Follow Up After Bariatric Surgery May Save Your Life
by Mary Jo Rapini, LPC
 
Suicide is one of those things you can never change your mind about. It is final, and it hurts everyone who ever loved or cared for the person who commits it. A recent study reports an increase in suicides two to three years after surgery. Considering that about 225,000 Americans are now having bariatric surgery each year, according to the American Society for Metabolic and Bariatric Surgery, this is a problem we cannot ignore.
     The latest study, which tracked deaths among Pennsylvania residents who underwent bariatric surgery, examined a longer period than previous research — up to 10 years following the procedure. Among 16,683 who had bariatric surgery between 1995 and 2004, 31 committed suicide by the end of 2006, the researchers found. The data translate into a suicide rate of nearly 14 per 10,000 men per year, and five per 10,000 women each year. Those numbers are substantially higher than the suicide rates among Pennsylvanians in the same 35-to-64 age range, during the same period. Among all men in the state, the suicide rate in 2005 was 2.5 per 10,000, while the rate among women was 0.6 per 10,000. Overall, 30 percent of suicides in the surgery group occurred within two years of the procedure, and 70 percent occurred within three years.
     Study author, Dr. Hilary A. Tindle of the University of Pittsburgh, reports that the reasons for the higher suicide rates are unclear. She was not able to examine the details surrounding the individual suicides. She does state that this study does not imply bariatric surgery itself leads to suicide, but it may be the emotional conditions the patients suffered prior to bariatric surgery or they may have developed after the surgery which leads to suicide.
     I work as a psychotherapist on the bariatric team with the Methodist Weight Management Center in Houston Texas. We see a wide range of patients prior to surgery. Many of these patients come to us with life stories of being verbally, sexually and physically abused. In fact the most recent statistic is that more than 40% of women who suffer obesity have been sexually or physically abused. Obesity is known to correlate highly with depression. When we evaluate these patients psychologically our goal is to get an honest and candid history from the patient of anxiety, depression, addictions, abuse as well as trauma suffered in the past or present. The patients are often afraid to reveal too much, fearing they may not qualify to have the surgery. If the staff is unaware of what the patient has endured from an emotional aspect they cannot know how best to follow them. Society’s prejudice toward the obese patient has created a cycle of shame for many of these patients. They feel awkward and overwhelmed when they do reach out, and many times have lost their ability to trust that anyone wants to help them. This feeling adds to their lack of motivation to follow up care after the bariatric surgery. The study clearly states the chance for suicide goes up as the rapid weight loss has stabilized (two to three years out). The “honeymoon phase” of quick weight loss has ended and the patient is returning to the issues that were underneath the weight and also contributed to their reasons for using food as a stress reliever.
     Support groups offer another insight that may be beneficial in understanding the high incidence of suicide two to three years after Bariatric Surgery. Patients report the support groups as being helpful with teaching them how to deal with issues about their personality they never dealt with.
 
Member Voices:
Suicide & Grieving The Loss of a Fellow Post-op
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They may have blamed their weight for their lack of success in areas of life. After they lose the weight they realize many of their failures have nothing to do with their weight. Believing your weight is the main issue and the only issue can be devastating when you lose the weight and realize it is “You” and not your weight that is the issue. Many of these patients don’t have the support from family or long term friends and they don’t know how to deal with their new bodies, or expectations others now hold for them. Turning to support groups can help normalize this process for patients and prevent them from turning to food for comfort.
Guidelines for helping patients successfully transition to a healthy life style after weight loss surgery.
1. Secure follow-up appointments prior to surgery. Follow-up should be ongoing through three years post-operatively.
2. Make sure you know your whole team. That means you know your nurse’s name, your dietician’s name and your counselor’s name prior to surgery.
3. Follow up care will help you (the patient) develop a relationship of honesty and accountability with the staff. This relationship enhances the patient experience with staff support and care after the bariatric surgery.
4. Depression, anxiety and addictions do not go away with bariatric surgery. Patients can learn to better manage these more effectively with staff help in follow-up food addiction groups.
5. Follow up care affords you (the patient) a team of emotional support that can be called upon any time as you transition to a healthy life style after bariatric surgery. Patients are less likely to commit suicide if they have someone they can talk to and with whom they feel connected.

