Somita Pal – We have with us Psychologist Kaehalee Shinde, who works at a Bariatric clinic in Pune. She will be talking about role of a psychologist in treating obesity. We will also be speaking with a person who has undergone an obesity surgery, her name is Abha Padgaonkar and she will be sharing her experience pre and post-obesity surgery.
Dr Kaehalee Shinde – Bariatric psychology is very less explored in India. But we cannot avoid the fact that most bariatric patients do have a psychiatric co-morbidity. Every clinic should have a standard protocol for a pre-up evaluation. There are lot of issues it’s not only a psychiatric diagnosis that you should do allow but from behavioural medicine perspective you should understand the patients psychology, you should understand their coping mechanism if there are stress modulators. There are lots of things that need to be checked.
The protocol that I usually follow is we do a semi structured interview which explores developmental history of obesity, we talk about eating pattern, and we check, primarily what is the motive for surgery and their expectations from the surgery as well. It’s very important that a patient is psychologically-educated, it is important that they understand that surgery is like a tool and they will have to incorporate lifestyle modifications from their end. They will have to diet, they will have to exercise and that requires a lot of effort.
Now what happens is that due to obesity there are weight issue, weight related problems which reduce the quality of life; there are many things that these guys are suffering from, which include relationship problems as well. This a reason why when they come and they take sessions with the psychologist it helps improve weight loss, it increases the efficacy of the surgery. It’s like an add on which is very necessary as well. So, it’s very important that I feel lot of psychologists should get trained in bariatric psychology.
There is a big dearth, I mean even today the scenario is like every clinic will have a nutritionist but there are few well trained bariatric psychologists on board. So, anybody who thinks they want to go in for weight loss, it’s very important that they should go through counselling themselves. So that they understand what they are going through. They need to understand what is required of them as well it cannot be that they have gone and sat in front of the doctor and think ‘fix me now’. They have to take lot of efforts from their end as well. Even adjusting I think post-surgery when a lot of changes happen you must have experienced that. You start fitting into new dresses and etc. but in that time period also you need to do lot of things you cannot completely go flowing with it as well. Because the implications is long term.
Your weight loss will keep on happening for a year and a half and post this you have to start maintaining it on your own. That one and a half period is very important wherein you can try and deal you the weight loss and you are on a high and you are happy about it and so it gets very easy to work with the psychologist and solving a lot of issue that come up. I don’t know whether you have experienced it or not but children come up with lot of bullying problem because of weight, there is fat shaming that happens. The psychology of obesity considers all of this. Your intestine and brain are connected. You cannot treat it as a two separate things. They influence each other. So it very important you cannot ignore this part at all.
Somita Pal – Abha, you underwent bariatric surgery two years back. Can you talk about your experience, the psychological problems that you have gone through?
Abha Padgaonkar – Well I’ve never been a slim child, as far as I remember I was always fat and plump. The one thing I would like to start is that parents need to take care of certain things when they are dealing with their children. See what’s happens is if a kid is eating too much, they are children they are going to eat. They love chocolates; they love everything that tastes yummy so, they are going to eat.
Just because certain child put on weight that doesn’t mean you start criminalising your child. And I am using the term criminalising because that is how a kid starts feeling that if I am fat then probably I am not a good person. That is how children start feeling. And it goes on and is carried forward by that particular person as they grow up. That is what happened with me. I still remember when I was in first standard one of my classmate used to tease me ‘Abha Dholi’ dholi means fat. I was hardly six year old and at the age of six I had been teased for being fat and that went on for year and years. It wasn’t just my friends who did that it was people from my own family.
Every time I would meet my family members, my relatives, the first thing they would say that you have put on so much weight please go and do some exercise, stop eating this, stop eating that. But everybody just points out the problem and person who is suffering from obesity need somebody to give a solution instead.
Most importantly that person is already low in self-confidence, what is important is that you should give that person some confidence that you will be able to cope up with this and you will be able to deal with it and you will be able to fight with it, that confidence is required.
Dr Kaehalee Shinde – Abha don’t you think that people should understand that you don’t enjoy being that way. You are trying really hard. I have this one thing to say, you know stop calling people fat. Fat is something you have, the way you have muscle, the way you have feet. You have finger nails.