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August 09, 2016

6 Reasons Why Bariatric Surgery Won’t Cure Your Eating Disorder — Dr. Julie Friedman

caduceusWhile there is no sure way to achieve and maintain weight loss, bariatric surgery is considered the most aggressive (and most effective) treatment for obesity and obesity-related comorbidities. Patients often turn to bariatric surgery in the hopes of:
  • Losing weight and maintaining the weight lost
  • Improving their health
  • Achieving a better quality of life
While bariatric surgery can yield all of the benefits listed above, preoperative eating disorders that are not identified and treated BEFORE surgery can, and do, emerge after surgery.

Disordered eating impacts ONE IN FIVE higher weight patients. And, obese patients with eating disorders are often overlooked and undiagnosed. Of particular concern, a core feature of eating disorders is an overemphasis of weight and shape. Thus, eating disorder patients are more likely to seek out weight loss methods, including surgery.

We are now seeing a number of eating disorder-related concerns in patients who undergo bariatric surgery. In essence, bariatric surgery won't cure your eating disorder. Here are six reasons why:
  1. Post-surgical eating avoidance disorder (PSEAD) — This eating disorder is more common than you might think. Following bariatric surgery and rapid weight loss after bariatric surgery, patients with PSEAD stop eating altogether (or eat very little) to avoid weight regain. Often, these patients have experienced postoperative complications that have made them scared to eat; at times, they will develop a phobic avoidance of food. Patients with PSEAD will often present with excessive weight loss (i.e. over 50 percent of their initial body weight lost). Refeeding these patients when they have a postoperative stomach is tricky and requires specialty care.
  1. “Plugging” or purging disorder Bariatric surgery makes your stomach smaller, about the size of an egg (vs. the size of a fist). Following surgery, patients must chew their food very thoroughly in order for it to pass through the smaller opening to the stomach and into the smaller stomach. If patients don’t chew thoroughly, the food will actually get stuck on the way down. Some patients discover that they can “plug” their stomach in this way and will induce vomiting by not chewing enough or by eating dry foods that get “stuck” and need to be vomited up. Many patients use “plugging” and vomiting as a way to purge and control their weight — similar to Bulimia Nervosa.
  1. Loss of control eating/unspecified feeding/eating disorder — Loss of control eating is very similar to binge eating disorder and also has a compulsive feel to it. This type of disordered eating is characterized by eating small meals and snacks all day long, perhaps just a handful of food every 30 minutes to every hour. Even though patients are only eating small ingestions of food at a time, they start to regain weight. This is not the same as binge eating disorder, because patients are not consuming an objectively large volume of food, but it is still a disordered way of eating.
  1. Nutritional compromise — Following bariatric surgery, patients do not absorb nutrients as well from their food. They must take multivitamins and supplements specifically designed for post-surgery patients. However, some patients do not adhere to the recommended guidelines regarding supplements and will end up experiencing a severe nutritional deficiency. Along with serious risks to one’s health, confusion, disorientation and dementia-like symptoms can occur.
  1. Addiction — Unable to use food to regulate mood in the same ways that they could preoperatively, some patients may see an increase in compulsive behaviors after bariatric surgery, including drug abuse, alcohol abuse, compulsive internet use, and compulsive gambling. While some studies show that patients actually drink less alcohol after surgery, half of all patients with eating disorders struggle with substance abuse disorders before surgery. Therefore, patients showing addictive behaviors BEFORE surgery should be carefully monitored for the first two years AFTER surgery.
  1. Body image issues — Many patients are very happy with the weight they lose after surgery, but some patients become unhappy with their physical appearance following surgery. Typically, patients want to “get their body back” after surgery. They fantasize about getting their younger body back, remembering how they looked 10 or 20 years ago. They may not consider how much the body has changed with age — and they may not consider the skin changes that can occur with drastic weight loss. Some patients become fixated on loose, hanging skin or other unwanted physical changes, becoming increasingly self-conscious and isolative.
Choose quality of life

If you are considering bariatric surgery, know that this is a serious decision and that your body will never be the same after surgery. You will need specialized medical care for life and will always have to adhere to specific diet protocols and guidelines.

Of greatest concern to me personally is this: if you have struggled with mental health issues or eating disorders in the past (including binge eating or addictions) please seek help from a mental health professional before you have this surgery.

If you are post-surgery and struggling with one of the above issues, know that it’s never too late to get the help that you need.


Julie Kabat Friedman, PhD is Vice President of the Binge Eating Treatment and Recovery Program (BETR) at Insight Behavioral Health Center in Illinois. She is also Assistant Professor in the Department of Psychiatry at Northwestern University Feinberg School of Medicine.  
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