Weight Management Counseling
Dr. Ronelle Sato,
Lead clinical psychologist with the Comprehensive Weight Management Program at The Queen’s Medical Center
Where did you receive your schooling and training?
I earned my undergraduate degree at UH Manoa and then completed my doctorate at Hawaii School of Professional Psychology at Argosy. I have been with Queen’s Comprehensive Weight Management Program since July of last year.
What interested you in going into the field of psychology?
Simply, I wanted to help people.
Can you talk about the link between depression and obesity?
We know from research that about half the patients who come to us have some kind of clinical disorder — depression, anxiety, trauma — but depression is certainly a common one. It functions as a cycle. If you have an emotional disturbance, then you’re not motivated to take care of yourself in general. So you’re not going to exercise or eat right, and that’s going to contribute to weight gain. With increasing weight, people can lose functioning, which then increases their depression and the cycle continues. This can be particularly harmful if a person relies on food for comfort.
Do you counsel people so they can become functional and avoid bariatric surgery, or do you counsel them to prepare them for the surgery?
Both. We have a non-surgical program, where we see patients if they need or want our help to change behaviors. With our surgical candidates, they have to attend our program. It’s part of our requirement because we want to make sure that they’re healthy and stable, and that the surgery is going to be a positive thing. We don’t want to ever set up someone for failure. Part of that process involves a formal assessment. We do a brief interview and have them fill out some questionnaires. We want to understand their overall functioning and identify any stressors that may become obstacles to their success. People often come in with various stress-related issues. They may have a hard time setting clear boundaries with their work demands, they may be caregivers or they may have relationship concerns. It’s very common for people to let these kinds of things take precedence over their health, and that’s how they end up gaining weight.
In our sessions, we help people develop strategies to make better choices. We might work on specific things, like replacing junk food with healthier foods or practicing mindfulness with eating. We also look at the bigger picture in helping them find better ways to manage stress instead of turning to food or ultimately harming their health.
If it’s called for, we’ll create a treatment plan for them — a framework for them to be successful. If their stressors are great, we want to get them connected with a therapist in their community to have that consistent one-to-one support. When we refer them out, we try to collaborate with that provider to make sure we’re all on the same page and, if they do go forward with surgery, they have our support afterward.
So the program is multidisciplinary?
Yes. I’m only speaking about the psychology part of it. Under this roof, we have dietitians, a bariatrician (physician who specializes in weight management) and, of course, the surgeons. We function as a team. We meet regularly to discuss cases with the shared goal of making sure our patients are set up for success after surgery.
How intensive is the psychological support that you offer after the surgery?
There’s this idea that people see a psychologist before surgery, but not after. Our program is different because we emphasize aftercare. If you can imagine, shedding a significant amount of weight in a short span of time is going to bring all kinds of changes. Most of the changes are positive, but there can be challenging or unexpected ones as well. The changes may affect how you interact with people and it can certainly impact your close relationships. We’ve seen spouses get jealous or dynamics in friendships change. The patient is not always anticipating these side effects of weight loss. We want to be sure we can be there to help them through those transitions.
What got you interested in weight management?
I’ve always been interested in health psychology, but I didn’t set out to come into this field. It was happenstance, where an opportunity came and I was open to the experience. The more I learned, the more I came to see this as incredibly satisfying work. It’s difficult sometimes because patients aren’t always wanting to, or willing to, look at issues leading up to surgery. We know what they’re going to face after surgery, so there’s a bit of a veil that they’re not aware of, but that we can see. After surgery, it’s so rewarding to see the improvements made, the quality of life that they gain.
How do you help them in the long term?
We look at sustainable lifestyle changes. Everyone can diet and lose 10 pounds, but then you regain it. The behaviors we try to put in place are lifestyle changes, so we ask them to really be in touch with their health. If they have diabetes, for example, we want them to be very active in managing their medical conditions. We encourage them to exercise and we set milestones for the exercises, which can be challenging for some. But we’re setting up those behaviors because they will need them after surgery to have optimal weight loss.
At what point is someone obese and should come to you?
By the time most patients come here, they have several other ailments. They have diabetes or heart problems, or they can’t walk because they have joint issues, so they often come to us through referral. The BMI (body mass index) has been lowered by some of the insurance companies so that if you have comorbid disorders, like diabetes or sleep apnea, you can have a lower BMI and still be able to get into our program, non-surgical or surgical.
What determines whether someone needs surgical intervention?
With some it’s pretty obvious. If they’ve lost mobility or have serious health issues, then surgery is probably going to be an appropriate option. Patients may opt to work with us on the non-surgical track and see the dietitian and the bariatrician for weight loss. If they are successful, great, but if they can’t lose as much weight as they want, then they can begin considering surgery. And they get to ask any questions they may have: How much do I need to lose so I can start walking again? How much improvement can I expect if I modify my eating and increase activity? At some point they make the decision: Can I do it with diet and exercise or am I going to have a jump start with surgery?
For more info on non-surgical and surgical weight loss options, call The Queen’s Comprehensive Weight Management Program at 691- 7546 or visit queens.org/weightloss.