Regaining Control

“Imagine you are approved for a roux-en-Y gastric bypass surgery – you lose your excess weight, buy new clothes, throw away your ‘big’ clothes, get attention – then you gradually start regaining weight,” says Laura Anderson, assistant professor and licensed psychologist. “Imagine the depression and dismay, the hopelessness that ensues.”

Anderson’s observation that many of her post-operative bariatric clients experience difficulty maintaining a longterm healthy weight following surgery was the impetus for her Bariatric Outcomes: Skills for Sustained Surgical Success (BOSSSS) pilot study.

“I noticed these clients were not prepared psychologically and were never taught coping skills to get to the core of the problem that resulted in obesity in the first place,” explains Anderson. “They need these skills at any weight so they don’t turn to things like food or alcohol. If pre-surgery habits and coping skills are not modified, their weight will eventually come back.”

What makes the BOSSSS intervention unique, Anderson says, is the utilization of self-determination theory, which enables clients to customize their program. The 12-week intervention incorporates energy balance selfmanagement, requiring participants to report daily their weight and calories using the FatSecret application. Participants also wear their chosen electronic activity tracker and adjust caloric intake and weekly physical activity based on their weekly average weight.

Anderson understands daily self-weighing can be challenging for bariatric patients with pre-existing emotional difficulties. Since it is a vital component to sustained weight loss and energy balance selfmanagement, the BOSSSS intervention was designed to “support daily self-weighing in an emotionally adaptive manner.”

“The program focuses heavily on self-talk and reframing incoming weight data. I tell participants they need a mantra when they get on the scale – ‘data, not self-worth.’ Each day is just a piece of data to inform their weekly progress,” Anderson says.

The second half of BOSSSS centers on teaching clients dialectical behavior therapy and coping skills. “Each week we focus on one of four core skill areas: mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness,” Anderson explains. “They choose two skills in each area to learn based on their needs. We also focus on using internal resources and healthy, adaptive substances and activities to get pleasure and value from things that aren’t food and alcohol.”

With participants reacting so positively to BOSSSS, Anderson envisions converting the program to a telehealth or web-based platform to increase accessibility – it would ideally include features like social support groups, reinforcement inventories (to help establish what nonfood activities are rewarding), and visits with a clinician via a video calling application.

Anderson’s ultimate goal? “I’d like to see this kind of approach integrated into regular practice to reduce the risk of recidivism after surgery so I don’t see so many distressed clients referred who are regaining weight,” says Anderson. “The standard of care for post-op bariatric patients needs to change. They need personalized intervention – whether my program or something else – that will help them to self-manage and self-regulate.”