By Tara Bannow • The Bulletin

St. Charles post-bariatric support group

Who: Anyone who underwent a bariatric procedure of any kind at least two years ago, regardless of where surgery was performed. Patients only — group is not intended for loved ones or friends who have not undergone surgery.

When: 6:30 to 7:30 p.m., third Tuesday of each month (except June; next meeting is July 21)

Where: St. Charles Bend, 2500 N.E. Neff Road. The room will be listed on a sign at main hospital entrance.

Facilitator: Karen Campbell, Ph.D., psychologist with St. Charles

Cost: free

Registration: not necessary

A couple years after undergoing gastric bypass surgery, Susie Kay’s doctor told her the news she wanted to hear: He was happy with her weight. After a tough struggle with diet, exercise and mental blocks, those words were a relief.

“Then I almost felt like there was — and there wasn’t, of course — permission for me to do whatever I wanted,” said the 76-year-old Bend resident. “I felt like the reward was I could eat whatever I wanted.”

Falling back into old habits wasn’t really a conscious decision, but suddenly, Kay was eating at night again. (Her main vice is candy.)

“Life happens,” she said. “Some of our old habits reappear.”

Kay’s experience is typical of those who undergo bariatric procedures, weight-loss surgeries that restrict the stomach’s capacity for food. Around year two after the surgeries, experts say patients enter the so-called maintenance phase. At this point, dramatic weight loss has occurred, they may have reached their optimal weight and they’ve had time to adjust to new, tightly controlled diet and exercise regimens. Much of the initial excitement and attention likely have fizzled, and patients are more or less trying to stay the course in their new lifestyle.

For many patients, this is when it gets really tough.

“Around two years after surgery, it becomes more difficult to maintain the level of enthusiasm for diet and exercise,” said Dr. Stacy Brethauer, a bariatric surgeon with the Cleveland Clinic. “I tell my patients, ‘The real work starts about two years after the surgery when they start that maintenance phase.’”

Recognizing this, St. Charles recently launched a new support group specifically for patients whose bariatric procedures were at least two years ago. The health system has hosted bariatric support groups for many years, but Karen Campbell, a psychologist with St. Charles Health System who will lead the new group, said she recognized the need for one that could address issues specific to the maintenance phase.

People often mistake bariatric surgery as a quick fix or an easy way out from obesity, but it’s truly a lifestyle change that takes a lot of hard work to be successful, Brethauer said. Most of the weight following the procedures is lost within the first year to year and a half, he said.

“When the surgery has done its job for them to get down to the new weight, they have to do their part to maintain it, which is to be physically active and eat properly and avoid the easy calories,” said Brethauer, who also serves as secretary and treasurer of the American Society for Metabolic and Bariatric Surgery.

‘It’s not a future event’

The advice Campbell gives, both in support groups and one-on-one with patients, is to think about the deepest, most meaningful parts of their lives, which are usually the same things they wanted to lose weight for.

“Really think about what’s most important to you,” she said. “What are the values you want to live? What are the experiences you want to have?”

Then, she urges patients to connect those things to their daily decisions. People make hundreds of food-related decisions every day, and linking those back to what matters most — whether it’s taking that big trip or going to a loved one’s wedding — will help them see how relevant those decisions truly are in the larger scope of things, Campbell said.

“Maintaining these long-term changes, it happens on a moment-to-moment, day-to-day basis with all these little decisions,” she said. “It’s not a future event. The components of how to live this lifestyle are happening in the moment.”

Turning to old comforts

Dr. Stephen Archer, a surgeon with Advanced Specialty Care in Bend who performs more than half of the bariatric procedures in Bend, wrote in an email that patients need to change their relationships with sugar following the procedure. Many patients who undergo the surgery are addicted to sugar, and risk falling into the same habits after the surgery as before, he said.

“One has to work very hard to avoid sugar,” said Archer, who will move his practice to Bend Memorial Clinic in June. “People who want to be free of this addiction, whether they use bariatric surgery as a tool or not, have to deal with the issue of carbohydrates at some point.”

Dr. Jennifer Seger, an obesity medicine specialist at the Bariatric Medical Institute of Texas in San Antonio, agreed. She has found that refined sugar, especially in highly processed foods, is a major contributor to patients regaining their weight following a surgery. People tend to be very motivated in the beginning, but that wanes over time. When it does, the brain tends to call upon the same sources of comfort it did in the past, she said.

“If overconsumption of sugar or starch was a comfort or a mode of coping for that individual in the past, that’s going to be highlighted and they will turn toward that again,” Seger said.

But Brethauer countered that he doesn’t believe most of his obese patients are truly addicted to food. It’s a more complicated mixture of genetic and behavioral factors, he said.

In fact, Brethauer said he’s found some patients lose their taste for sweets after the surgeries, at least for several months.

By and large, most of his patients manage to stay away from sugar and high-calorie foods because they don’t want to regain the weight they’ve lost, Brethauer said. There is a subset of patients, however, that do gain it back, and he said it’s not well-understood why that is.

“I think it’s a little too easy to say that it’s the patient’s fault and that they failed the operation,” Brethauer said. “I think it’s also a little too easy to say the operation failed them.”

Recognizing a problem

Campbell’s support group, which is free and open to patients regardless of where they had their surgery done, begins with a mindfulness activity like meditation and a general inventory of what’s on everyone’s minds. Then Campbell usually gives a presentation on a specific topic.

No one in the support group is ever forced to disclose personal information, although — like any good support group — people tend to want to share their stories, Campbell said.

Dr. Gary Korus, a surgeon with the Penn Metabolic & Bariatric Surgery Program in Philadelphia, said seeking support is crucial during the maintenance phase following a bariatric procedure. He said he commends those who attend support groups like the ones at St. Charles, even if they are doing so because they feel like they have fallen behind in their weight-loss goals.

“Recognizing that is probably the toughest thing and the biggest step to getting back on track,” he said.

Kay said support groups were crucial. She said her struggle felt isolating, and learning others had the same issues made her feel less alone.

“If you can’t talk about the habits, you’re not going to get anywhere, like the alcoholic who doesn’t go to AA,” she said. “People who are successful need to be willing to be confronted, to be willing to grow and allow themselves to learn to trust.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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