Anne Talbot, Psy.D. presented a program on self-confidence and assertiveness to the Bariatric Support Group at Regional West Medical Center on Tuesday, September 4, 2006. Dr. Talbot’s talk was focused on the adjustment process following weight reduction surgery when losing weight means finding new definitions of self, body image, and relationships. After weight loss surgery, not only is there a different feel and look to the physical self, there is often also a difference in the way people feel about themselves, their identity, their relationships, and their general way of dealing with the world. What follows here is a summary of some of the lively discussion that took place in the group about the social impact of bariatric surgery.

For some, but not all, being overweight has been a barrier to developing fully as a person. Sometimes this barrier is self-imposed and sometimes it is an external one imposed by the way other people respond to us, such as making stereotypical assumptions about who we are and what we can be. Although weight loss can certainly help a person feel better physically, we all know that simply changing the way we look does not bring automatic life satisfaction without some honest self-searching and personal accountability. In dealing with a sometimes drastic loss of weight, many people begin to reconsider their way of thinking about themselves, their relationships with their family members and friends, and their ways of relating to other people in general. Sometimes painful social experiences can lead an overweight person to avoid certain situations, opportunities, and even relationships, that might come with the risk of being rejected, dismissed, put-down, or somehow made to feel bad. These protective behaviors can include hiding behind obesity so no one really knows you, being a people pleaser, never showing your true feelings or stating your opinion, never asking for anything, and generally limiting your aspirations and dreams in order to avoid disappointment. Some people might take an aggressive approach to hide behind, perhaps using anger as a defense. Some of us couldn’t even begin to describe or define ourselves because we really have no idea or at all!

So like any experience of drastic change, going through weight reduction surgery can bring both a challenge and an opportunity for a renewed and revitalized sense of self. This challenge and opportunity begins with a searching self-appraisal of who you are and how you deal with others. One of the activities in the group meeting on September 4th was a self-esteem checklist that led to some lively discussion about attitudes about oneself and others, what it takes to feel worthwhile, needs for approval, whether it is important what other people think, and being in relationships. That discussion led to sometimes enthusiastic talking, and even some debate, about the different paths to self-confidence and assertiveness.

There was some agreement that self-esteem is all about being confident in yourself and your ability to get what you need as well as the belief in your ability to deal with hardships and loss. Healthy assertiveness is an outcome of a strong self-awareness and a healthy confidence in yourself and your abilities. It includes the ability to set appropriate boundaries between your self and others, including not only how to say NO when necessary, but also allowing yourself to care about others and, not least of all, to let others care about you.  Along that path to healthy self confidence and assertiveness are opportunities for sometimes surprising self-discovery while we take some risks, try out different styles, and get used to being a stronger and sometimes more alive version of who we were before. There is certainly an irony in talking about broadening and expanding who we can be and the opportunities we give ourselves while at the same time going through weight loss. So, along with the personal responsibility involved in changing one’s lifestyle for the sake of physical health and well being, there is also personal responsibility for making the changes necessary for healthy psychological well-being. You could say that dealing with the challenging opportunity of bariatric surgery can be a journey through physical reduction to self-expansion!

Anne Talbot, Psy.D. is a Licensed Psychologist with Options In Psychology, LLC  
Dr. Talbot frequently conducts pre-operative psychological evaluations on bariatric surgery patients.