Best Practices: Treating the Shame of Weight Gain

Most folks that go on diets lose weight and most of the time gain it back. And often gain back more than they lost. Even bariatric surgery is wrought with substantial regains.

 Bariatric practitioners have identified a most prevalent shame based diagnosis:

Avoidant Personality Disorder, that is common to many that have weight relapses/collapses.  As the diagnosis suggests, the main coping mechanism of those with avoidant personality disorder is avoidance. They will avoid most things that elicits their deep feelings of personal shame, like weight gain.  As a result they are most vulnerable to relapse/collapse stages.

Anecdote: Julie was introduced to a group of patients seeking surgery, as a successful patient that lost and keeps off 60 pounds for over five years. Julie interrupted and said, “That’s not true”.  I gain back about 60 pounds every couple of years but instead of completely relapsing, I gain and lose 2-3 pounds about 20 times every couple of years”.

Prudent bariatric counseling had taught Julie that weight gain is a typical expectancy following weight loss and no longer avoided that expectancy and viewed her lapses as part of her recovery and not worthy of shame or guilt.

Reducing Shame Narrative for Rational Cognitive Therapy:

Most intuitive, naturally thin people, without weighing themselves, or consciously censoring their food choices stay within a weight range… they do go up and down the scale, but stay within a tight range. Using them as our index we realize that weight gain is a natural occurrence. But here lies the difference, most diet veterans or surgical patients that have intentionally lost weight eventually start regaining weight. But they do not have that compensatory intuitive mechanism that allows them to stay within a tight range of their desired lower weight. If we know in advance that weight gain is simply a typical expectancy following weight loss, why view that as a failing? Why feed into that irrational belief system of weight gain and failure? It is that very belief that can elicit shame and avoidance behaviors and that is how a manageable lapse becomes a relapse/collapse.

Learning How to Gain Weight Without Shame:

Learning how to shamelessly accept and not avoid the expectancy of weight gain is an important stage for long-term obesity recovery. When a patient does reach their desired weight goal or during the weight-loss process, asking them to surplus calories and gain a pound or two (lapse) and then reverse it, is prudent relapse prevention counseling. That is a lifelong behavioral skill they will need, long after they have left our care. When we praise patients for confronting a lapse and then reversing that lapse, they reduce both weight and shame importantly they learn to master a skill they will likely need forever. Ironically, realistic patient preparation to prevent relapse/collapse is teaching patients how to gain weight with both their and your approval.

Dr. Brené Brown: “Shame Is Lethal” | SuperSoul Sunday | Oprah Winfrey Network

The price of shame | Monica Lewinsky



Lamees El-Derbi RD Awarded National Board Certification

Lamees El-Derbi RD, CBC

Lamees El-Derbi, a Registered Dietitian from Abu-Dhabi, UAE, has been awarded Board Certification by the American Association of Bariatric Counselors (AABC). After completing a specialized training and education program in bariatric science she was recently credentialed as a Board Certified Bariatric Counselor (CBC).

Ms. El-Derbi, RD, currently serves as a Bariatric Dietitian at Imperial College London Diabetic Center in Abu-Dhabi. She is an integral member of the multi-disciplinary bariatric surgery team that provides comprehensive care and treatment for patients, pre and post bariatric surgery.  In addition to her clinical responsibilities she has the honor of being the UAE Representative to International Affiliate of The Academy of Nutrition and Dietetics (IAAND). In this international capacity, she has an opportunity to share best dietetic practices with a global community.

Ms. El-Derbi, RD, completed her professional nutrition education at Mount Saint Vincent University in Halifax, Canada. Her clinical experience and recognition of the obesity pandemic and the need for specialized competency in bariatric science inspired her post-graduate training and certification with AABC. Her experience, scholarship and commitment to public health will further the AABC global mission of providing best practices in the care and treatment of obesities.


The American Association of Bariatric Counseling is an official US Federal not-for-profit, professional international fellowship association dedicated to the advancement of bariatric science education and to the enhancement of obesity care and treatment. Founded in 2005, AABC is the world’s largest association exclusively representing professional multi-disciplinary bariatric counselors. Board Certification by AABC affirms that their credentialed fellows are licensed/registered/certified health or education professionals that have completed a specialized academic program in Bariatric Science and must continue their specialized education and training to maintain their Board Certification.