Stigma, Shame, and a Choice to Have Bariatric Surgery

A new review in JAMA is unequivocal. The choice to have bariatric surgery is something that every patient with severe obesity should be considering:

All patients with severe obesity – and especially those with type 2 diabetes – should be engaged in a shared decision-making conversation about the risks and benefits of surgery compared with continuing usual medical and lifestyle treatment, and the decision about surgery should be driven primarily by informed patient preferences.

And yet, this is far from being true. Why?

Stigma from Seeking Better Health

After having bariatric surgery a few months ago a patient wrote to me, “Thank you for being so open, and talking about it, and fighting the stigma. How in the world can there be stigma around trying to be healthy?”

One answer is that our society perpetuates a singular theme: individual choices related to nutrition and physical activity cause obesity. Another answer is the pervasive idea that bariatric surgery is unnecessary to achieve substantial weight loss. In other words, people who choose bariatric surgery don’t want to put in the hard work.

But quite the opposite is true. People who have undergone bariatric surgery will tell you it by no means is an easy way out. Instead, they consider it a lifesaving tool when all previous attempts at weight loss were unsuccessful.

To Tell or Not to Tell

Why do people feel shame about their decision to have bariatric surgery? Why do they either keep it a secret or fear judgment from friends and family if they do tell? Several themes commonly emerge. They don’t want to be second guessed. Nor do they want to hear about terrible experience of others. Most of all, they don’t want to hear they should just try harder. And many will say, it’s difficult to admit they need help losing weight.

Evoking internal narratives about the choice to have bariatric surgery is critical. We must help people understand that causes of obesity are never simple. Obesity is neither a character defect nor a lifestyle choice. Choosing to seek help for the chronic disease of obesity is taking responsibility even when not at fault.

Bariatric Surgery Is a Treatment of Medical Necessity

Bariatric surgery is clearly an efficacious treatment for severe obesity. Arguably, the most significant finding in metabolic and bariatric surgery research is that it is a more efficacious treatment for diabetes than medical therapy.

We have also learned in recent months, obesity is a serious risk factor for poor outcome with COVID-19. Dramatic improvements in health status after bariatric surgery would presumably be protective against poor outcome should exposure to COVID-19 occur as some resemblance of normalcy returns.

So the decision to have surgery is ultimately one of medical necessity that outweighs societal stigma, shame, and negative judgments of others.

There is no greater joy in work life than witnessing people living with obesity find again parts of themselves they assumed were lost forever.

Click here for the new review in JAMA by David Arterburn, then here and here for more new information from JAMA on the subject.

Today’s guest post comes from Gretchen Ames, who is a clinical psychologist in the Mayo Clinic Bariatric Center in Jacksonville, FL. Her clinical practice focuses on patients seeking treatment for obesity. This includes bariatric surgery, very low calorie diets, and cognitive behavioral therapy. She also has wide-ranging research interests. One is cognitive behavioral therapy for weight regain. Metabolic adaptation to weight change with large weight loss is another.

False Shame, lithograph by Hans Erik Krause / WPA Federal Art Project

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September 7, 2020