Fat Acceptance, Weight Loss Surgery & Addiction

Kelly Coffey

I was 300 pounds in my early 20s. I had spent years dieting only to gain more fat than I ever lost. My desperation to be happy left me no choice but to accept and love my body as it was, since it appeared I was powerless to change it. Though perhaps it would have been comforting to connect with a Fat Acceptance (FA) group at that moment in my life, in hindsight I’m grateful for the independent streak that kept me from reaching out to such a group. I don’t “do” moderation, so it’s likely I would have completely embraced FA at its most extreme, not just accepting but promoting fatness, and scoffing at any mention of Weight Loss Surgery (WLS), the holy trinity of food addiction 1  (sugar, starch and compulsive overeating), and anything else that might suggest that there is anything to fix about being fat. 2

The latest-wave FA movement, Healthy At Every Size (HAES) 3, was born out of Linda Bacon, Ph.D.’s 2010 book by the same name. Lisa DuBreuil, LICSW 4, is a HAES proponent.  As a clinical social worker, DuBreuil counsels postoperative WLS patients who develop complications following surgery. Last week,  I ran across a post written by DuBreuil entitled “Weight Stigma and Weight Loss Surgery.” The piece is part op-ed, part memoir, and firmly anti-WLS.

In DuBreuil’s piece, one post-WLS complication sticks out as particularly worthy of further exploration: Addiction 5. To hear DuBreuil tell it, addictions rise up out of nowhere for many postoperative WLS patients. One might go into surgery a social drinker, only to develop full blown alcoholism a short time later. DuBreuil reports seeing the same type of scenario play out with drugs, anorexia and bulimia, compulsive shopping, and gambling. “People have lost (or almost lost) their professional licensure, career or a marriage due to their new addiction post-WLS,” she cautions.

Addiction is hard-wired in the sufferer’s brain. It’s not the kind of thing that develops overnight, and it’s certainly not something that happens as the result of having surgery. Addiction doesn’t develop spontaneously, like an infection; for those who have it, Addiction is deeply embedded in their mental and emotional landscape.

Addiction is powerful. It can manifest in odd and unexpected ways when the pressure’s on. If one’s primary addiction is disabled, secondary addictions often rush to the surface to try to compensate 6. A great illustration of this phenomenon is the use of  Antabuse, a medication that disables alcoholism. When an alcoholic is on Antabuse, drinking alcohol makes them violently ill. Many who’ve tried to get sober by taking Antabuse often find themselves compulsively overeating (mainly sugar and starch 7), smoking, and taking drugs at times when they would normally drink. With their primary addiction disabled – but the disease of addiction still going strong – other addictive vices rush in to compensate.

Those  who choose to undergo WLS often experience something akin to the Antabuse scenario: Denied access to their primary addiction 8and, most importantly, denied appropriate resources to recover from that addiction 9, secondary addictions rise up to fill the void. At times when they would have overeaten or eaten sweets, they now drink to excess. Maybe they smoke. Or they start popping pills. Some have risky sex with multiple, poorly-chosen partners.  The “lucky” ones might develop addictions to “healthier” things, like exercise 10.

The illness of addiction plagues many, if not most, obese people (myself included). When the holy trinity of sugar, starch, and compulsive overeating is the primary addiction, obesity emerges as a symptom. As with any other addiction, abstinence is the cure. Problematically, most Fat Acceptance literature lumps abstinence in with traditional diets, cautioning folks away from both. Those of us who have counted calories or weighed and measured food in an effort to lose weight know exactly how traditional diets end – badly, sadly, angrily, and fatter for the effort. But those of us who have met our addiction with abstinence have a very different, positive – some would say spiritual – experience. We are free of obsessive thoughts about food, free of shame and regret, free of spikes and crashes brought on by surges of sugar and excesses of insulin. We sleep better, breathe more deeply, feel at peace. And we achieve and maintain a healthier, more comfortable weight.

