The decision to undergo bariatric surgery – whether sleeve gastrectomy, gastric bypass, LAP-BAND or other associated procedures – is one that carries a lot of responsibility and the necessity for nutritional, anatomical and psychological education. Sometimes, those considering these procedures, may even experience some degree of scrutiny.

With all of the changes both mentally and physically, the process of deciding, undergoing the surgery, recovering and maintaining efficacy of the surgery can understandably be overwhelming. A lot of thought needs to go into making a decision that will effect so many areas of life. For starters, bariatric surgeries can be highly invasive and risky. They can be costly, and make one prone to post-surgery complications such as gastric dumping syndrome, nutritional deficiencies, infection and pneumonia, among others.

With all these potential problems, there is also the promise of weight reduction, improved cardiovascular function and an increase to one’s quality of life. It is this promise that often makes all the valid risks an afterthought for the millions of Americans who have gone through these procedures.

Because the decision is ultimately that of the person considering the surgery, it is important to evaluate the pros and cons. One area that has been gaining more attention recently is the link between eating disorders and weight loss surgery. Studies show a substantial number of post-bariatric surgery patients present with clinical eating disorder symptoms that require specialized treatment.

Adjusting to the post-op dietary restrictions are difficult for anyone, but especially difficult for those who have struggled or continue to struggle with an eating disorder. For instance, binging behavior presents very different consequences for those who now have a significantly smaller stomach capacity. When left untreated, post-surgical eating disorders can result in weight gain, medical maladies and added healthcare costs.

So how can one best adjust to their post-op diet, reduce the risk of eating disorders – and in the end, maximize surgery results? Here are some recommendations:

1). Be honest. Preventing eating disorders post-surgery can actually start before the procedure. Prior to being deemed “appropriate” for surgery, one must first seek a consult. Some individuals may view this as their “only” shot at “better life,” fearful that disclosing a history of mental illness or disordered eating may result in denial from the surgery. That’s far from the truth. Being honest about these things does not automatically exclude you as a bariatric surgery candidate. In fact, being able to receive the appropriate specialized support prior to surgery only serves to improve surgery results.

2). Thoroughly research the surgical team. A strong bariatric surgeon will collaborate with an eating disorder specialist to fully assess and support potential candidates. The care of the bariatric patient is best when the entire expert team works together to increase the patients’ success through the process. According to the National Institute of Health, “Patients who are candidates for bariatric surgical procedures should be selected carefully by a multidisciplinary team with access to medical, surgical, psychiatric and nutritional expertise.”

3). Find and attend a local support group or intensive outpatient program. This should be a group that meets regularly (ideally weekly) prior to surgery. By attending these programs before surgery, and making yourself accountable, you’re more prone to continue with them post-surgery. In fact, those that receive ongoing counseling are actually much more likely to be successful, as it states in the Scientific World Journal,surgery combined with treatment for emotional eating might provide the only opportunity for bariatric candidates who engage in emotional eating to optimize outcomes.”

4). Recognize and embrace the need for behavior change. Sustained, long-term weight loss doesn’t occur without positive behavioral change over time. This requires ongoing education and insight, especially related to one’s relationship with food and family history/relationships with food, in addition to replacing maladaptive food-based coping skills with more positive mechanisms. According to the Obesity Action Coalition, “Having surgery without addressing the emotional attachment one may have to food, or the important purpose food has served in life could lead to cross-addiction.” This term “cross-addiction” refers to the development of eating and substance use disorders following bariatric surgery.

5). Focus on self-compassion. For some, surgery may follow a struggle defined by self-loathing, remorse, guilt and shame, often centered around weight or eating habits. For instance, binge eating disorder is the second most common psychiatric disorder in bariatric surgery populations, following major depressive disorder (Sarwar et al., 2004). Additionally, approximately one in three individuals who attend any weight-loss program actually have binge eating disorder, according to the OAC. Don’t give your power away to guilt and shame. Your relationship with food should never define you. Remember that you are doing the best you can in the moment, and congratulate yourself for any achievement—no matter how small.

Like other forms of surgery, complete and thorough follow-up is necessary in order to achieve the maximum benefits of bariatric surgery. Many complications, and even additional procedures, can be avoided by receiving ongoing care within a specialized setting.

Just as those in recovery from their substance use positively respond to peer/support group environments, the same holds true for those facing bariatric surgery. There are a growing number of programs where people can come together, discuss challenges and share advice. They are places where you can feel heard, respected and understood.

In fact, that’s what we do here at Walden with our specialized bariatric treatment track. Email us if you’re interested in learning more!

Additional Resources:

  • National Institute of Health
  • Eastern Connecticut Health Network (ECHN)
  • ECHN Center for Weight Loss


Rebekah Bardwell Doweyko is the Assistant Vice President of Clinical Operations for Walden Behavioral Care’s Connecticut region. In this role, she is responsible for program development and clinical, administrative and fiscal oversight of ambulatory clinics in Amherst, Mass., South Windsor, Conn. and Guilford, Conn., as well as clinical oversight of Connecticut’s first inpatient unit for eating disorders in Vernon, Conn. While at Walden, Rebekah has developed and implemented various specialized treatment tracks to further aid individuals on their journey to recovery. This includes a survivor track for those who experienced trauma, a substance abuse track and most recently a bariatric track designed for patients who are pre-or post-bariatric surgery. Prior to joining Walden, she was an Intensive Care Manager at the Connecticut Behavioral Health Partnership (Value Options, Inc.) in Rocky Hill, Conn., where she conducted clinical trainings and managed CT Medicaid cases with complex eating disorder issues. Rebekah also founded and directed the Intuitive Eating Program (IOP) at Hollywood Pavilion Hospital in Hollywood, Fla., where she developed the “Real-Life Excursion” program allowing patients to begin their transition from Residential treatment, and held various clinical positions at The Renfrew Center in Coconut Creek, Fla. She composed the foreword to the highly acclaimed “Maintaining Recovery from Eating Disorders” self-help book by Naomi Feigenbaum and was featured in the Emmy Nominated HBO Documentary “THIN.” Rebekah earned her Master’s degree in Mental Health Counseling from Florida Atlantic University in Boca Raton, FL, is a Licensed Professional Counselor in the State of Connecticut and is a Certified Eating Disorder Specialist.