It's not about Blame, it's about Change

Obesity is a disease, as much as alcoholism is a disease.  It's part of our genetics, conditions, choices and behavior within our environment.  It is a complex relationship with our mind and body.  As someone who has experienced uncontrolled hunger that willpower could not overcome, and at other times, felt to be in control of, that makes sense to me-- that it is driven by the impacts of hormones in our bodies. The relationships between our hormones: insulin, ghrelin, leptin, testosterone, estrogen, and the processes activated in the brain between dopamine and seratonin, fed by the circulation of water and nutrients--  are all working together to support our biochemistry and are influenced by all of these factors.  It is certain there are people who eat an unhealthy diet and have no instances or struggles with obesity, and others, who suffer dearly, starving into desperation as certain foods act as a drug for them. We are all impacted by certain substances differently.

Many people have inaccurate opinions, pass judgment, and entertain prejudices towards those who suffer from Obesity, and it is an abomination that there are still people who think it is acceptable to be insensitive to those who do. 

I am sad to say that I know for a fact that there are many very smart people in the medical field that fail to consider that we all differ as individuals and that obesity is not merely caused by overeating, or rather, eating the wrong foods. While I agree with the "Wheat Belly" and Paleo theories, I fear tunnel driven opinions to undermine quality standards, education, support and structural services to aid bariatric patients may be cut from insurance, rather that included and encouraged. Let us lobby that these things DO NOT occur. Bariatric patients need to be able to see their surgeons 1-2 times a year at 3-5 years out. Continuation of care, follow up, and interfacing with multiple MD caretakers has much, much merit in our evolving medscape.

There are notable prejudices that come with obesity treatment. Learning to treat someone with empathy, and while this is not a skill of every surgeon, when their demeanor comes across as compassion: sympathetic pity and concern for the suffering and misfortune of others-- we should treat patients with tenderness and benevolent concern .  It is unfortunate that surgeons can not walk a mile in their patients shoes, though, they could try walking a mile with their patients. I am a big believer in walk and talk therapy.  Trusting relationships and programs built around success are what bariatric service providers need to develop.  Community awareness, education services, commitments to each patient's success. That is the future I would like to see.  To ensure success at the highest rates possible, we must lobby to change our society.

If hospitals would integrate food as medicine kitchens (over pharmacies) as they have wellness centers for exercise physiology and physical therapy, we could change a lot. Attitudes and perceptions are skewed in this "Fight from Obesity," it's not a fight, it's a progressive movement toward change, societal paradigm shifts in attitude and access to care. Support groups should be available every single week.  Topics should be covered on every element of lifestyle change. Our people must push for community gardens and turn around the marketeers to cater to low calorie options at restaurants and in schools.  No one should live in a food desert, community markets should carry natural food products produced locally, and we should make our food at home as often as possible.

Every Step Counts. Why limit "Walks from Obesity" to once a year or even once a month. Once a week with someone who will hold you to your commit, and once on your own every week is both therapeutic for mind and body. But truthfully, the Walk from Obesity is EVERY SINGLE DAY. 20k, 15k, 10k... whatever you can do to move forward. With the help of surgery, we are able to conquer many metabolic imbalances that occur from obesity.

But it is not the end all, be all for everyone. I don't like the idea of obesity drugs, but they have their place in the profit margins of "Big Pharma." With side effects yet to be discovered, we risk developing more dependency on psycho-pharmcology. Everyone has an opinion, but we're all out to make a buck.  There's a difference between an honest buck and a buck of persuasive luck. Good marketing of fads has long driven the weight loss industry. But this thinking that bariatric surgery, which has proven to be an effective form of weight reduction when behavior changes are also made, should not be shot down, deregulated, and allowed to be done in environments that do not support the long term outcomes but rather, hack a gut alteration and send a patient on their way. That is not what this medical specialty area needs, what it needs are constantly examined and improved methods to drive the health of society.

Ethics and Professionality in Bariatric Counseling

In the counseling profession, the code of ethics and responsibilities we have to keep confidentiality is a crucial element of our practice.  It's not an option, if we have a client who comes to see us, initially, we must explain to them what our code of ethics and our responsibility to them as a client is in the scope of confidentiality. 

What does all of that mean?

Simply put, if you are my client and I am seeing you in a therapeutic role and thereafter, I will always have an ethical obligation to you to minimize our contact outside of the counseling session, not disclose personal information about you as a client to anyone who you have not given me permission to discuss your case, and to always explain to you my position and role in and outside of the counseling session. Basically, if I see you at the grocery store, gym, church, school, etc, I will purposely avoid you.  If you say hello to me, I will say hello back and go about my business as I would had you not seen me.  I care about you enough to pretend to not know you to protect your privacy and not have any of your private issues potentially be discussed outside of the protected counseling environment.

I will always be upfront with my clients about my personal experience with bariatric surgery.  I cannot ethically, work in this field without telling my clients that I am a bariatric surgery patient.  My experience is not the same as other weight loss surgery patients' experiences.  I recognize and acknowledge that we all have our own reasons as to why we choose weight loss surgery as an assistive tool for us to lose weight. 

Some have major medical issues, others are preemptively electing to have surgery to prevent potential medical issues in the future.  I consider myself as part of the latter group that was anticipating that my health would decline in the long run due to excess weight.  I know that many clients are already suffering from painful, major medical issues and their reasoning behind their choice to undergo surgery maybe different from my own.

I will never use my role as a counselor to seek out my needs as a weight loss surgery patient.  I am in this field because I see a dire need for bariatric counseling in the process of long term after care.  Losing weight will not solve all of life's problems.  More often than not, the new issues are going to be challenging, changing and identifying of underlying problems that may not have been observed by "the cloak."  The cloak is all of the things we've hidden from addressing throughout our lives about what's bothering us on the inside.  What was it that made us turn to food in the first place.  How did we ignore or fail to understand our body's needs and limits?  Our internal ability to find satiation was skewed in some way.  Again, we are all different, each person is an individual and gaining this insight and understanding is crucial for adopting permanent healthy habits. 

Understanding the weight loss surgery community, online communications, and confidentiality, I will never identify in discuss a single person's experience or relay information regarding that person that could impact their life.  First and foremost, I do no harm.  I will never engage in, take sides with or include myself in the conversations that occur regarding a person's situation and/or the choices they make.  Quite frankly, I will acknowledge that talking amongst each other occurs, but as a counselor, I respect the privacy of others.  If someone seeks out help from me, they can be assured that I will take their trust in me seriously and apply my ethical standards to their confidence in me, no matter they be a paying client or an online contact asking for my help.  The only time I would ever breach confidentiality is if the person made me aware of their intention to harm themselves or someone else.  In taking any action, I will make that person aware of my duties prior to doing so and specifically know what that action is I must ethically take.

Also, as a counselor intern in the State of Louisiana, I cannot treat people who reside out of my state.  The practice of counseling must occur in the state, therefore unless I have established a face to face relationship with a client in the State of Louisiana, I will not work with a client through video conferencing mediums.  In email, I am limited in my ability to help and assist clients with their problems.  I will not offer advice but rather ask you how you can change your current situation or what it is you could do to move toward the progress you seek that you are not currently finding.  If I have the resources for professional mental health practitioners in your area, I will refer you to those resources.

This post is meant to be a documentation and clarification for everyone who I have met, become friends with, and come to know in the bariatric community.  It takes a long time to build confidence and rapport in a community. As a counselor intern in the mental health field, I want to establish clear and concise guidelines that show my clients and colleagues that I am aware of my role and responsibility to this community.   I may be seen as a newbie, but counseling is nothing new to me.  We are always learning, and we learn by doing.