DuBreuil is on the front lines with WLS patients, many of whom imagined surgery would “fix” them. But surgery cannot undo addiction. There, in patients’ darkest, most confused and desperate hours, she compassionately counsels them from a HAES perspective. I imagine her encouraging them to love themselves, to seek help for their drug and alcohol or other (new) problems, and to put the unfortunate choice to have WLS behind them. If you’re destined to be obese, why not embrace it and focus on being as healthy as your obesity allows?

Because obesity is not our destiny. It’s not insurmountable.  Obesity is usually a symptom of an illness we have the power to cure.

The prevalence of obesity would plummet and the long term success of WLS 11 would skyrocket if DuBreuil and others who work with the obese population could accept obesity for what it very often is: a symptom of addiction. DuBreuil notes in her article  that “pursuing weight loss leads to weight gain over time and makes people less healthy in the long run.” She’s absolutely, 100% right. Weight loss for the sake of weight loss just shy of always results in more weight gain, poorer health and, over time, incomprehensible demoralization. However, when we adopt abstinence as a regular practice 12 in an effort to recover from the emotionally, mentally, and physically damaging reality of food addiction 13, our bodies are able to settle naturally into a healthy, sustainable weight. People respect and prioritize addiction recovery. The respect and support afforded recovery efforts versus diets increases the odds that  sugar & starch addicts will maintain abstinence and, therefore, a more comfortable weight long term.

But it isn’t the cultural norm to say that obesity is the result of an addition. That’s not the language we use 14. As such, the obesity issue and those of us carrying the weight of it don’t receive the respect or the resources we need in order to recover. Instead, we get inundated with diets, fads, fat farms and surgeries 15. In the end, we’re more obese as a population, more depressed, and feel progressively less empowered.

HAES facilitates community, encourages self-acceptance, self-love, personal empowerment, and improved health for obese men and women – all important steps in the right direction.  Sadly – for Fat Acceptance fans generally and DuBreuil’s WLS clients specifically – HAES’s exhaustive online resource list includes not one mention of the words “addict” or “addiction.”

I hope the Fat Acceptance movement continues to build strength and momentum. WLS patients specifically – and obese people generally – absolutely deserve and should  be encouraged to accept and love their bodies 16. I also hope that the next wave of the Fat Acceptance movement promotes frank discussions of  the holy trinity of food addiction. 17  All obese people, regardless of where we stand on WLS, deserve access to information about our illness, and the resources and support we need if we wish to pursue recovery.


  1. The concept of food addiction is bothersome to many, and I’m sad that I stand to alienate a lot of potential readers by whipping it out. No, I’m not a Registered Dietician, I’m not an academic, hell, I’m not even a nutritionist. I’m not capable of quoting studies, nor do I care to. I’ve lived the problem and I witness – first-hand, everyday – what recovery does to the body and mind.
  2. From a place of self-acceptance I chose to have Roux-en-Y Gastric Bypass weight loss surgery in March 2003. Later that year the initial high of losing weight wore off and I sank to new depths of depression. I realized something much more profound than my weight needed to change if I was to ever be happy and healthy long term. After some serious introspection, I realized much of my misery was the product of unchecked Addiction (with a capital ‘A’), of which my obesity had been a symptom.  I’ve been working on recovery from my primary addiction, food, for much of the last 10 years.
  3. HAES does not promote fatness, but rather encourages good health regardless of size. HAES’s major principles are:

    1- Accepting and respecting the natural diversity of body sizes and shapes.

    2-Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.

    3-Finding the joy in moving one’s body and becoming more physically vital.