Bariatric surgery alleviates medical conditions and affords so many patients an improved quality of life. It is not an easy transition though, and without staff support it can be insurmountable to many. Follow up care may be the key for a healthy transition as well as saving patients lives.
 
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21 Comment(s)
Comment by honeybee22 on Oct 22, 2010 at 05:26pm
I totally agree with the support group i belong and belonged to a bariatric support group a year before my surgery and still continue to go also i am part of a weight clinic called Wharton Medical Clinic in Burlington Ontario Canada and its soooowonderful its because of Dr. Sean Wharton that I was able to have this wonderful surgery and a second change on my life, I also have gone to follow up appts at the hospital with the bariatric team we are all part of the team and me being the captain and being surrounded by surgeon, nurses, dietician, social workers etc. Also a supportive family and friends help a lot and dont be afraid to discuss what u are going through and what you have gone through its good therapy to talk!Bee from Mississauga
Comment by bettyjoeweekes on Oct 23, 2010 at 04:17am
what bunch of crap, glad i dont have to listen to her.
Comment by Paige1243 on Oct 23, 2010 at 04:52am
Before anyone consider bariatric surgery, one should make sure that the center has an educational team, support, good psychiatric screening, a qualified dietician/nutritian, competent surgerians, doctors and nurses. There are many hospitals and doctors that will perform the surgery. But there are few that will serve the whole person. That is why I highly recommend St. Vincent Charity Medical Center in Cleveland, Ohio. Once a patient always a patient. I am three years out. I am being taking care of superbly. They are very professional and competent. They are not there for the money. They are there to give you a good qualty of life. If you fail, it is because you did not do what you were told to do.
Comment by seamist50 on Oct 24, 2010 at 06:43am
I was recently discussing suicide after surgery with a friend who is a nurse, and other post patients. We wondered if suicide is a factor. Prior to surgery, I was told insurance will pay for plastic surgery. Well, The Dr forgot to mention, it only pays for the abdomen.So you are to live with disgusting hanging skin everywhere else, unless you have the money ( a lot of it) to continue with the other procedures. My feeling is, had I known the hanging skin would remain on my body, I would never have undergone the surgery. It is far worse emotionaly than being fat was! At least fat, i could still wear shorts, skirts, short sleeve shirts, bathing suit. After surgery, I hid behind clothes. Ya I know you think fat people hide behind clothes. Not so true. Body image was far preferable fat than looking grotesque.In 2 years since surgery, I have not worn shorts or skirts. Waiting on my last PS surgery for the inner thighs. Lucky for me, I came up with the money to contiue with the PS procedures. Have to sell my house to do it however.Sure I look fantastic with clothes on.Bathing suit??? No way! Intimate relationships? No way! Basicly, I have been in recovery from surgeries for over 2 years.Now I wonder after the thigh surgery, will that disgusting skin hanging off my butt, chin, make me want more surgery...Yes I do belive bariatric surgery will be worth all this in the end, but I had no clue how hard this would be, and expensive! I believe I would have had major emotional issues had I not been able to pay for these surgeries.Emotional enough to commit suicide? That would have been a possibility.I lived a far more open and public, social life fat. I was not hiding my body to the extent I did after weight loss.I would suggest before surgery, visit a plastic surgeon and see pictures of before and after.Get estimates from the Dr on all the procedures.Decide if you can live a full comfortable life with the hanging skin, if you can not afford the surgeries.I saw the naked before and afters PS on TV, on the web. Belive me, they were not as real as sitting with the plastic surgeon, and seeing his picures and getting prices to fix it all!
