LA Times - WLS and Mental Health

Suicide attempts increase in wake of weight-loss surgery
By Melissa Healy
Los Angeles Times
In the three years after they go under the knife, patients who have bariatric surgery to aid in weight loss are more likely than they were before the operation to attempt suicide or end up in the hospital after doing harm to themselves, new research says.
As complications of weightloss surgery go, the hazard was rare. A Canadian study that tracked 8,815 bariatric surgery patients found that in their three post-surgical years, just 1.3 percent of those patients landed in the hospital following a selfharm emergency, whi*****luded intentional drug overdoses or suicide attempts by other means.
But that rate of self-injurious behavior represented a 54 percent increase over that seen in the same patient population during the three years before these patients had surgery.
Published last week in the journal JAMA Surgery, the new research sheds light on a grim fact about obesity: Long before an obese patient enters the OR, he or she is more likely to suffer depression and a wide range of other psychiatric ills than is the average person of normal weight. Several studies have established that bariatric surgery patients are as much as four times likelier than those who are not to attempt suicide.
In the three years before undergoing bariatric surgery, participants in the current study already were twice as likely to intentionally harm them selves as were those in the general population.
But in the three years following their surgery, these patients' already outsized burden of mental illness increased; during the post-surgical period studied, the participants were three times more likely to have a self-harm emergency than were those in the general population.
Among those most likely to experience self-harm events following surgery were lowincome patients and those living in rural areas.
The new research highlights a little-recognized challenge patients face in the wake of surgery that replumbs the stomach but also drives far-reaching changes beyond the digestive system.
The authors of the current study suggest changes in patients' ability to metabolize alcohol in the wake of bariatric surgery might be implicated in some patients' worsening mental health.
Following certain bariatric surgery procedures that bypass parts of the stomach, patients who drink alcohol often find their tolerance low and become inebriated quickly. Such changes, wrote the new study's authors, might affect some patients' risk-taking behavior and ability to suppress self-destructive impulses while under the influence.
The authors also suggested that addictive behaviors which, for some, have contributed to obesity in the first place might be displaced toward other substances, including medications, following surgery that limits stomach capacity. In the current study, 68 percent of the 168 selfharm emergencies noted were attributed primarily to medication overdoses.
But the study's authors also urged further research into the possibility that altered brain chemistry wrought by the surgical replumbing of the digestive tract might contribute to depression or suicidal behavior.
The research also underscores the need for bariatric surgery practices -- a specialty seeing rapid growth -- to attend to the mental health of their obese patients not just before surgery but for several years beyond. Most of the bariatric patients' psychological crises occurred in the second and third years after surgery, a period when there was little interaction between patients and the practices that provided their bariatric services.
In the three years before undergoing bariatric surg ery, partic ip ants in the current study already were twice as likely to intentionally harm themselves as were those in the general population.Suicide attempts increase in wake of weight-loss surgery
By Melissa Healy
Los Angeles Times
In the three years after they go under the knife, patients who have bariatric surgery to aid in weight loss are more likely than they were before the operation to attempt suicide or end up in the hospital after doing harm to themselves, new research says.
As complications of weightloss surgery go, the hazard was rare. A Canadian study that tracked 8,815 bariatric surgery patients found that in their three post-surgical years, just 1.3 percent of those patients landed in the hospital following a selfharm emergency, whi*****luded intentional drug overdoses or suicide attempts by other means.
But that rate of self-injurious behavior represented a 54 percent increase over that seen in the same patient population during the three years before these patients had surgery.
Published last week in the journal JAMA Surgery, the new research sheds light on a grim fact about obesity: Long before an obese patient enters the OR, he or she is more likely to suffer depression and a wide range of other psychiatric ills than is the average person of normal weight. Several studies have established that bariatric surgery patients are as much as four times likelier than those who are not to attempt suicide.
In the three years before undergoing bariatric surgery, participants in the current study already were twice as likely to intentionally harm them selves as were those in the general population.
But in the three years following their surgery, these patients' already outsized burden of mental illness increased; during the post-surgical period studied, the participants were three times more likely to have a self-harm emergency than were those in the general population.
Among those most likely to experience self-harm events following surgery were lowincome patients and those living in rural areas.
The new research highlights a little-recognized challenge patients face in the wake of surgery that replumbs the stomach but also drives far-reaching changes beyond the digestive system.
The authors of the current study suggest changes in patients' ability to metabolize alcohol in the wake of bariatric surgery might be implicated in some patients' worsening mental health.
Following certain bariatric surgery procedures that bypass parts of the stomach, patients who drink alcohol often find their tolerance low and become inebriated quickly. Such changes, wrote the new study's authors, might affect some patients' risk-taking behavior and ability to suppress self-destructive impulses while under the influence.
The authors also suggested that addictive behaviors which, for some, have contributed to obesity in the first place might be displaced toward other substances, including medications, following surgery that limits stomach capacity. In the current study, 68 percent of the 168 selfharm emergencies noted were attributed primarily to medication overdoses.
But the study's authors also urged further research into the possibility that altered brain chemistry wrought by the surgical replumbing of the digestive tract might contribute to depression or suicidal behavior.
The research also underscores the need for bariatric surgery practices -- a specialty seeing rapid growth -- to attend to the mental health of their obese patients not just before surgery but for several years beyond. Most of the bariatric patients' psychological crises occurred in the second and third years after surgery, a period when there was little interaction between patients and the practices that provided their bariatric services.
In the three years before undergoing bariatric surg ery, partic ip ants in the current study already were twice as likely to intentionally harm themselves as were those in the general population.

Thanks for sharing this. My husband committed suicide a year after his weight loss surgery.

oh my gosh, I am so sorry. :(

I don't understand why anyone would do this at the peak of their weight loss.

I regret your husband's passing. No one yet knows how complicated these weight issues are.

I am so sorry for the loss of your husband.

So sorry for your loss.

This particular study focused on WLS and speculates about altered brain chemistry (which could be caused in part by altered diet), but I would be willing to bet the stats are similar for cosmetic surgery as well. A lot of it's about emotional expectations. We tend to blame all our problems on our appearance. "I didn't get that promotion because I'm fat." "He secretly laughs at me because of my nose/chin/toes, fill-in-the-blank." And in these days of social media, a lot of the time bullies are very upfront about it - albeit anonymously, the cowards.

And then we get to a normal size, and we're devastated to discover that we're STILL fearful, depressed, anxious, shy, inarticulate, ashamed, whatever - the same flawed person we always were, except now we're normal-appearing - on the outside. It can be a major eye opener. It was for me, the first time I lost a significant amount of weight many decades ago. I expected to be happy, and I wasn't. Just thinner.

For me, this time I knew what to expect, and surprisingly I did end up happier, mostly because I feel so much better physically. But also by the time I had my surgery at 60, I pretty much knew what to expect emotionally. That doesn't mean I'm no longer fearful and shy at times, or sad, angry, depressed - that's just life, and those feelings pass. I only wish some folks wouldn't take such sad and drastic action before they do. :-(