Let's Talk About What Scares You

Let's address this directly: the mortality risk for gastric sleeve surgery is approximately 0.1-0.2% (1-2 in 1,000). That's comparable to a gallbladder removal and lower than a hip replacement.

Context that matters:

- Modern bariatric surgery is one of the safest procedures in medicine

- Surgeons perform these operations daily with established protocols

- The risk of NOT having surgery when severely obese is significantly higher

- Obesity-related conditions (heart disease, diabetes, sleep apnea) carry much higher mortality risks

What increases risk:

- Very high BMI (>60)

- Multiple existing health conditions

- Smoking

- Sleep apnea (untreated)

What decreases risk:

- Experienced, FRACS-certified surgeon

- Accredited hospital with bariatric program

- Proper pre-operative preparation

- Following medical advice

Your surgeon will assess your individual risk during consultation. For most patients, the life-extending benefits far outweigh the surgical risks.

This is one of the most common fears, and it's understandable. Here's the honest truth:

Success rates:

- 10-15% of patients regain significant weight

- 70-80% maintain substantial weight loss long-term

- 5-10% lose all excess weight and never regain

What makes people regain:

❌ Returning to old eating habits

❌ Not addressing emotional eating

❌ Skipping follow-up appointments

❌ Stopping exercise completely

❌ Drinking high-calorie beverages

❌ Grazing all day

What prevents regain:

✅ Building healthy habits BEFORE surgery

✅ Regular therapy for food relationships

✅ Staying connected to support groups

✅ Annual check-ins with bariatric team

✅ Treating surgery as a tool, not a cure

✅ Finding non-food coping mechanisms

The reality:

Surgery makes it physically easier to eat less, but you still need to do the mental and emotional work. Most people who regain weight didn't fail—they just didn't have adequate support for the psychological component.

If you regain some weight, revision surgery is an option, but prevention through support is the goal.

Some might. And that says everything about them and nothing about you.

The truth:

Weight loss surgery is not easy. It's:

- Major abdominal surgery

- Lifelong dietary restrictions

- Daily vitamin requirements

- Permanent lifestyle changes

- Harder work than you've ever done

What to tell judgmental people:

"Would you tell a diabetic not to take insulin? This is medical treatment for a medical condition."

What most people actually think:

- Family: Often supportive once they understand

- Friends: Usually impressed by your courage

- Strangers: Don't need to know your medical history

Handling judgment:

1. You don't owe anyone an explanation

2. Share on YOUR terms, with YOUR people

3. Focus on health, not weight

4. Let results speak for themselves

5. Connect with others who understand

Consider this:

The same people who judge surgery would judge your weight. You can't win with critics, so focus on winning for yourself.

You're choosing to live longer and healthier. That's brave, not easy.

This is a legitimate concern. Let's break it down honestly:

If you have private health insurance:

Out-of-pocket: $3,500 - $7,000

- Most people can manage this with payment plans

- Many insurers offer interest-free hospital payment plans

- Consider it an investment in 20+ extra years of life

If you're self-funding:

Total cost: $15,000 - $25,000

- Payment plans available through most practices

- Medical loan options (MacCredit, TLC)

- Some people save for 12-18 months

- Tax deductible as medical expense

Can't afford it right now?

- Public system option (1-2 year wait)

- Start saving systematically

- Use waiting period to prepare mentally

- Build insurance coverage if possible

Cost of NOT having surgery:

- Ongoing medical costs for obesity-related conditions

- Reduced work capacity/earning potential

- Shorter life expectancy

- Quality of life impact

Real talk:

Yes, it's expensive. But most people who have surgery say it's the best money they ever spent. It's not about affording it—it's about prioritizing it.

If you can afford a car payment, you can find a way to afford this.

This fear is completely normal. You're considering a life-changing, irreversible decision.

