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Mental health and wellness

You may be wondering why we talk about mental health and wellness when preparing for surgery. It’s good to remember that your mental health is the foundation of your emotional, psychological, and social well-being. It affects how you think, feel, and act as you cope with life. It also helps determine how you handle stress, relate to others, and make choices. Caring for your mental health is important at every stage of life.

Mental health issues take many forms. Some are mild and only affect daily life in limited ways, such as certain phobias (fears). Others are more severe.

No matter what, it’s important to know that mental health issues are common and nothing to be ashamed of.

Your mind and body are connected. You deserve care that supports your total health—mind, body, and spirit. If depression, anxiety, addiction, or other issues like these are interfering with your daily life, Kaiser Permanente can help.

Key areas of mental health

In the Options program, we like to think about mental health and wellness in three key areas: relationship with self, relationship with food, and relationship with others. Each topic has some key messages to keep in mind.

Woman in gym looking into mirror while holding exercise ball

Relationship with self

Realistic expectations

Surgery is just a tool. Long-term lifestyle changes are the key to success after surgery.

Power of your mind

One main difference between people who are successful and people who regain weight after surgery is the proper use of mental health and wellness tools, resources, and professional support when needed (before and after surgery).

Embracing change

Behavior change takes time. You don’t have to be perfect, and it’s normal to slip up or get off track. Finding coping tools that work for you will help you feel your best and maintain weight loss long term.

Positive body image

Many people who have had surgery struggle with body image before and after surgery. Developing a positive body image before surgery can help you begin to feel at home in your own skin and prevent serious complications, such as depression, isolation, and eating disorders.

Getting support

Recognizing when you need a bit more help is a strength. There is no shame in knowing what you need for long-term health and getting professional help.

Woman at farmers market picking out green onions

Relationship with food

Realistic expectations

Surgery is just a tool. While your physical sensations of hunger may change after surgery, your emotional relationship with food will not unless you change your behavior.

Healthy relationship with food

Developing a healthy relationship with food before surgery will help you long after.

Emotional eating

Your relationship with food and eating will change after surgery. You can learn skills to help prevent emotional eating and manage slipups if and when they happen.

Addiction transfer

It’s common for addiction to transfer from food to smoking, alcohol, or other substances or activities before and after surgery. You need to understand the risk factors, signs, and symptoms of addiction and know where and how to get help.

Getting support

Recognizing when you need a bit more help is a strength. There is no shame in knowing what you need for long-term health and getting professional help.

Man and woman playing guitar together

Relationship with others

Realistic expectations

Understand that your support system is an important part of your life, but you also need to prioritize taking care of yourself.

Preparing yourself and others

Surgery not only affects you but also those around you and how you react to them. It’s important to prepare yourself, your family, and your friends for life after surgery.

Communication skills and boundary setting

After surgery, open communication, being assertive, setting boundaries, and managing emotions are important skills that will help you cope in your relationships with others.

Relapse and getting back on track

Getting off track is normal. Recognizing when you’ve returned to old habits and seeking helpful resources is how you can get back on track.

Getting support

Recognizing when you need a bit more help is a strength. There is no shame in knowing what you need for long-term health and getting professional help.

Important mental health and wellness considerations

Metabolic and bariatric surgery is a tool that can support overall health and wellness. However, it is important to be aware of some important mental health and wellness considerations that surgery can impact or influence, including trauma, addiction, depression, disordered eating/eating disorders, and relationships.


What do we mean by trauma?

We often think of trauma as a specific event, but trauma has a much broader definition. Trauma stems from a life-threatening or physically or emotionally harmful event or set of circumstances that has lasting effects on a person’s functioning and mental, physical, social, emotional, or spiritual well-being. In the United States, 61% of men and 51% of women report exposure to at least one lifetime traumatic event.

Why is recognizing trauma important?

If you have had any type of trauma in your past that may be affecting your current behavior, it can help to talk to a professional. Trauma, whether experienced in childhood, adolescence, or adulthood, can impact the success of surgery and reduce the likelihood of long-term weight loss.

Professionals can help you get past events or learn to cope so you can have long-term success and happiness after surgery.

There are many resources at Kaiser Permanente and elsewhere that can support you and help you get back on track. You are not alone.


People who have had surgery are at increased risk for addiction transfer (also called cross addiction). This means trading one compulsive behavior for another one. Addiction can take many forms, such as alcohol, opioids or other pain management medications, and other substances or behaviors. It’s important to understand the risk factors and signs and symptoms of addiction and know how to get help.

