Bariatric Surgery – Psychological Themes

Psychological Themes

Bariatric surgery enables significant weight loss over a short period of time, and supports recovery from physical conditions accompanying obesity, such as type 2 diabetes. Weight loss surgery is also linked to improved self-esteem, quality of life and increased life span.

However, surgery may have an impact on mental health, with some individuals struggling with psychological themes such as self-identity and body image.

The management of mental health is important, and best practice recommends the following underlying psychological issues are addressed both before and after weight loss surgery:

  • Avoidance of emotions
  • Relationship difficulties
  • Negative core beliefs
  • Poor body image
  • Self-sabotaging behaviours
  • Self-identity
  • Low self-worth

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Some people, following their bariatric surgery, are able to adjust naturally to their rapid weight loss and new body image, yet others might experience difficulties in accepting their new appearance.

Weight loss is a welcome and wanted outcome of bariatric surgery, however, extreme weight loss can lead to loose skin, and some small scars may show following the laparoscopic surgical procedure.

Some individuals may continue to experience body dissatisfaction about their appearance, leading to major distress, critical internal thoughts that maintain low self-worth, and feelings of anxiety and depression.

When unhelpful thinking patterns are not challenged with psychotherapy, you may still see your body as unattractive and large, even if you have lost weight, and convince yourself through faulty perceptions that your weight loss surgery wasn’t successful in making you feel happier and more confident in your body.


Many people adjust well to their weight loss surgery, enjoying all the positive benefits bariatric surgery can bring. Sadly for some, this is not the case. Rapid weight loss and the speed at which this can change the shape and size of your body, can be a complex emotional rollercoaster for some people, resulting in a psychological struggle with their body image.

This is because their self-concept or self-identity is stuck as seeing themselves as a fat person. If negative core beliefs remain unchallenged, they may believe they are not good enough. A web of unhelpful thoughts maintain their struggle with low self-worth. This creates a clash between how they see themselves now, their shrinking body in the mirror, and the perception of how they have always seen themselves, overweight and fat. Targeted psychotherapy can help to challenge these unhelpful thinking styles and perceptions, to allow for a healthier adjustment to a changing body shape after weight loss surgery.

Some people may feel vulnerable when they lose weight, due to deeper themes being evoked around experiencing their size as a barrier between themselves and the world, relationships and ultimately intimacy. Therapy allows for these existential life problems to be gently explored and worked through.

Staying large, fat or obese can also be a protective physical barrier for some people. Feeling that you are unattractive to others, is a way of avoiding unwanted attention. In these cases, weight loss can result in fear and danger, which can trigger self-sabotaging behaviour like binge eating as a way to feel safe and hide from the world.


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Most people who choose a bariatric surgery procedure to provide rapid weight loss and better health, have developed unhealthy habits around emotional eating.

Somehow, somewhere in their timeline, their way of managing stress, anxiety and emotions has become enmeshed with their eating behaviour, often as a way of distracting from their emotional experience and providing comfort.

If this is not worked through in therapy, emotions that were originally soothed with food before surgery, will be more prominent and vivid in a world post weight loss surgery, where food is no longer freely available.

This in turn may trigger and activate new disordered eating patterns, such as chewing and spitting of food, purging behaviour or periods of severe food restriction following a binge eating episode.

Many people who are trapped in a cycle of emotional eating, experience an inner critical voice that fires up core negative beliefs around not being good enough. This reinforces low self-worth and can often result in feeling like a failure, and complex emotions like shame, which in turn can activate the cycle of emotional eating, and reaching for food for comfort.

Specialised psychotherapy before and after weight loss surgery can support clients in breaking down these unhelpful patterns of thinking, feeling and behaviour, and support the creation of new healthier ways to manage emotions and stress.

In some rare cases following bariatric surgery, when food is no longer available in the same way to manage emotions, a cross addiction may develop. This is a food or substance misuse behaviour, such as drinking, drug use or gambling, which are all ways to escape reality and distract yourself from painful emotions


Relationship dynamics are unique and significant to everyone who chooses the course of weight loss surgery. Both the presence or absence of a significant other, family dynamics and peer group experiences can all influence the reasons why somebody chooses a bariatric surgery procedure.

Excess weight can represent many things in a relationship; protection, defence or even anger. The excitement that rapid weight loss can bring after surgery, and the mix of positive praise and attention, together with greater psychological and emotional exposure can be complex. In a marriage or partnership that was already fragile, this can trigger a more permanent fracture.

Weight loss surgery requires a new mindset to self-care, food management and emotional wellbeing. If parents or a partner do not change their mindset, and continue to manage eating and meals in the same way they always have, this may be at odds to the person who has just experienced surgery.

Psychotherapy allows you to prepare for the changes in your family and friendship systems that will need to take place for you to maximise the best outcomes from bariatric surgery. Learning new skills around assertiveness, boundaries and emotional agility will help you navigate social and relationship issues moving forwards.


When psychological factors to weight issues run much deeper, and have influenced how your personality has been structured, a deeper psychotherapy is needed, that disconnects these early patterns with the unhealthy behaviours you find yourself repeating today.

Psychotherapy with our specialist team supports you in developing a new system, where you can manage stress, find balance with your eating, update your self-identity and experience your body in a healthy way.

We recommend our Integrate Package of support, where you work with our psychological and nutritional teams both pre and post your weight loss surgery, so we can prepare you for all the amazing life-changing opportunities that weight loss surgery can offer.