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I am wondering how this can fit into helping someone who wants to undiet their life and is ready to stop the diet cycle: how do you manage this when the person is morbidly obese and needs a back surgery that the surgeon stated cannot be done until weight loss? The doctor recommended bariatric surgery.

She doesn’t want the surgery but is in constant pain.

I feel like letting go of diet culture and slowly embracing gentle nutrition and movement will have the effect of healthier life and likely weight loss as a by-product. But feels at odds with undieting. And is this a harmful step for her?

How do you work through this type of situation?


This is a great question. Are you ready? Let’s do this.

There’s a lot to unpack here.

I want you to know that it is normal to think that weight loss surgery is the solution, given the fatphobic society that we live in. However, that doesn’t make things true.

Let’s explore the root of the term “morbid obesity.” This term was coined in 1963 to justify asking for reimbursement for the cost of bypass surgery from health insurance providers. As a result, we see this occurring quite often where doctors are required to prove to hospital administrators and insurance providers that they have discussed their patients’ weight with them and have a plan to bring it down. Otherwise, this impacts their performance reviews or being denied reimbursement if they refer other patients for specialized care. Weight stigma and fatphobia in the medical space are pervasive, and weight loss has become the band-aid solution to everything. The doctor has not taken into account all the factors that may impact your friend’s health.

There is yet to be any research that confirms that intentional weight loss for health reasons is sustainable in the long term. Rather, evidence shows that what promotes health is a focus on health-promoting behaviors, including intuitive eating, body acceptance, and joyful movement. This is an opportunity to see this experience from an empowered perspective. What could that look like?

First, it’s about learning how to advocate for oneself. Can she get curious about the rationale for the surgery and explore possible fatphobia and internalized weight stigma. If the surgery is to help her lose weight so that the back pain goes away, why does she need to lose weight to get the surgery? Are there other health-promoting behaviours she could engage in to help her feel better in her body? Has she considered possible complications that may arise from the surgery? Would the doctor recommend surgery for back pain if she were in a thinner, conforming body?

What are the thoughts that she has about her body, back and the pain? Is there a deeper desire that she’s hoping the surgery will give her? Our thoughts drive how we feel and act about every circumstance, so I would recommend exploring the thoughts about body, back and pain.

For those wondering about this, here are two models that could lead to very different results. I recommend exploring those models, then submitting any follow-up questions to coach corner.

-Circumstance 1: Back pain
-T: I’m morbidly obese and need to lose weight
-Circumstance 2: Back pain
-T: People of all sizes experience back pain

We’d love to see your models if you need help navigating this issue too.