  4. Lisa DuBreuil, LICSW, is a clinical social worker  who treats people dealing with addictions, eating disorders and problems post-weight loss surgery (WLS) at an outpatient psychiatry clinic in Boston.
  5. Addiction is a mental illness, a mental and physical compulsion and what is often referred to as a physical “allergy.” Addiction affects how one relates to any and/or every feeling-altering substance they ingest, circumstance they encounter, and activity or relationship in which they participate.
  6. Muffle, stifle or change the feelings left to run wild by disabling the primary addiction.
  7. Well, isn’t that a surprise!
  8. Eating large quantities is a physical impossibility following WLS. Also, eating sugar makes some WLS postoperative patients sick as a dog. It is weeks or months, and in some cases years before sugar ceases to cause this intensely unpleasant physical response. Weight Loss Surgery:  Antabuse for Sugar Addiction.
  9. Before surgery, most WLS patients get a handful of appointments with a nutritionist or Registered Dietician, one pre-op sit-down with a shrink, and one pre-op chit chat with the surgeon. Post-op we get a few appointments with a nutritionist or Registered Dietitian (“Are you eating enough protein? No? Then eat more.”), and encouragement to attend WLS support group meetings which are often a complete waste of time.
  10. Exercise addiction is a real thing. Exercise addiction is nothing to covet and nothing to laugh at, but it’s better, at least in the beginning, than crystal meth.
  11. …and other, less invasive efforts to achieve a healthy weight…
  12. As do many postoperative WLS patients when we realize that the alternative is either gaining the weight back, adopting an eating disorder or losing our minds in an effort to eat in a measured and controlled way – just typing that makes my head hurt.
  13. Here: Sugar +  starch x compulsive overeating.
  14. Our culture prefers to call obesity the result of laziness, a lack of motivation; some like to suggest it’s a genetic predisposition; others, the result of the increasingly popular diagnosis of thyroid problems…
  15. Let’s note here – for shits and giggles – that some giant companies and whole industries profit to the tune of BILLIONS from every one of these “fat fixes.” The only person who stands to benefit from abstinence is the addict herself. I’m not a conspiracy theorist, but I think I’m on to something here.
  16. Acceptance and love are the necessary ingredients for health and happiness, regardless of size.
  17. If you find the idea of food addiction unpalatable, I offer this piece I wrote about the nutritional conditions under which the human body evolved, including the natural, annual cycle that helped people stay within a reasonable weight range. Modernity has completely divorced us from this natural cycle.
Showing 14 comments
  • Rosemary Keeler

    I love the way you share about addiction. As you probably remember, I too am an addict. It started with sugar-binging as a kid and later developed into a one French-fry a day to go with a six-pack of beer and a pack of Marlboros. After many years clean and sober I weigh 40 pounds more than I did when I was using – but I got what was left of my life back and take little comfort in watching others suffer with “The Great Sadness” as I have come to call it. Keep it up. And thanks.

    • Coffey

      Rosemary, I’m sure you know many others who have similar stories of addictions coming out sideways once the primary addiction is put to bed. I’m sorry you went through it, but I’m grateful you’re open about it. No matter how far down the scale we have gone (or up, for that matter), it’s clear that our experience can benefit others.
      Thanks for commenting.

  • Suzanne

    I definitely see sugars as my drug of choice. I never identified with the cycle of binging – guilt – depression. It was more like stress/depression – binging – ahhhhhhh. I “took my medicine” and felt better. Not that I am happy being overweight, but when I need/want that “fix”, it is sugar, chocolate, and bread that makes me feel physically better. It is certainly an addiction. One which I am not even sure I want to give up yet.

    Thanks for a great article.

    • Coffey

      Thanks for speaking up, Suzanne. And thanks for your honesty. If there’s anything I have deep respect for it’s self-knowledge. If you’re not of the mind to make some change, fully inhabit that. Own it. There’s tremendous strength and freedom available to those of us who embrace the truth about ourselves, regardless of what, if anything, we choose to do with it.
      Keep commenting!

  • tina

    I used to be skinny until i was 9, since then i hv been overweight. I look at myself as depressed and wish i wouldnt wake up the next morning. I want to be small b4 i die but i dont see that happening. I hv no friend really to care to encourage me and help me in person. I dont know what im doing wrong with eating.

    • Ann

      Tina….I will be your friend…it may not be in person as I don’t know where you are but we can be friends and I will encourage you.

