Surgery Not “A Magic Pill” for Obese Patients

After working at a bariatric surgery center in a major Boston hospital and in my private practice, I’ve seen life changing successes and heart breaking disasters.  Surgical weight loss is not for everyone but it is right the right people. What makes it right is when the procedure is used only after everything else has been tried and when it becomes a spring board to do the hard work of learning to listen to your body; eat when it ‘s hungry and stop when it’s full and pay attention to the feelings that are no longer being stuffed with food.  It’s even possible to learn to love your body exactly the way it is, fat, thin or even with sagging post surgical flesh after weight loss surgery. There are no long term quick fixes.  Even after surgery, it takes time and commitment and often support from a professional to maintain the weight what has been so hard to achieve and to develop a self image and intimate relationship that is based on love and acceptance rather than the habit of self hate.  This article, For Obese, Intimate Lives Often Sufferexplains what happened to a couple and their sex life before and after bariatric surgery.

September 21, 2011 from KQED, Part of an ongoing series on obesity in America

It’s well known that obesity can lead to a lot of health problems, but what’s rarely talked about is the impact on people’s sexual health. As the obesity rate has soared in the U.S., more and more marriage and family therapists are getting questions from obese clients about problems in the bedroom.

It’s an issue that Dana Englehardt and her husband, Larry Boynton, of Belmont, Calif., know well.

When Englehardt met Boynton more than a decade ago, she was quite heavy. She was a straight-talking nurse, widowed with three kids. He was a local contractor looking to end his swinging bachelor days and get serious. Boynton says he didn’t focus on Englehardt’s size.

 “Once I decided to put that out of my mind and allow the relationship to grow with the person I was falling in love with — her personality and how much fun we had together — it just really wasn’t an issue,” Boynton says.

After they married, Englehardt gained another 60 pounds. Her joints ached. She could barely stand during her nursing shifts. Grocery shopping and gardening left her winded. She had terrible sleep apnea and was exhausted all the time. And then there was the sex. The thought of making love to her husband felt like a chore.

“I suffered a lot of guilt because I knew that I wasn’t meeting my husband’s needs. That was the worst part — the guilt,” Englehardt says.

In all this, Englehardt came to see her body as something separate from herself. She wouldn’t look at her reflection in storefront windows. She raised her makeup mirror so she could see only from her nose on up. And when she settled in for the night, she didn’t want Boynton to touch her.

“I just felt kind of hideous. I didn’t like when he would touch me because it reminded me of all the bulk there. And then I just kind of avoided sex for a long time,” Englehardt says.

 “At one point it was six months. And I was almost climbing the walls. She would get intimate, kissing and everything, but then it wouldn’t go anywhere, and that makes a guy very frustrated. And so I didn’t want to get frustrated, so therefore, I just shut down,” Boynton says.

All of this went unsaid. The pair didn’t talk about it. They did what so many couples do: They retreated.

A Pattern Emerges

Clearly, there are obese people who are happy, fulfilled and feel deeply connected in their relationships — emotionally and sexually. But in the interviews done for this story with marriage therapists, sexual health doctors and weight researchers, a pattern emerges: Obese people — especially those trying to lose weight — are more dissatisfied with their sexual lives, and obese women seem to suffer the most.

I suffered a lot of guilt because I knew that I wasn’t meeting my husband’s needs. That was the worst part — the guilt.  – Dana Englehardt

“Instead of enjoying their sexual intimacy, they’re worried about the size of their stomach or, ‘Oh my god, he’s going to touch my stomach. What’s he going to think about my stomach?’ ” says Ronnie Kolotkin, a psychologist at Duke University Medical Center who designed a widely used survey that measures how obesity affects quality of life.

 “Women reported many more problems with sexual functioning than men. And in fact, women’s scores were even lower than a reference group of cancer survivors,” she says. Kolotkin says the problems for men and women are different.

