Shawn Tarman can consider herself a success story after bariatric surgery, having lost 100 pounds since the procedure at Temple University Hospital three years ago. But it wasn’t always that way. The 42-year-old mother of two said she had to face her demons — the psychological reasons for her overeating — which she accomplished through counseling prior to surgery.

“People who get to be 100-plus pounds overweight don’t get that way because they like food. Food becomes something else. It’s what you comfort yourself with,” she said. “If you don’t deal with this first, the surgery will be a nightmare because you won’t have your food crutch.”

The patient’s mindset and willingness to change is critical to successful bariatric surgery, which is a tool but not a panacea, explains Chris Combs, Ph.D., a psychologist who is part of the Temple Bariatric Surgery Program team led by John Meilahn, M.D.

Temple’s program has dedicated bariatric psychologists who evaluate patients before surgery to measure their willingness and ability to make the lifestyle changes that are necessary for success. Patients also undergo comprehensive medical and nutritional evaluations.

“We make sure patients understand the risks and benefits of the surgery, and that it’s just the first step in a lifelong set of changes. This helps them make an informed decision about whether surgery is right for them,” Combs said. “We also look at whether they have been successful in other parts of their lives; we check that they have a good support system, are able to maintain good relationships, and that they’re not suffering from severe psychiatric illness or abusing alcohol or drugs, which could counteract the benefits of the surgery.”

Combs and his colleagues also talk with patients about two common causes of weight gain: binge eating and emotional eating, which is using food to relieve boredom or deal with negative or even positive emotions. Then they work on finding other ways to self-soothe and cope with stress and emotions. Some patients decide to enter long-term counseling while others are already in counseling to deal with these issues.

John Meilahn, M.D., associate professor of surgery at the School of Medicine, who performed Tarman’s surgery at Temple, stresses that patients can keep the weight off long term if they are able to make the necessary lifestyle changes and are committed to sticking with a new eating and activity plan.

“Bariatric surgery is a life-changing event. In addition to the physical transformation, patients need to adjust to many other challenges related to eating and drinking, mental health and well-being, physical activity and personal relationships,” he said.

During gastric bypass surgery, surgeons reduce the size of the stomach and bypass part of the small intestine. The smaller stomach fills more quickly, so patients eat smaller amounts of food and feel full. Patients are also very uncomfortable and can get sick if they eat too much.

Still, as many patients have learned, it is possible to gain weight after surgery, either by eating high-calorie foods or by eating a lot of food, just in smaller portions, spread over the course of the day.

“People don’t understand that you can become overweight again even with the bypass surgery. That’s why you must go to counseling and talk about it first. It’s the absolute first step,” said Tarman.

To prevent self-sabotage and help patients adjust physically and mentally, Temple’s program also offers individual counseling and support groups after surgery.

“Some patients still see an overweight person in the mirror no matter how much weight they lose. Others struggle with the effects of childhood abuse or turn to alcohol or drugs in place of food,” Combs explained.

Tarman encourages others to be persistent about making changes, which can be especially difficult in the first year following surgery.

“In the beginning, it seems like the portions are so small and the types of foods you can eat are so limited. But I started realizing that I had been eating a ton of food. Portion sizes amazed me too. I found out that I was eating three to four times the normal serving sizes. These are the things that take a while for you to learn,” she said.

After the first year, though, the body begins to adjust and stabilize.

Today Tarman is able to eat “pretty much everything.” If she wants something high-calorie, she’ll just have a little taste. She also stopped doing all of things she used to do that revolved around food, and gradually, she’s found that she no longer thinks so much about food.

“I enjoy it and I’m done with it. I don’t give what I eat a second thought anymore. If I feel like having a snack, I have a snack. I’ve just learned to make better choices. Re-learning is what the first year is all about.”

This summer, Shawn went white water rafting and wore a bathing suit for the first time in 15 years. She also is happy to report higher energy levels, which keep her in pace with her kids and their busy sports schedules.

“It does make a tremendous impact on your life, not being obese. I feel better at 42 than I did at 32. Everything about me has changed for the better. I’m a lot more outgoing and energetic.”

Temple’s Bariatric Program offers all forms of weight loss surgery including open and laparoscopic gastric bypass, laparoscopic adjustable gastric banding (known as lap band) and revisional surgery. For more information, visit www.bariatric.templehealth.org or call 215-707-5555.