  • Kali

    Kelly, what does abstinence look like for food addicts? I’m currently on nutrisystem, and recognize it as one of those industrial fat fixes. For me, for now, it works- it still feeds my sugar addiction and my craving for all things food, but it’s structured, and proportioned, and so I lose weight. For the moment, it feels like a win-win! I’m even eating mass amounts of veggies!!! However, I recognized from about day 2 that I need a solid plan for once I’m done with this “diet”. Perfectly proportioned muffins made with soy will quickly become massively large muffins made with…????? That being said, I just keep hearing the “everything in moderation” rule, and I want to scream because, well obviously I can’t use moderation with food! I need some support and my steak, bread, and potatoes friends here in montana have little to offer on this subject 🙁

    • Coffey

      Kali, Thanks for writing. Abstinence is different for different folks. What’s important is that you become mindful around your eating, discover what makes you crazy, what makes you binge, what makes you obsess, etc. And then develop some boundaries around those things. For me, it’s anything sweet or processed. Boom. When I eat it, I’m obsessed, I’m hungry all the time, and I immediately start to gain weight. When I don’t, I’m happier, healthier, and more energetic. What is it for you?

  • Shannon

    So see where u were, I’m there. Post RNY I lost masses of my weight. Addiction(relapse) and the attention I got came to replace food. Fast forward and finally was blessed with a child, a life long prayer I never dreamed would happen. That’s after divorce, 3 spine surgeries, New boyfriend, moving from family and friends for him. Chronic pain sucks and I am lost and alone, fatter and unhealthy as ever. Got to stop & be a mommy with out crying, as best I can.

  • Tired of being tired

    I know I’m a late commenter here, but I think the ideas behind this article are so obvious once you hear it and that makes it completely profound to me. I did the Whole 30 challenge in September 2012 and the change in me was stunning. I went from compulsively eating and feeling like I had no ability to stop myself to eating very intuitively and only when I was truly hungry (which was far less often than the “standard” and expected three square meals a day. For that time frame I freed myself from having to follow that and just listened to my body. The lack of sugar and starches along with the increase in protein and veg just did unbelievable changes in me (not the least of which was losing about 25 lbs in a month). I have sadly fallen off the bandwagon but you have given me a lot to mull over once again. Thank you very much for sharing.

  • Kris

    Wow. Love your blog. I discovered Overeaters Anonymous (OA) last spring and thought…my god, I’m not crazy and not the only one with this problem. It’s worth a try for readers that recognize themselves in food addiction. Even better, the only real cost is a couple of books–good for me, because I can’t afford a therapist. One question: would you go through the weight loss surgery again, if you could go back in time?

    • Coffey

      Hey Kris. Yeah, I have a particular affinity for the 12-step programs m’self. You know what – I’m about as happy as a human can be, and because that’s the case, I wouldn’t want to change anything in my past, good or bad. So, yes, I’d do it again.

  • Grace

    Hi Kelly, thank you for this great blog. I love the ‘holy trinity’ idea! I have had my own weight and food additions struggles which I’ve largely recovered from through years of therapy (although not completely). My guess it is a life long issue but its blessing is that it keeps us awake to ourselves and what we need. I work as a counsellor with clients who want to lose weight and some of them have chosen the bariatric route, and I have also noticed the slide of addictions towards exercise, shopping etc once the main route of food is blocked. The thing I would add to this discussion about addictions is that underneath those compulsions and cravings is usually a lot of painful feelings from childhood, feelings of emptiness, betrayal or not feeling loved for example and this is what needs attention in order to heal. Doing this recovery work through counseling or whatever mode someone chooses makes it easier to bring compassion and self acceptance to oneself. One last thing – I have to ask you if you have Irish roots? Your name made me think you might have. I was raised in Ireland and live now in Canada.

    • Kelly Coffey

      Hey there! You’re absolutely right. Most of us who suffer from addiction and/or obesity generally have some history of adversity in childhood.
      And yuppers on the Irish roots 🙂

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