The other day, I was at my apartment complex’s pool with a few of my friends when two women – I would estimate to be in their 40’s – started an unprovoked conversation with us. Among other details of their lives that they shared with us, somehow it came up that both of them had undergone bariatric surgery.
Now, I don’t necessarily have a strong opinion for or against the surgery; I think it can be great for some people and not so great for others. What concerned me however, was the way these women were talking about their food intake, behaviors around food and their exercise regimens. Their food rules appeared very rigid and they spoke unrelentingly about what they would eat and what they wouldn’t eat. I am not a clinician, but I have been in the field long enough to understand that these women, one in particular, would have likely been appropriate for eating disorder treatment.
The same woman reported that she had used some inappropriate weight control methods so that she would meet her doctor’s weight requirement to qualify for the surgery. The fact that these measures can so easily be performed was frightening, but as these surgeries become more widely available (many insurance providers are covering them), it seems that some facilities have become lackadaisical with their mental health pre-screening and post-screening protocols. In particular, they often fail to consider the very common possibility of an underlying eating disorder
In a sample of nearly 300 obese individuals qualifying for gastric bypass surgery, 66 percent had a lifetime history of an eating disorder and 48 percent met the diagnostic criteria for Binge Eating Disorder (a diagnosis characterized by recurrent episodes of eating more than what is considered normal, in a short amount of time, marked distress, and without the use of compensatory behaviors) during their preoperative evaluation. Another study revealed 37 percent of people who binge ate before surgery continued feeling out of control when eating up to 15 years after surgery.
While many bariatric surgery facilities are extremely skilled at screening out candidates who may be struggling with some type of eating concern, it is unfortunately quite common for these patients to fly under the radar. Candidates often become very skilled in researching ways to “properly” answer the eating disorder screening questions, or like the women above, manipulate their weight in order to bypass any possibility of being denied the surgery. Most of these patients think that the key to fixing their weight problem is with a physical surgery, when in actuality, they would likely benefit more from a psychological intervention.
The issue with Binge Eating Disorder (and most mental health issues), is that they simply cannot be treated and cured without first putting in the psychological change work.
If there is an eating disorder pre-surgery, it will be there post-surgery. If maladaptive coping skills (binging) aren’t replaced with healthy coping skills, a triggering event becomes even more dangerous when a client binges with a stomach less than half of its pre-surgery size.
While we see many clients at different points in their weight loss surgery journeys, I think the most unfortunate cases are those who have found themselves months or years after their surgery still engaging in disordered eating thoughts and behaviors and suffering from both mental and physical side effects, a common occurrence shown in the figures above. This is why I think it is so important for a weight loss surgery candidate to treat the Binge Eating Disorder BEFORE undergoing any type of body and life altering surgeries (if that is the path they choose), to ensure maximum benefits of the procedure.
This population of people deserve better. A fully integrated treatment team is essential in helping bariatric surgery candidates make the most informed decision regarding their physical and emotional health. More in depth mental health screenings prior to surgery should be mandated, and extensive protocols for those with a suspected eating disorder should be enforced. Providers need to work together to ensure that we are treating the whole individual and taking into account their full medical story, which includes mental health, prior to approving surgical interventions.
What do you think?
Natalie Cohen is the Senior Marketing and Community Relations Associate as well as the Social Media Coordinator for Walden Behavioral Care. She earned her Bachelor of Arts degree in Journalism from the University of Maine in Orono. Her favorite part of working at Walden is being able to act as an advocate for clients suffering with mental illnesses and interacting with other eating disorder professionals in the community. In her free time, Ms. Cohen enjoys yoga, shopping and doting on her dogter Bella.
*This blog post does not necessarily represent the views of Walden and its management. The Walden Blog is meant to represent a broad variety of opinions relating to eating disorders and their treatment. Comments are welcome, but respect for the opinions of others is encouraged.