Peer to Peer

This is just an idea but please think about it for a moment. If bariatric surgeons could and would connect patients in the post-surgical phase with patients who are investigating the potential for having weight loss surgery, it could prove to be an effective and inexpensive way to provide real-world information to the pre-surgical patient which may be more useful than what can be obtained alone. Pairing people who have gone through weight loss surgery (WLS) with someone thinking about it, can often give them both the support they vitally need to help them. Could weekly support sessions, one on one discussion, email communications, or even an occasional phone call be of assistance?

Success or failure in the post-surgical WLS world is almost totally dependent upon the commitment and will of the patient. The surgeon, given a good surgical outcome can essentially promise weight loss, but they cannot promise that the patient will not have some side-effects or will not regain some weight. They can explain some of the potential side-effects of the surgery on our digestive process, yet they do not discuss the potential change in lifestyles or eating strategies that may be required. There is little if any pre-surgical discussion of the discipline that is required to effectively live with the results of the weight loss surgery.

Group sessions are almost always recommended for patients both before and after weight loss surgery. This peer support does provide value to many patients, but not to all. Sitting in a group of fellow patients sometimes does not support the real and often painful discussions of the effects from the weight loss. This may be where peer to peer personal contact may be useful. Part of the reason I have been writing this blog is to get people who either are contemplating WLS or have had it, to have a place to read about real world experiences with the process, the physiological ups and downs and the potential to live a terrific new life after the weight loss. I don’t feel like some “poster child” for bariatric surgery but I have had a lot of experience with the digestive aspects of this process, with my first wife for 24 years and now for myself for two and a half years.

I have spent a lot of time discussing the process of weight loss surgery, occasionally with someone who has had it, more often with either someone who could use it, or just interested folks. It seems like there are a lot of misconceptions about the various surgeries and they tend to be lumped into the general categories of Lapband or gastric bypass. The same issues are continually brought up. These include: basic misunderstanding about the surgical processes, weight gain after the surgery; complications with the surgery, effects of having to change lifestyles, ability to eat whatever you want, restrictions, insurance support, costs, health issues and the long term implications of both weight loss as well as the psychological and emotional changes the patient goes through. These are all important issues that I believe can be best discussed in a peer to peer setting and not just in a group setting. Real life effects and real life issues are important to those contemplating the surgery.

This proposed effort is not to generate a research proposal but to stimulate thinking on the part of those reading this blog and hopefully physicians dealing with bariatric surgery to assess the level of information transfer to patients and then potentially between new patients and patients who have undergone this surgery. This could include providing the names of peers who have undergone the surgery and are willing to spend the time to discuss it with those contemplating it. Recommending adequate peer support, as well as providing the option of attending group sessions might be appropriate.

In the very personal world of post-surgical weight loss, sometimes we feel a bit adrift as to what we can, should, or need to do. How do we reconcile the demands of our jobs, including dinners with clients and maintaining the discipline we need? How do we enjoy eating with our family and friends when we constantly receive comments about how little we eat or do we want anything more? How can we enjoy eating if we can only eat eight bites? How do we see ourselves in this new world? How many times can you take in the waistband of your favorite pants?

Patients who are contemplating surgery might be better motivated themselves if given the opportunity to both discuss and receive help from another person who has faced the challenges already and has been able to effectively cope.

It appears that study is needed to evaluate which parts of a peer intervention environment are most successful. These could include: face to face discussions between pre- and post-surgical patients; phone calls offering a supportive voice and also a mechanism for answering questions, group meetings and or even one-on-one counseling with professional counselors.

In many medical issues, the time spent with the patient can be directly related to a successful outcome since this time reminds the patient to do something or to be more engaged. It is my contention that this added time provided by peer to peer discussions may be better suited to the understanding of the bariatric process, help allay fears and provide a long term view of where the patient is going. The patient needs to feel empowered and confident, knowing that they are in charge of the ultimate outcome and that it requires personal discipline and will, but also someone to talk to. It's not so much knowing what to eat but how to change behavior and how will this influence your life and lifestyle. That involves problem-solving and goal-setting skills and the evidence shows that the patient may relate better to a peer who might have more similarities than a teacher in the front of the room.

If you want to use this blog to ask questions and maybe get some answers, please feel free.