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Today, during one of my pre-op psych evaluations, I heard a woman say “I just feel like once I start losing weight and start feeling so much better about my self- I will stop doing all the destructive things that got me here. Don’t you think?”
My response was “no I don’t agree.” I went on to explain that hers was a common assumption, a dangerous “magic-bullet” fantasy about what weight loss surgery can do.
Here’s why: The part of our brain that is responsible for the thought : “wow I look so much better, I better not mess this up,” or “I feel better than I have ever felt in my life, I am a changed person,” is not the same part of the brain that wakes us up in the middle of the night and says: “go on, finish that 1/2 pint of Chunky Monkey in the freezer, there’s only a little bit left anyway, and I have been so good here lately.”
We are dealing with two very different brains; the frontal cortex and the reptilian mid brain. The frontal cortex is the most newly developed (relative to other parts of the brain) part of the brain. It is the component that separates us from animals. It gives us the ability to think about consequences, plan, and execute. It is the “higher” part of ourselves, that often says “why do I keep on doing the same things I keep saying I won’t do anymore?” Or “I feel so out of control. This _______ (eating, smoking, drinking, gambling, pick your poison) is a temporary solution that produces long term pain. I have to find a different way.”
Our reptilian midbrain is the Commodore 64 to our MAC; it is the palm pilot to our iPhone; the horse and buggy to our Prius; the Tommy Lee to our Oprah. Our midbrain is antique equipment, long ago evolved to keep us alive and hence the reason it is still with us today- it keeps us alive. Our midbrain contains the parts of the brain that make us recoil at the site of a snake or a spider in our peripheral vision. It is hardwired to not have to go through superfluous channels of the brain that might otherwise say “hmmm what is that crawling over there? How do I feel about that? Oh its just a spider, my aunt had a collection of spiders, maybe I should collect things, etc etc.” We just jump, and process later.
That very system has helped humans survive for thousands of years. There is an adaptive quality to a brain that proverbially acts and asks forgiveness later. That very old structure once kept us out of harm’s way when a pack of tigers were first seen galloping across a horizon, or when a rivaling tribe could be heard in the far off distance, threatening to pillage our territory.
Our midbrain is associated with learning and reward. Learning what makes us feel bad, what eats us (in the past that would be in a literal sense- like tigers, but presently it might be a mercurial supervisor or unending debt), and even more relevant to this article- what makes us feel good. When our brains come across something that makes us feel good (ex: sex, drugs, food), we are then flooded with an influx of the powerful neurotransmitter- dopamine. Just like not everyone that is exposed to drugs will develop an addiction, not everyone that eats a Nutella crepe will develop a food addiction.
Much of the research on obesity currently, postulates that food addiction, no dissimilar than alcohol or drug addiction- is a reward system dysfunction or dysregulation, born out of genetic predisposition. It’s almost as if some brains think “if one slice of pizza feels good, how would four slices of pizza taste?”
To break these two very different parts up in a different, more basic way; our frontal cortex is the voluntary, while our midbrain is the involuntary.
This very dangerous fantasy, many people carry into weight loss surgery is a myth that I try to dispel quickly. This type of “magic bullet’ thinking is the very thing that gets so many gastric bypass and sleeve patients into trouble years down the road. No one wants to look at triggers. No one wants to sit with a therapist and devise a strategic coping plan. We want a pill, a surgery, a 16 minute solution to a 40 year old problem.
This is not to say that weight loss surgery is not a solution, just that its only part of the solution.

Despite our best intentions, we are still in some ways animalistic, hedonically-driven to feed our most basic impulses. This is part and parcel of why recidivism is the rule not the exception when it comes to recovery from most addiction. So what does this mean? Are all weight loss surgery patients destined for disappointment and disenchantment when the WLS honeymoon ends? No. But the answer to long term change lies more in two-pronged approach to long term weight loss success; surgery + behavioral change.
Simply thinking ourself slim is a fantasy. Think about your specific triggers for eating. For some it is that golden hour when all the kids are in bed and Narcos is queued up on your Netflix. For others it is that 2-3pm mid day slump. For some - it is when they are alone, the only time they can eat with abandon free from others’ judgement or their own embarrassment.
Whatever your triggers- the key is to identify what need is being met in that moment and to find a non-food alternative to meet each particular need ( many people have multiple triggers for over eating). If it is because its “your time,” after the kids are in bed- maybe you invest in a foot massager, or cultivate a self care space with textures, aromatherapy, candles, and books. If your trigger is that mid day slump, maybe you develop a yoga routine easily done in the office to help re-energize you. If it is the secretive quality to the trigger of being alone and eating, maybe it is finding another thing that is just your own that no one knows (going to a movie in the middle of the day, getting an overly priced facial on your lunch hour, playing hooky with your kid one day, etc).
