biginjapan

The first meeting with a patient preparing to have weight loss surgery, whether it be sleeve, bypass, or balloon, carries so much hope, anticipation, and excitement- that you can almost cut it with a knife. For many people, by the time they have reached the point of considering weight loss surgery, they have gained and lost hundreds of pounds. They finally have a beacon of hope in what was once a desolate psychological place of despair and hopelessness.
Trying to emphasize the need for simultaneous behavioral and psychological change, often makes me feel like Rachel Dratch in her SNL portrayal of Debbie Downer.
The reality is that there are many people who go into the surgery, carrying a magic bullet fantasy who don't intend to change anything about their lifestyle or psychological landscape, and that actually still works - for a while....
The sheer reduction in portion size over time would dictate that most will lose a significant amount of weight. There is no other way of losing weight that has such a fail safe element to prevent "cheating," or "relapse." You simply can't go overboard after the surgery, or you will get very sick and regret it.
However, after the party is over. All the folks have gone home, all the social reinforcement has diminished, and six to twelve months post- you are still faced with the demons that got you here in the first place; depression, past trauma, abuse, a bad relationship, lack of purpose, addictive propensities, boredom, loneliness, lack of a sense of self efficacy, etc.
Your Psychological Tool Belt is Here.

Baptism - go back to the drawing board when you know you've gotten off track. I am in the midst of potty training my three toddlers at the moment and am reminded of her directive if the kids start to have accidents more frequently that we need to go back to square one and do another three day round of the pants off dance off, where we are sequestered to our home for 72 solid hours so that I can act like a psychological seismograph and quickly put a peeing kid on the potty mid stream.
Same thing applies to bad habits or addiction. To have the same motivation and gusto you once came out of the gates with, you have to go back and come out of the gates again. Perhaps this means reading the literature that got you motivated to change in the first place. Maybe this means going back to OA meetings. This could mean training for a half marathon. Whatever helps to signify to you that another major shift is coming.
Psychological Absolvement- This is a layer of guilt that I see many who relapse, carry. This serves no one. In fact, it sometimes perpetuates the problem because when we feel bad, we do badder (that's a word right?). Understand that this journey you are on is not a simple downhill road, but a twisting, winding, and sometimes uphill battle. This struggle is all part of your process.
In any true change process or metamorphosis there is significant struggle, whether it be the caterpillar in its cocoon, or the crucible in the kiln.
Higher Desires- Make a list of what you at your best self feels and looks like. Are there famouss people or celebrities that have recovered from addiction that inspire you? Are there people in your life that live it with vigor that you would want to emulate?
Environmental prompts- make sure your life is surrounded by items that inspire and motivate you. It could be a beautiful quote on your mirror, a poem on your bedside journal, a beautiful picture on your phone's wallpaper, making sure your favorite health sites are showing up first in your social media feeds, making an effort to tune out negative social media, or triggering/toxic people. Whatever the things are that you know lend to you being your best self, need to be in place. Think of it like psychologically nesting for change.
Cons list- you need to have a list on your person or on your phone of all the reasons you did this in the first place; heart disease, hypertension, sleep apnea, chronic pain, not being able to keep up with the grandkids, poor sex life, feeling of embarrassment in public, social isolation, etc. These can be powerful reminders of why we started such an endeavor in the first place.
Spirituality- This doesn't mean religion but it can. If you have a solid faith- wonderful, use that. Allow your guiding principles to help you during your most vulnerable weak moments. If you don't have any form of spirituality - think about what that might look like for you; yoga, mindfulness, realignment with nature, serving your community.
Spirituality allows us to connect with our soul. It allows us to be in a place of openness and vulnerability without knowing all the answers. It provides us with the opportunity to have faith that everything is going to be alright even though things are really uncomfortable right now.
Daily/Weekly- What are you daily and weekly rituals that keep you on the right track? Make a list of the things you know you need to be doing daily and weekly to signify you are in a good space. Maybe daily it is drinking hot lemon water in the morning, meditation or "bed"itation, prayer, exercise, vitamins, meal prep. Then maybe weekly it is acupuncture, therapy, journaling, volunteering.
Try starting with these tools and see if you don't start to feel a sense of renewed motivation. For more tools, please check out the full psychological tool belt here. For my free supplemental course on weight loss, click here.