eating disorders in post ops

A friend of mine asked about it and they were referrred to the "addictions" forum (which she said had nothing to do with ED or even FOOD addiction for that matter).  I confess that I have not looked myself.

As a counselor, though, I can tell you that there are lot more people with eating disorders after WLS (mostly anoriexia-type after RNY and mostly bulimia-type after DS) than anyone would probably guess.  Certainly many more than *I* expected.

Lora

I looked at the addictions forum awhile back and nobody was talking about food. now I can't even find the addictions forum, did it go away?

more ED after surgery? that's disturbing. what would be your guess as to why, just the stress of major changes even if the changes are "healthy"?

Lora, do you mind sharing what kind of counselor you are and what kinds of patients do you work with?

pm if you prefer.

Jackie

I don't see the addictions forum anymore, either.... hmmm.

I am a master's-degree mental health counselor in private practice.  I deal with all sorts of issues, but most of my clients come in with depression and/or anxiety issues.  Many of my clients are women with a history of rape or childhood sexual abuse (and, not surprisingly, many of them also have weight issues or eating disorders).  Some of them have had WLS, ahve been denied for surgery, or are considering having it.

The reasons for increased EDs after WLS are varied, of course.  For RNYers the biggest reason seems to be the sense that the surgery was their last hope of ever being a normal weight and they feel very desperate about "making it work"... so they over-control what they eat (or, more properly, what they DON'T eat).  Ironically, they are often not very compliant about taking their vitamin supplements.  For DSers, there is sometimes a sense that, because the only thing that kept them form eating whatever they wanted before was the fear of gaining even more weight, now that they malabsorb so much of what they eat and don't have to worry about any serious re-gain, it's sort of a "get out of jail free" card and they return to (or sometimes start) binging.

For some, it is a fine line between a disorder and just being "diligent"/"extreme" in following a meal plan.  For most, however, it is a failure to address psychological and behavioral issues before having the surgery (or unrealistic expectations that surgery would "cure" the mental/emotional contributors to their obesity).  Some people were never made aware of the non-physical contributors ot overeating.  (We all have these contributors to one degree or another... very few people become morbidly obese for purely physical reasons.)

The most distressing kind of post-op eating disorders, though, are the ones that don't fit any official DSM diagnostic classification and include things like chewing and spitting, people going back to unhealthy fad-type diets post-op (including people *****peatedly go back to the so-called "5-day pouch test" or the zero-carb Atkins induction diet), or going back to (or starting) taking OTC drugs (laxatives, fat blockers, etc.) in order to be able to eat more like they did pre-op without suffering any weight consequences.  Not surprisingly, this happens more with RNY and band patients (binging and laxatives are the only issues I have seen or heard of with DS patients)... since DS patients have much less worry about gaining weight back.

I do have to wonder if the reason OH may have (apparently) taken the addictions forum down and does not have an ED forum (and this is purely speculation on my part) may have to do with potential liability issues.

Lora

very interesting stuff, thanks for sharing it.

pre-op I read a book called The Emotional First+Aid Kit by Cynthia Alexander.

she made a good case for getting all your good post-op habits in place before surgery, which was then the last piece of the puzzle. so that meant counseling for any eating disorders, besides getting used to eating more slowing, drinking all the water but not with meals, etc.

also - correct me if I'm wrong - I assume many have just garden variety emotional or stress eating that isn't a full-blown ED.

the book made sense but I went ahead and had surgery first just because...hey I've never been one to delay any kind of gratification. figured I'd deal when I had to. which would be now: honeymoon over, time to face the music.

so, to get away from my specific issue, you would agree that many could benefit from an ED forum? 

Jackie

Yes, certainly for some people (for most of us, actually) the problem is simply eating to comfort ourselves or reduce stress or eating out of boredom or loneliness.

Yes I think an ED forum would be very useful (and probably generate a lot of traffic).  If nothing else, it would help people realize how many otehrs there are out there and help eliminate some of the embarrassment or shame surrounding an ED.

Lora

I've had people here tell me that "everyone" has an eating disorder and I think that is showing a need for education, if nothing else.

I have contacted OH and am waiting to hear from them; also talking to everyone I can find who is interested in the subject.

if we can't get our own forum then we will find one nobody's using and settle in there. politely, of course!

Lora, do you mind answering a few questions? not sure how you feel about it: maybe you need your own support and prefer not to spend more time on this. let me know how you feel.

Jackie

I certainly don't mind answering general questions based on my own experience as a WLS patient or based on my research as a counselor.  One of my HUGE pet peeves about WLS surgeons (in general) is that not enough of them emphasize the behavioral and psychological aspects of WLS either pre-op OR post-op.  The psych evaluation is often a joke and many people would be more successful (or have a much less difficult time of things) post-op if they had gone through some kind of counseling or even informational behavioral training BEFORE surgery.

Lora

that makes good sense. and then there are those of us who go to Mexico. although my surgeon's office is always willing to answer questions I considered it my responsibility to line up a nutrition and a counselor who have experience with WLS patients. everybody should have that support even without an ED.

Lora, whats the deal with everything getting so hard later in the day? I posted elsewhere that I feel like over night someone hit the reset button and I am a different person. perfectly willing to eat when hungry, stop when not and never think about over eating.

the later in the day, the harder things go. often I do well right up until right before bed and then...

others have said you are just busy all day until then but I don't think that's it. on days off it's the same. I don't remember ever having the slightest urge to binge until at least mid afternoon.

what do you think?

Jackie

I think they combined the addictions with mental health awhile back (before the new format).

Hi Jackie,
I think this is an excellent idea! I hope OH looks into it and creates a forum for it. I think there is a true need for an eating disorder forum.
How about it OH? Will you make us a forum?