no longer feels so painful or traumatic and the person is able to focus on making accommodations and moving forward with life. Often people become more open with others about the loss and how they are managing it. Examples include:
• I will always have to work harder than most to manage my weight
• I told my boss that I can no longer work through my lunch hour . My health requires that I eat regular meals.
• Even though I have regained some weight, I know that I can do what I need to in order to get back on track.
• I need to find an exercise routine that I enjoy in order to stick with it
Grieving WellEffective grieving requires awareness, time and support. It is important to give yourself permission to go through each stage and experience the associated thoughts and feelings. Trying to avoid certain stages or rush to acceptance will stall your progress. As new challenges come up, you may find yourself revisiting a completed phase of the process. This is normal, and does not mean that you will never reach acceptance, rather that grieving is an ongoing process. If you are finding yourself stuck, journaling about your feelings and talking with others may help. Consider attending support group to get feedback from others who are experiencing similar challenges. If you are really struggling, contact the office and make an appointment to see the social worker. Above all, don’t judge yourself or your grieving process. Although everybody’s process is different, with willingness, support and understanding, everyone can make it through.
Labels: acceptance, denial, grief, loss