 “Women often talk about difficulties with enjoyment, low sexual desire, avoidance of sexual intimacy, as well as some difficulty with sexual performance; whereas men are more apt to tell me in private practice or in group therapy about performance difficulties and embarrassment related to that,” she says. Some of this is biological: As men’s weight increases, testosterone production can plummet, leading to erectile dysfunction. Weight-related diabetes, too, can result in sexual problems.

But sex is not simply desire and arousal. For many long-term couples, emotional closeness and physical intimacy hinge on trust. Eric Leckbee, a tall and friendly 42-year-old software engineer, knows all too well what happens when that trust is broken. He lives in San Francisco with his wife, who didn’t want to be interviewed. At times, he’s reached 300 pounds. But it was when Leckbee’s wife caught him hiding food that his sex life really took a nosedive.

 “It causes the question of what else are you hiding? I’m not being honest with her. To be really, truly intimate with someone, sexually and emotionally, you have to be able to trust them. So she puts barriers up, and then I feel defensive and I put barriers up, and then it causes more of a chasm to occur between us,” Leckbee says. “When you start feeling more emotionally distanced from each other, then you’re less likely to want to have sex or even enjoy the sex that you have.”

Leckbee has done a lot of therapy just to talk about all this. Still, he’s often repulsed by his body and has had a hard time imagining that his wife finds him attractive.

“I felt it nearly impossible, not impossible, but very, very hard to approach my wife for sex, to hit on my wife, and then I would think, ‘God, you’re a loser, you don’t know how to hit on your wife, the one woman in the world who should be open to your sexual advances,’ and yet, I would have that fear,” he says. (from NPR)

Finding A Path To Openness

All of this would crawl around in his head. It still does. When he feels confident, he’s able to maintain his diet, even go on a bike ride. But those periods give way to darker ones when he becomes quiet and distant.

“When I’m feeling fat and depressed, I’m not communicating very well, and that breaks down the intimacy, which breaks down the amount of sex and the frequency of sexual intimacy,” Leckbee says.

Leckbee’s weight still fluctuates. But he and his wife are now trying a new approach: to separate his weight from their sex life.

 “My wife, saying to me, ‘I love you and I’m attracted to you regardless of your weight.’ That was something I needed to hear and something I needed to believe, though I still struggle with it,” Leckbee says. “But it’s, now I’m more self-aware, now I understand it, now I’m able to look at it and go, ‘My libido is really low right now because I’ve been eating too much and I’m feeling bad about myself.’ I can express it to my wife and let her know I’m feeling this way.”

This process of recovery — both physical and psychological — is messy and seemingly unending. For Englehardt, her health had become so bad she took the drastic step of getting bariatric surgery.

Post-surgery, Englehardt says she fantasized about a renewed sex life with her husband.

 “I think I did have unrealistic expectations that after I got this new body that he was going to suddenly be all over me, and that didn’t happen. And I think he went so long with me being uninterested that when I was interested again, I don’t know if you have trouble believing it, that I was interested again, but you … it took a while for you come around,” she says.

“It took a while for me to realize what the signs were again,” Boynton says.

The couple went to counseling and started figuring out how to communicate — about a lot of things, including sex. Now, Boynton says, he knows the signs.  

(In the CBS swries Mike & Molly, Molly Flynn (Melissa McCarthy) and Mike Biggs (Billy Gardell) show a healthy intimate relationship. While many obese people lead happy and healthy sex lives, therapists are seeing more obese people who say their intimate lives are suffering because of their weight.)

“I know it now, and it’s nice. It’s very, very nice,” he says.

Englehardt sought her own counseling to exorcise her deeply held belief that she was an unlikable fat girl. “It’s kind of nice ’cause I can just kind of lose myself in the moment and not be thinking about, you know, ‘Oh God, he’s touching my belly fat again,’ ” she says.

It’s been several years now of hard discipline to keep the weight off and of painful therapy, but finally Englehardt is able to fall into that fugue state — that dreamy abandon — that lovers often inhabit.