The ground-breaking bariatric surgeries that have become a common treatment for obesity can change lives in a matter of months — often faster than the patients can adjust to these changes.
The surgeries, which limit the amount people can eat, lead to significant weight loss over a year or two, but really are only weight-loss tools, according to Nina Arnold of Baricoach, LLC, Integrative Health & Wellness Consulting. Arnold, a certified bariatric nurse with training in integrated health coaching, uses mobile technology to reach out to post-surgical patients who find themselves struggling with motivation and weight gain a few years after their surgery.
Many of Arnold’s clients contact her through her website — www.baricoach.com — a number of them met Arnold when she was working as a bariatric nurse in a surgical group. People then set up appointments to chat with Arnold via e-mail, phone, Skype, or text messages. While Arnold works primarily from home, she also has an office at New England Integrative Health Associates, 345 North Main St., in West Hartford. “I’m actually meeting my first in-person client this week,” she said.
Most clients, though, like the convenience of “meeting” remotely and for some who are self-conscious about their weight gain, the technology provides them with an ideal comfort zone for their first step toward getting back on track.
“I felt there was a need for alternative options,” Arnold said. “Some people have been too embarrassed to return to their physicians, or their diabetes may have come back (because of weight gain). I try to give them insight into how they can use the tools they have. Surgery is only a tool. If they haven’t changed their behavior, they can regain weight.”
Arnold assists her clients in identifying the changes they want to make in their lives and in developing an action plan to help them regain confidence. “I focus on wellness,” she added. “I usually work with someone for at least three months,” she said. “After three to six months of support, people usually can maintain changes for 18 months to two years.”
If she encounters any individuals with signs of more severe adjustment problems, such as post traumatic stress disorder symptoms or erratic behavior, Arnold works with those clients to contact their primary care provider. And if they didn’t have one, she refers them to a psychologist or psychiatrist for further assessment.
For some, the weight loss brings even more changes. Bariatric surgery patients have a higher divorce rate than other people, according to Arnold. Providers believe this may be related to the increased confidence people feel after losing weight, which in turn may prompt them to socialize, flirt, or shop more — in short, behave differently than they did before. When asked about changes in their behavior on an individual basis, Arnold says some of her clients say they have changed for the better.
One of Arnold’s clients, Cheryl from Colchester, Conn., had lap-band surgery in 2007 and lost about 100 pounds. But recently, she found herself in a “lull” and was discouraged after regaining 20 pounds. She received a notice from Arnold about her new practice and reached out to her because Arnold was a nurse at the surgical practice where Cheryl had her surgery.
“It’s a much bigger life change than you can imagine before the surgery,” Cheryl said. “In order to use the surgery as the tool it is supposed to be you still have to continue making good life choices in terms of food, exercise, stress reduction — it’s a much bigger thing than just losing the pounds. The bigger picture is about staying well and keeping my blood pressure down and blood sugar down.
Talking with Arnold has been very helpful in regaining her focus, Cheryl said, adding that Arnold “takes a full view of health and wellness.”
Initially, Cheryl said, she was skeptical that “remote” appointments would be effective. Now she contacts Arnold for their weekly hour-long meetings by phone, text message, or e-mail, and added that “Nina makes it a very safe and non-judgmental environment.”
Their conversations deal in part with mindfulness — focusing on living in the moment and worrying less about the past and future — and different ways of looking at situations, Cheryl said. Arnold also assigns readings and exercises, as well as practice with mediation and deep breathing to help manage stress.
Much as she dislikes exercise, Cheryl knew it had to become part of her daily routine to help maintain her weight and overall wellness. “I made a commitment to getting on the exercise bike and getting congratulations from Nina helps you to see your accomplishments in ways you don’t always see them. She helps you to reframe situations — if I didn’t lose weight that week, what else was going on?”
After five months of working with Arnold, Cheryl said her motivation is back. “I’m realizing that it’s not all about the pounds, it’s how your health is, how you are feeling and living in the present.”
Arnold also hopes to expand her services beyond Connecticut and possibly the U.S. She is in the early stages of educating providers locally and internationally on the benefits of integrative health coaching for individuals, including those who have had bariatric surgery.
Besides post-bariatric surgery patients, Arnold also works with people who want help improving their overall wellness by developing a more healthful lifestyle and those who want to make lifestyle changes to limit or eliminate the affects of a chronic illness.