Factors that increase the risk for addiction transfer:

  • History of eating disorders, food addiction, or compulsive eating
  • Family history of substance abuse
  • Regular alcohol use before surgery
  • History of chronic pain or overuse of narcotics for pain management
  • History of trauma, especially childhood sexual abuse
  • History of depression and other mood or anxiety disorders
  • Lack of adequate support or feeling isolated
  • Avoidance of emotions and experiences
  • History of engaging in self-sabotaging behaviors (binge eating)

Signs and symptoms of addiction may include:

  • Needing more of the substance or behavior to get the same effect
  • Doing a behavior or using a substance longer or in higher amounts than planned
  • Not being able to cut down, even when you want to
  • An increase in negative consequences caused by the use or behavior (issues with self, family, friends, work, and/or legal problems)
  • Others have suggested that you stop or cut down
  • An increase in hiding or covering up the behavior or use
  • An increase in feelings of guilt and shame
  • Craving or having a strong desire or urge for the substance or behavior
  • Withdrawing from important social, job-related, or recreational activities because of substance use

A Special Note on Alcohol

After surgery, the way the body tolerates alcohol changes for many reasons.

Faster alcohol absorption Your stomach is smaller and/or bypassed, so you will absorb alcohol much faster.
Alcohol takes longer to process For many reasons, alcohol may take longer to be processed by your liver and clear your system.
No eating while drinking Because the diet after surgery recommends that you do not eat and drink at the same time, alcohol will be absorbed faster because there is no food to slow it down in your digestive system.
Chemical/hormonal changes from surgery The chemical/hormonal changes that result from surgery can affect the way your body and brain process and respond to alcohol.

Alcohol is not recommended after surgery. It’s important to get help if you’re struggling with any substance abuse before or after surgery. Learn more about resources to support your health at Kaiser Permanente.

There are many resources at Kaiser Permanente and elsewhere that can support you and help you get back on track. You are not alone.

Learn more about cross addiction and bariatric surgery.


How common is depression after surgery?

Most people who have surgery will not become clinically depressed. About one-third of patients do report some minor symptoms of depression, which we call “post-op blues” (like “baby blues” after giving birth). Post-op blues often happen in the first few weeks or months after surgery when you are still recovering and adjusting to a new way of life. You may ask yourself:

  • Why did I do this?
  • What was I thinking?

This is not depression, and it’s normal to feel this way. It usually goes away within a couple of months.

Depression can range from very mild to severe. It’s important to be able to recognize symptoms and ask for help if needed, both before and after surgery.

If post-op blues don’t go away or get worse, you may be having symptoms of underlying depression. If you have the following symptoms, it’s important to know that you can get support. Depression is very treatable.

Symptoms of depression:

  • Sadness
  • Loss of interest
  • Changes in sleep
  • Changes in appetite
  • Social isolation
  • Helplessness
  • Hopelessness
  • Worthlessness
  • Irritability
  • Low motivation
  • Thoughts of suicide
  • Difficulty concentrating
  • Increased anger and/or frustration

If you are currently on depression medications, it’s also important to let your doctor know. Your doctor may need to adjust your medications after surgery depending on the dosage.

There are many resources at Kaiser Permanente and elsewhere that can support you and help you get back on track. You are not alone.

Disordered Eating and Eating Disorders

Having surgery does not address underlying contributors to disordered eating, which may continue to get in the way of your weight loss efforts after surgery. Therefore, it’s important to recognize symptoms of disordered eating or an eating disorder because it can have serious complications, especially when paired with surgery.

Learn more at about eating disorders at or

Recovery is possible, and help is available! Talking to a professional can help. There are many resources at Kaiser Permanente and elsewhere that can support you and help you get back on track. You are not alone.

Recognizing relapse
and staying on track

Things don’t always go as planned, and making a major lifestyle change is not always easy. It’s OK to slip up. Check out some quick tips for getting back on track.

Do something that signals you’re back on track right away
  • Throw away a trigger food that you bought.
  • Go for a 5-minute walk.
  • Take a few deep breaths.
Anticipate tough situations

Anticipate which part of the day is the hardest to get through without caving into a craving. Plan for how you will handle it.

Call someone from your support system

Having a strong social support system is important. Think of someone who can be there for you in tough times.

Remind yourself of your “why”

Keeping your focus on your “why” (what matters to you most in life) can help make obstacles easier to overcome.


List your trigger situations and some plans for how you can cope with each one ahead of time.

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