What People Don’t Talk About After They Get Weight-Loss Surgery

When you lose weight the surgical way, naysayers may accuse you of taking the easy way out. But how does that affect your own self-image? (GIF: Yahoo Health/Getty Images)

Surgery is often a last resort for people who have struggled to lose weight for years — but it’s not a guaranteed happy ending.

First, consider the research: A recent study in the journal JAMA Surgery found that the average patient who undergoes a laparoscopic sleeve gastrectomy, in which a smaller stomach is created, gains back nearly half the weight five years after having the surgery. And other research published in the Journal of Obesity found that while most people have better self-esteem, confidence, and body image after surgery, some continue to struggle with weight loss and maintenance, which can lead to body-image dissatisfaction.

Patients also often have to deal with naysayers who tell them they took the easy way out. And, while the surgery helps, losing weight — and keeping it off — takes serious effort. For these patients, the surgery was a last-resort option, often in an effort to get healthy, after years of struggling to do it on their own.

That’s a fact salon manager Amber Akers, who underwent sleeve surgery in September 2015, is very aware of. At her heaviest, the 31-year-old was 438 pounds, but now, a few months after surgery, she weighs 336 pounds.

“I definitely do not think surgery was the easy way out,” she tells Yahoo Health. “This has been the hardest thing I’ve done in my life.”

While the impressive results of weight-loss surgery are often celebrated, few talk about the emotional and physical difficulty behind it. Patients must completely alter their workout and eating habits, and remain dedicated for life, lest the weight sneak back. Akers now exercises religiously and makes an effort to eat well. While she remains upbeat and positive about her progress, she admits the idea of gaining the weight back is “definitely a concern and something I am prepared to face.”

Amber Akers, 31, lost more than 100 pounds after undergoing weight-loss surgery. (Photos courtesy of Amber Akers)

But it’s important to her to keep the weight off. Akers says she’s always felt attractive and positive about her body but decided to have the surgery for fertility reasons. She suffers from polycystic ovarian syndrome and has had trouble conceiving. According to her doctor, weight loss may help.

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While Akers is happy with the progress she’s made so far, she says it was hard to break her food addiction. “There was a definite grieving process for a few weeks after my surgery,” she says. “I knew that once I made that step, I was killing the ‘person’ that had been my best friend for a long time — but that best friend was also the most abusive force in my life.”

Now Akers says her biggest challenge is not comparing her body with others. She belongs to several online support groups for weight-loss-surgery patients and often reads about other patients’ success stories. “It’s easy when you look at some people who have lost over 200 pounds in a six-month period,” she says. “I’ve done everything I can do — my birthday dessert was an apple with peanut butter. I’m losing weight, but not as quickly as other people.”

Akers before (left) and after the surgery. (Photos courtesy of Amber Akers)

Akers admits that comparison can “get in your head and make you kind of bitter,” but she keeps repeating the quote “Comparison is the thief of joy” to remind her that she’s doing the best she can.

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That’s a sentiment shared by Donald Stankalis, who underwent gastric-bypass surgery in August 2013. The 56-year-old went from 444 pounds to 188 pounds, and now weighs 201.

Donald Stankalis lost more than 250 pounds after undergoing weight-loss surgery. (Photo courtesy of Donald Stankalis)

Stankalis says he feels “great” about his body — but that took time.

“It wasn’t immediate, like a switch was turned on, the choirs sang, and all is well with the world,” he says. Stankalis says it took a lot of hard work — including eating right and exercising regularly — to reach his goal weight of 188 pounds. Though he has since gained some of it back, he remains optimistic about that. “It’s not that I failed,” he says. “My body is just getting used to things.”

Stankalis regularly attends a bariatric-surgery support group at NYU Lutheran Medical Center, where he had his surgery, and says the support is crucial.

However, he still suffers from depression, although he’s on less medication than he was pre-surgery. He’s also had to deal with some people who say he took the easy route, as well as those who say he’ll just gain back the weight he lost. “I haven’t done it yet,” he points out.

While Stankalis says he’s “content” with his body now, he’s also aware that he’s always going to have to work at his weight.

Stankalis after his surgery. (Photo courtesy of Donald Stankalis)

Clinical psychologist and bariatric counselor Daniel Stettner, PhD, an adjunct professor at Wayne State University, works with patients before and after surgery to make sure they have the right mindset for weight-loss and body-image success. He tells Yahoo Health that people are often euphoric after surgery, but the challenge is to funnel that feeling into action to get and keep the weight off. After about one year, he says, people can start to return to old behavior patterns and begin gaining weight, which can be tough psychologically.

Related: Weight-Loss Surgery Linked to Increased Suicide Risk

“They begin to get downhearted and sometimes depressed with the attitude of ‘Here we go again, another failure. I’ve failed at weight loss again,’” he says. “Unless they make lifestyle changes, they’re going to get back in trouble again.”

Stettner says his biggest challenge is helping patients to focus on long-term goals and lifestyle changes in order to stay healthy and positive about their bodies. He repeatedly stresses this to patients: “The surgery is not a cure, it’s a tool for change.”

Both Akers and Stankalis say they’re aware they’ll always have to work to keep the weight off, but they’re happy with the way they look now. While Akers says her No.1 goal is to be healthy, she’s dreaming of the day she hits 199 pounds. “To get at least 199 would be perfect,” she says. “That would be a wonderland, to have a weight that starts with a one.”

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Body-Peace Resolution is Yahoo Health’s January initiative to motivate you to pursue wellness goals that are not vanity-driven, but that strive for more meaningful outcomes. We’re talking strength, mental fitness, self-acceptance — true and total body peace. Our big hope: This month of resolutions will inspire a body-peace revolution. Want to join us? Start by sharing your own body-positive moments on social media using the hashtag #bodypeaceresolution.