Ice Cream Isn’t A Hug

Indiana University| Tue Aug 01 06:01:40 EDT 2017
Ice Cream Isn’t A Hug

It’s not just what’s on the outside. It’s also what’s on the inside.

William Hilgendorf’s role at IU Health Bariatric Surgery is to help assess a patient’s state of mind before surgery. He wants to prepare them for the changes – not just physically, but also mentally.

“These folks don’t make this decision hastily. One of the questions we ask is ‘how long have you been considering surgery?’ Most of the time the answer is one to two years but sometimes the answer is 10 years,” said Hilgendorf.

Whether the answer is one or 10 years, Hilgendorf said by the time the patient reaches the decision to seek help, many have already experienced weight bias. “A lot of times they are hesitant to go out in public because of the way they look and the way others see them. I’m told sometimes the first thing they do when they walk into a room is look for a chair they can sit in – whether it’s in a doctor’s office or at a theater.”

Hilgendorf sees patients who have already experienced a lifetime of emotions including frustration, embarrassment and disappointment.

“They want their life back or transformed. We need to help them understand this is about becoming healthier and it’s not a quick fix.” He hears a variety of reasons patients opt for surgery. Most have tried a number of diets.

“Sometimes it’s a lifelong awareness; sometimes it’s an ‘a ha’ moment. Research suggests with severe obesity you can lose 8-10 years of your life. So maybe a doctor told them they needed to lose weight. Maybe it’s that they are not pictured with their kids because they are ashamed of the way they look, or maybe they want to get on the floor and play with their grandkids but they just can’t.”

Bariatric surgery is an elective procedure, so Hilgendorf wants to take the emotional pulse of clients to determine their readiness. He often asks if they know someone else who has gone through the procedure.

“It’s hard to lose weight but it’s harder to keep it off. We talk a lot about eating habits,” said Hilgendorf, who begins his assessment with a 20-page packet that includes a number of questions to gage the patient’s lifestyle and mindset.

“The paperwork gives us a running start and then we look at the areas that are most relevant,” said Hilgendorf. Those areas might include untreated depression or difficulty adhering to treatment for a medical condition. “Obesity is so multi-faceted. There are many contributors including behavior, genetics, our environment, and socio-economic status.”

There are patients who were raised in the “clean plate club” generation and there are patients who don’t have the resources to purchase fresh fruits and vegetables. There are also patients who have recently quit smoking who have gained weight.

“We talk about the two r’s - we might eat for ‘relief’ and ‘reward.’ It varies with different patients. Sometimes loneliness and boredom come into play,” said Hilgendorf.

“I like to say ice cream is not a hug. I’m looking to identify factors that could increase the risk of complications and to help them adjust to changing their bodies and going from a full plate of food to about four ounces,” said Hilgendorf, who works with a team of professionals including a nutritionist. Patients complete a number of pre-surgery office visits – all in an effort to help them learn about, and cope with life after weight loss.

For most, that means changing the way they view food. They keep journals, maintain an exercise plan, take vitamins and work toward a healthier lifestyle. The goal is to swap a menu of food for a full menu of coping strategies.

“If they rely on food to regulate their emotions and all of sudden that changes, then we would be pulling the rug out from beneath them,” said Hilgendorf. “We want to help them begin making those adjustments well before surgery.”

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