It sounds like the weight you're carrying is dangerous to your health and welfare, and you know it. Yet you say you keep perversely sabotaging your own best interests and canceling your surgery. You even have some ideas as to why you may be doing this and where your low self-esteem may be coming from. It doesn't sound like you're afraid of the surgery per se, so much as afraid of being successful with this.
This may not sound very therapeutic, but “Why can’t I get past these goblins?” may be the wrong question. The right question could be: “How do I get this done?”
Enough with the insight-mulling already! Certainly for some people, insight into their motivation can really help change their behavior. But it's not working for you, so either delving into the why's are just a cerebral stall and a complete, self-lacerating waste of time; or else your insights are off-track and there are other factors driving your behavior that you don't want to look at (some possibilities, for instance, might be that perhaps your happily married husband of 46 years wants you to stay heavy and off-track work-wise, because he's threatened by the idea of an independent, attractive, capable wife??... or maybe he's irrationally worried that something could go wrong in surgery and he's terrified of losing you?? Or you’re a survivor of early childhood trauma and the weight is serving an unconscious need for protection and insulation…I could come up with reasonable conjectures all day ... ).
The fact that you've been feeling somewhat dysfunctional, self-hating, self-sabotaging, health-challenged and dangerously overweight, yet state you are happily married, is what makes me throw out those family-systems guesses. Seems to me if you're in this kind of trouble, there ought to be some strain on your marriage. If there isn't, either your husband is extremely passive or else he could be playing a part in this.
But no matter, because, as I suggested earlier, the right question for you is “How do I get this done?”
My suggestion would be this: Get into some short-term family counseling with a skilled, experienced family therapist. (Keep in mind that a good individual therapist can be a really lousy family therapist - and vice versa - they are different skills).
The goal should be very behavioral: to help you set a date and follow through on your surgery. Your husband has to be on board with this, as do your kids, if they're still around, living at home. That's your cheering section and you need to structure them into this endeavor.
Talk out your fears and worries together. And, even though we know you have a history of letting yourself down, I'm betting it's not so easy for you to let them down. And being as how they need you to be healthy and breathing, they can remind you of their wishes in this matter.
You can help handle your (and possibly your husband's) anxiety and your sagging self-esteem with guided imagery. Traci Stein’s Self-Esteem/Self-Esteem during Sleep combo is a perfect aide for you at this time. If you’re sabotaging yourself in a waking state, Traci will sneak up on you while you’re sleeping and set you straight!
And my Weight Loss imagery would be a perfect complement for this – you could alternate these three titles in whatever way feels right to you.
And of course, for the two weeks before your surgery (the one you’re going to follow through on, m’dear), the Successful Surgery imagery is just the ticket – it will help with pain, anxiety, blood loss and post-op recovery time.
Get cracking, Miss Mary!! No more time to lose!! You can have a good 20-30 years left of being healthy, mobile and energized, if you get this done now.
All best wishes and let us all know how it goes,