Comment by truisi on Oct 24, 2010 at 12:17pm
I had gastric bypass surgery 10.5 years ago at the University of Massachusetts Medical Center in Worcester, MA. I have successfully maintained more than 150 pound weight loss by maintaining relationships with the bariatric team. I see my medical team annually to follow manageable issues that have developed. Maintaining close contact during the first 2-3 years was of critical importance to me because I needed the emotional support of fellow patients to validate the feelings and managements issues I was having. Shopping for clothing was a major challenge after weight loss, and my peers were the only people who could understand this. The UMass team had an extremely rigorous screening policy for who would be appropriate candidates for surgery. They maintain these very high standards today. That is one reason why their program has a very high success rate with post-ops. Pre-ops go through extensive preparation before surgery and if the team doesn't feel you are ready, you do not progress on to meet the surgeon and get a surgery date- plain and simple. It is all about the patient and their readiness for the surgery, not about how much money they can make for the hospital. Patients must give up their power and control before this process begins. They must trust the team and their decisions-even though they may not like their decisions-they are in the patient's best interest. Any patient considering or having bypass surgery should in my opinion be involved in long term therapy. Their weight did not come on quickly. Their weight issues are a result of long term coping strategies for dealing with maladaptive people or behaviors; so when food can no longer be used to cope with those situations, the patient needs to learn alternative coping strategies with the support of a qualified professional because it is not going to be easy to learn to replace eating. Short term group therapy with a nutritionist and a psychologist together, like our program had was extremely beneficial to focus on these issues. I can't say enough good things about my experience with my program. As far as plastic surgery goes, one has to be realistic. I knew I wasn't going to look like Barbie. And no way, no how, would I want the scars left behind by some of the procedures. Fortunately for me, my insurance covered the 3 procedures I had. So it basically comes down to individual insurance companies. I don't think any doctor out there would lead anyone to believe that any procedure will be covered. I have had friends denied for the panniculectomy as their were no medical indications for it-hanging skin is not a medical necessity. Remember if someone threatens suicide, that is a person that was never prepared for the changed that would happen post op, and someone who most likely should have waited to have surgery until they were more emotional stable.
Comment by cabram5 on Oct 24, 2010 at 06:53pm
Biartric surgery change my whole outlook on life. The surgery is a tool and it doesn't change the individual but it changes your outlook. It is so important to have family support as well as be apart of a support group. I suggest to anyone contemplating wls to research and follow through with your nutritional consults, doctor visit before and after. I feel like life has just begun for me at 60 . When you have been over weight all your life, and here people say you have a baby face you are so pretty but, if you just loose a few pounds. My knees have ache me so bad down through the years that being 126 lbs lighter is a miracle for me. I love life and I recommend Gastric Bypass surgery. When you weigh 346 lbs. and loose down to 220 pounds living has just begun. Sagging skin doesn't even matter. I put on my skinny jeans and show off my new body . I workout at 24 hr fitness with the others, Yes the skin is there but it's better than wearing a size 28 dress and pants. It's a good feeling to wear a 16. I love life and can't believe anyone would even consider taking their life, after reaching a journey that they choose to take. If any one out there is interested in being part of Lean and Fit Online Support Group we have a weekly chat we just started . Get on the Lean and Fit post and ,let's tallk about how to take Life by the horns and live. Enjopy the moment you have always wanted to be healthy and smaller.
Comment by Elevator on Oct 25, 2010 at 07:31am
I have never been happier than I am since my surgery. Instead of looking at the down side, I think about the good. Yes, I have some saggy skin - hey, it used to be filled with fat! I exercise 6 days a week - because after losing 90 pounds - I CAN! I'm still new at this, but I dieted for 50 years, and this tool works! The things that made me overeat are still there - but being successful (finally) is enough to help me make the right decisions about dealing with the triggers in my life. elevator ("life is full of ups and downs - I'm ready to go down!")