Regret statistics:

- 1-5% report significant regret

- 3-8% have mixed feelings

- 87-96% would do it again

Who regrets surgery:

- Those who had unrealistic expectations

- Those who didn't address mental health first

- Those who were pressured into it

- Those who didn't understand the commitment

- Those with undiagnosed eating disorders

Who celebrates their decision:

- Those who took time to prepare mentally

- Those who built support systems first

- Those who understood it as a tool, not magic

- Those who committed to lifelong changes

- Those who addressed food relationships

How to minimize regret:

1. Take our "Am I Ready?" assessment

2. Talk to a bariatric psychologist

3. Attend support groups BEFORE surgery

4. Be honest about your relationship with food

5. Don't rush—preparation matters

6. Address any "red flags" first

What patients say:

"I wish I'd done it sooner" is more common than "I wish I hadn't done it."

If you're unsure:

That's okay. Wait. Prepare. Therapy. Support groups. There's no deadline. Better to wait and be ready than rush and regret.

This is a huge fear, especially if food has been your comfort. The honest answer: yes, but differently.

What changes:

- Smaller portions (fist-sized meals)

- Eating becomes fuel AND pleasure

- You learn to savor, not inhale

- Quality over quantity matters

- Some foods may not agree with you

What you CAN still eat:

✅ Restaurant meals (just less)

✅ Special occasion foods

✅ Desserts (small amounts)

✅ Your favorite foods (modified)

✅ Social dining experiences

What becomes difficult:

❌ Large buffets

❌ Drinking with meals

❌ Very sugary foods (may cause dumping)

❌ Mindless snacking

❌ Using food to cope with emotions

The surprising truth:

Most people report enjoying food MORE after surgery because:

- They actually taste food instead of inhaling it

- They're not controlled by cravings

- They choose foods mindfully

- Hunger isn't constant

- Food stops being the enemy

Your relationship with food changes from:

"I eat to cope" → "I eat to nourish"

"I can't stop" → "I choose when"

"Food controls me" → "I control food"

This is scary if food is your primary joy. But most patients discover new pleasures: energy, mobility, confidence, relationships, activities they couldn't do before.

Honest answer: some will change. Not all for the worse.

What might happen:

Positive changes:

✅ Partners often feel more attracted

✅ Increased confidence improves intimacy

✅ More energy for relationships

✅ Better mood reduces conflict

✅ Can do activities together

Challenging changes:

⚠️ Some friends may feel threatened

⚠️ Partners may feel insecure

⚠️ Social dynamics shift

⚠️ You outgrow some relationships

⚠️ Jealousy can emerge

Why relationships struggle:

- Your change highlights their inaction

- Dynamics were based on your weight

- They lose their eating buddy

- They feel left behind

- Roles in relationship shift

Protecting relationships:

1. Communicate throughout the process

2. Include partner in consultations

3. Address insecurities directly

4. Don't become "preachy" about health

5. Make time for non-food activities

6. Couples therapy if needed

Red flags:

If someone actively sabotages your health journey, that's not love—that's control. You deserve relationships that support your wellbeing.

The truth:

Real friends and healthy relationships survive and strengthen. Toxic ones expose themselves. Most patients say their relationships improved overall, even though some friendships faded.

You're not losing relationships—you're discovering who was really there for you.

This is a critical concern that deserves a thorough answer.

The complex truth:

For most people (60-70%):

✅ Depression and anxiety IMPROVE after surgery

✅ Better physical health = better mental health

✅ Increased confidence and mobility help

✅ No longer carrying obesity stigma

For some people (20-30%):

⚠️ Depression continues or worsens

⚠️ Lose food as primary coping mechanism

⚠️ Transfer addiction to alcohol, shopping, etc.

⚠️ Body image issues don't resolve

⚠️ Expected life transformation doesn't happen

High-risk factors:

- Untreated mental health conditions

- History of substance abuse

- Severe trauma or PTSD

- Food as only coping mechanism

- Unrealistic expectations about life changes

Essential before surgery:

1. Psychological evaluation (required)

2. Therapy if any mental health history

3. Alternative coping mechanisms in place

4. Support system established

5. Medication stable if applicable

Red flags - surgery should wait:

- Active suicidal thoughts

- Untreated eating disorder

- Recent major trauma

- Unstable medication

- No support system

What you need:

- Mental health professional experienced with bariatric patients

- Plan for when food can't be your comfort anymore

- Understanding that surgery fixes body, not life problems

- Realistic expectations

- Ongoing therapy commitment

The message:

If you're currently depressed, surgery can help BUT only as part of comprehensive mental health treatment. Surgery alone won't cure depression—but it can be a powerful tool alongside proper mental health care.