The rule of the brain is : what fires together, wires together. So over time- if you have paired 8pm, Narcos, and nachos- you have created a neurological super highway. The moment 8pm rolls around, you are likely already getting the chips ready and didn’t even realize the thought pathway that just occurred. The idea is to repair our triggers with alternative behaviors and over time “clip those wires” or create “toll roads” to our superhighways (aka neurosynaptic pruning), so that we no longer experience such strong urges and can call upon the higher structures of our frontal cortex to guide the way again.
When we are in the midst of addiction, it is important to understand that our frontal cortex is not at the wheel. It has been duck taped and tied to a chair in the basement by our hedonic midbrain who is used to getting what it wants when it wants it. The closer we come to accepting this principle, the closer we come to being more mindful of our midbrain’s powerful rationalizations and sick contracts and see them for just that. We are better able to dis-identify from the thought, knowing it is not coming from our best self, but from our most carnal self.
Think of that distant cousin that only shows up when they need something, the Uncle Eddy that tells you he’ll move the RV when he leaves next month, indifferent to how it makes you feel. Except in addiction- that distant cousin has taken over, pretending its you until you can no longer tell the difference.
References
http://brainspotting-switzerland.ch/4_artikel/Corrigan & Grand 2013 Med Hyp paper (proofs).pdf
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Freedom from Medical Chains
Medical benefits are probably most closely related to weight loss, but they are still worth noting as a “side” benefit of Weight Loss Surgery. As you lose weight, you may have improvements in blood sugar control, blood pressure, and cholesterol levels. You may have less joint and back pain. You may have fewer trips to the doctor, and be able to take fewer medications.
Better Sleep
Never underestimate the power of sleep! Losing weight can help you sleep more deeply so you feel better all day, every day. Your sleep can improve as you feel more comfortable in bed, and if you had sleep apnea that goes away or diminishes with weight loss. Just think how good life could be if you did not have to did not have to use a CPAP machine!
New Food Finds
Strange but true…there is a whole food world aside from burgers, burritos, fries, and bagels. Who knew that you might end up loving to start your day with oatmeal cottage cheese protein pancakes? Your favorite snack could turn out to be kale chips with parmesan. Dinner might be roasted cauliflower with grilled salmon – something you might never have considered when your go-to was mac and cheese from a box.
Sure, you might miss a few foods, but you might notice that you are loving all kinds of new health foods, and the way they make you feel. On top of it, eating slowly can help you savor each bite and enjoy the textures and flavors more.
Saving Money
Saving money probably was not your main reason for considering weight loss surgery, especially if your insurance is not footing the bill. Still, Weight Loss Surgery could be a financial gain in the long run as you consider some potential savings.
Lower medical bills for doctors’ visits, prescription medications, and complications such as complications of diabetes. Fewer sick days taken from work. Lower food bills as you eat less and potentially eat more homemade food. Fewer “extras,” such as higher prices of plus-sized clothing or needing to reserve two seats on a plane. More Meaningful Relationships
Were your relationships built around food before Weight Loss Surgery? Did you consider your friends your best eating buddies, with each of your meetings at a restaurant or each other’s houses for a (unhealthy) meal? Weight loss surgery frees you up to explore other interests. Deepen your relationships with your friends as you walk together or meet at museums or other sights instead of depending on food to bring you together. And, if you do meet for a meal or snack, feel good knowing you can focus on the conversation as you eat slowly.
Confidence
Ultimately, weight loss surgery is for you, and you can benefit inside as you look better on the outside. You can gain confidence from your new looks, maybe as you fit into clothes you love, or you see a few muscles popping out. Confidence also comes from your achievements. If you can do something as hard as going through Weight Loss Surgery and sticking to all those healthy lifestyle changes, you can do pretty much anything you set your mind to.
Energy
Energy is a wonderful thing, but it may be in short supply when you are carrying around extra pounds. Lose a few, and you might feel your endurance explode. You can keep up with your kids, enjoy a day at the mall or beach, and go on vacations. Getting through the work day can be easier. Life is better all around when you have energy.
Bariatric surgery is a weight loss tool, and it is so much more. Use it properly, and you can make great gains in many areas of your life. Part 2 of the series – to be published soon – will discuss ways to get what you deserve – maximum gains from Weight Loss Surgery!