• Living Well Psychology

To Tell or Not to Tell? That is a question....

Last week I was sitting with a client who was due to have a gastric bypass. Towards the end of the session, I asked if there was anything else she would like to discuss before we ended. “There is one thing…” she said, “should I tell people about the surgery or not?”. My heart sank slightly as I wished we had saved more time to discuss this matter. I do not wish to sound like a typical psychologist, sitting on the fence, unable to give a straight answer, but this is an important and complicated question.

I can completely understand why a person may decide not to share their decision to have bariatric surgery. There is very little understanding amongst the general public about weight management. Over the past decade, Vanessa and I have become quite expert in coming to understand the way physical hunger works, the way it is regulated by hormones sending messages between the gut and the brain telling us when we are hungry and when we are full and also how the body protects itself from weight loss. That’s right, I said protects itself against weight loss! If you think about it, we all have an inbuilt survival mechanism, and so it simply doesn’t make sense for the body to allow us to lose weight easily. But most people don’t know this and as a result we are bombarded by messages telling us to eat less and move more. Most people who struggle with weight have first-hand experience that whilst this message might make sense on paper and in fact losing weight might be easy, maintaining this weight loss it is very, very difficult. Unfortunately, this lack of understanding is also present amongst health professionals.

Under these circumstances, of course people may feel somewhat reluctant to share a decision to have surgery. On the other hand, the vast amount of research on this subject tells us that support is essential to be able to adjust well, maintain good health and weight losses. We have met many people who have decided not to tell anyone, not even their partners and of course we all have the right to our privacy. However, if the reason not to tell is shame, and the sense that this a ‘dirty secret’ that simply can’t be told, then this can end up causing us problems.

Goffman, a social psychologist from the 1970s, talked about the different ways in which people handle shame. One strategy we all use from time to time is to hide away and avoid being exposed. The downside of this strategy is that we are constantly in a state of fear of being ‘caught out’ in some way. When people feel that they can’t tell, they also find it difficult to know how to respond when people comment on their weight loss, or when people want to know their ‘secret’ or even ask if they are unwell. Vanessa and I have also known people to dread social occasions that involve eating. We have known people to cut up their food into smaller portions, hide meat under a lettuce leaf or even quietly scoop food into a napkin, all with the intention of hoping that others will not notice how much (or little) they have eaten. Keeping up the pretence can be really anxiety provoking and sometimes people are so focussed on this, they don’t end up enjoying the event, leave early and vow not to do this again. In essence, keeping the fact that that you have had surgery quiet can mean that there are so many more things that also need to be kept under wraps too. This is really sad as most people enter into having bariatric surgery to improve and enrich the quality of their lives, not to become isolated and have their lives shrink in front of them.

One of my clients, I shall call her ‘Jennie’ decided to be somewhat selective about who she told about surgery. But in her words, “Jackie, everyone needs a wing man or woman”. So, what is the role of the wing man/woman? For Jennie it was having someone who sat with her when she had, “what have I done?”, thoughts two days after the surgery. The wing woman was also the person who instantly understood when Jennie got up in the middle of a meal to rush to the toilet as a piece of food had got stuck. Someone who celebrated her weight losses without jealousy, reminded her that she probably didn’t need to buy size 24 clothes anymore and told her not to panic when the weight loss slowed down.

Vanessa and I are not saying this is easy. We are well aware that not all support is equal and simply having plenty of people around you, does not always mean that you feel supported. You may not be struggling with the question to tell or not to tell, however, if you are, can you spend some time considering who or what can be in the background supporting you, accepting you so that you can come to accept yourself, cheering you on in life. In my mind the bigger question is not whether to tell or not to tell but how can we come to accept ourselves with kindness and compassion??

If there is no specific person, how about a support group, in person or online? Or why not join one of our workshops or retreats? Vanessa and I are really excited about continuing to create a community of people who can support each other through this process together.

Hope to see you soon. Warm wishes to you all,


Dr Jackie Doyle

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