Don't skip the psychological preparation. It's not a hoop to jump through—it's essential for your success and safety.

Let's be honest: possibly yes, probably some, depends on several factors.

What determines loose skin:

- Age: Younger skin bounces back better

- Amount to lose: 50kg vs 150kg makes a difference

- Genetics: Skin elasticity varies

- Speed of loss: Gradual is better

- Exercise: Muscle building helps

- Hydration: Keeps skin healthier

Realistic expectations:

Mild (20-40kg loss):

- Some arm looseness

- Minor belly skin

- Usually hidden in clothes

- May not need surgery

Moderate (40-70kg loss):

- Noticeable arm & thigh skin

- Abdominal apron possible

- Can be managed

- May want surgery eventually

Significant (70kg+ loss):

- Loose skin likely on arms, thighs, belly, breasts

- May interfere with exercise

- Can cause rashes/hygiene issues

- Skin removal surgery often needed

The truth most people don't tell you:

Almost everyone prefers loose skin to 100kg of extra weight. Here's why:

✅ You can hide loose skin in clothes

✅ You can't hide obesity

✅ Loose skin doesn't cause diabetes

✅ You can exercise with loose skin

✅ Skin removal is possible later

✅ You'll still feel so much better

Managing loose skin:

- Weight training (builds muscle underneath)

- Gradual loss (gives skin time to adapt)

- Proper hydration

- Compression garments

- Collagen supplements (limited evidence)

- Skin removal surgery (1-2 years post-surgery)

Cost of skin removal:

- $8,000 - $25,000 (not usually covered)

- Consider it phase 2 of your journey

- Many people never do it and are fine

What patients say:

"I'd rather have loose skin and be healthy than tight skin and dying of obesity complications."

It's a valid concern, but it shouldn't stop you. The benefits outweigh the cosmetic considerations.

You get to decide what to share and with whom. Here's guidance:

With Kids (age-appropriate):

Young kids (5-10):

"Mommy/Daddy is having an operation to help be healthier so I can play with you more and be around for a long time."

Tweens (11-14):

"I'm having surgery to help with my weight and health. The doctor says it's the best option for me. I'll need some help while I recover."

Teens (15+):

Consider being more direct about obesity being a disease and surgery being treatment. Can be educational.

With Extended Family:

Option 1 - Direct:

"I'm having weight loss surgery on [date]. Here's what I need from you..."

Option 2 - General:

"I'm having a medical procedure. I'll share more when I'm ready."

Option 3 - After the fact:

"I had surgery. I'm doing well. Thanks for your support."

Dealing with unsupportive reactions:

- "I understand your concern. My doctors and I are confident."

- "I've done extensive research. This is the right choice for me."

- "I need support, not judgment. Can you give me that?"

At Work:

What to say:

"I'm having a planned medical procedure. I'll be off for 2-3 weeks."

What NOT to say:

You don't owe details. "Personal medical procedure" is sufficient.

If asked directly:

"Yes, it's weight loss surgery. I'm excited about improving my health."

FMLA: You're entitled to job-protected leave.

With Friends:

Close friends:

Be honest. Real friends support your health.

Acquaintances:

Share what feels comfortable. "I'm focusing on my health" works.

Online:

Consider privacy. Once posted, it's permanent. Many people wait until they're comfortable with results.

Social situations:

When people notice weight loss:

- "Thanks! I'm feeling great."

- "I made some health changes."

- "I'm working with my doctor on my health."

If someone guesses surgery:

- If you trust them: "Yes, it's been a great decision."

- If you don't: "I'm just focusing on being healthier."

Remember:

Your medical decisions are YOUR business. Share on YOUR terms. Anyone who makes you feel bad about improving your health isn't serving you well.

Most people care far less than you think they will.