Comment by shrinkpachyderm on Oct 25, 2010 at 02:55pm
Hi guys. This is my post after such a long time. I was not ready to be part of a weight loss surgery forum when i first signed up, hense the long time since posting.At the time of signing up i was miserable and occasionaly roller coasted through suicidal tendancies. They ranged from thoughts to plans and finaly reaching out to my dr. I basically felt my life was meaningless. Being disabled due to my 357 pound self induced slow suicide i found basically there was no quick fix to my frame of mind, no medication would numb me, no person could love me enough to make me feel worthy as i did not love myself. I used to like me so it was pretty clear that the weight was the cause of the self loathing. I just want to share that on fri this week i have my first therapy session after a year and a half wait for the appointment. My expectations are that i hope to achieve enough peeling away of the onion layers to boost my self worth, clean out the puss infected areas of my past , enough to accept i can't change the past and how to recapture a desire to want to embrace life. Its a tall order. I am worried about many things but they are not going to be excuses any longer. I did this to myself. It wasnt my fault i was sexuallt abused at 8 years old but its been an obsession that i havent been able to put down in its entirety. I feel at present i have just over come a great hurdle. The blame game. oh lordy this one was a doozy.All my life after the abuse revolved around me numbing myself with food. I justified it by accepting i did this because ...............so therefore i literally didnt see it as my responsability that i got so big and unhealthy. Anger at my abuser was my justification for the self sabotaging. I know with honesty i will change and through trust in others i will have help. im about to embark on a 20 week therapy session. after that if the assesment shows great promise i will see the surgeon again. ive been given a yes as long as i do well in therapy. Bring it on.Im blessed to have had victom support help me. i had OA for 5 years on and off(disbanded). What do i have to lose. Im scared of life today so any improvement on this is progress. I do have fears about loose skin as i cant be intimate with my partner. He puts me down because hes tried to motivate me and his frustration has turned into bullying. I have putrid exema and skininfections in personal areas that keep me chained like a chastity belt. I wonder how he will cope with seeing loose skin drooping. To be honest i may be out of this relationship by then. I want to feel alive, to be able to walk and stand for more than five minutes. I hope never to hate myself the way i did. I am nurturing the little girl i carry with me inside. Through her i learned she needs love , nurturing, tlc, mental stimulation because i most certainly do need all these things. I am deserving of all these things either way. It will be scary but hey i need to get back on the roller coaster. ive been a reclusive for 2 years now. My future entries should be less lengthy. Hope i can find acceptance here. Thank you and i hope someone will read this and understand. Bye for now
Comment by joannep on Oct 25, 2010 at 04:04pm
The very best to you, you are worth it! Joanne
Comment by geebee2010 on Oct 27, 2010 at 07:54am
I agree so much with this article. Most of us are overweight in the first place because of many mental reasons that have caused us to turn to food. We have turned to food in the middle of the night because we are lonely, we have turned to food because we are bored, or we have turned to food to fulfill some kind of need. Unless these issues are addressed, weight loss surgery is not the answer. Just as seamist50 has stated, after weight loss surgery there are going to be many issues...dumping syndrome, the inability to eat as much or what you are used to, and the problem of excess skin...just to name a few of the problems you may encounters. Mentally, unless you have prepared yourself for these things, for some of us, depression will set in on you. Who knows, this depression may be to the extent that you may attempt suicide. This is just my opinion. So for the persons, who may say that this study is a bunch of crap, please, you may want to rethink your comments.
Comment by sparklyblue on Oct 28, 2010 at 06:17am
After having a gastric sleeve surgery, I thought it would be really easy to loose weight. I have no support system in Western Canada and I feel like a failure already two months post-surgery (lost 20 lbs.) and I am stuck there. I don't know what I'm doing wrong and have no one to turn to. I can say that if I wasn't a strong person this could lead to suicide.
Comment by newmacgirl on Oct 28, 2010 at 10:03am
Bettyjoeweekes I agree with you.
Comment by MsJello on Oct 29, 2010 at 07:19am
My friend recently had gastric bypass at a well known doctor's group in Houston. Prior to surgery she had to attend all these meetings. Post-op hardly anything. In fact twice she went to see the doctor for follow up and he was not there and she had to leave both times after sitting and waiting for 2 hours. I have mentioned this post-op woes now to various doctors as this is not right! You do need support and and nutrional evaluation often...I am very upset about this for my friend. It should not be this way. These type Bariatric surgeons need to be weeded out.
Comment by sparklyblue on Oct 29, 2010 at 10:11am
So, after care support is so, so important, and I was not told this before surgery.
Comment by AnneSaturley on Oct 29, 2010 at 06:45pm
The semi-literate woman who posted on October 23 "what bunch of crap, glad i don't have to listen to her"...now THAT'S the kind of supportive comment we all need! Keep them coming, Betty Joe!
Comment by acompton on Nov 01, 2010 at 11:15am
31% suicide rate? This must be a typo. That would imply that 1 in 3 people commit suicide after surgery. I'm pretty sure that insurance would not cover surgery if this were the case. OH - please check this number. Thanks!
Comment by MsJello on Nov 02, 2010 at 01:08pm
Yes, sparklyblue, post-op care/support is VERY IMPORTANT! One of the doctors I talked with about my freind's surgeon who gets them in and gets them out and then............... well she referred 3 of her patients over to another Gastric By-pass surgeon here in Houston as she knows how important after care is. Live and Learn from my patients's she said. Buyer be careful. Not all surgeon's are what they appear to be. Do your homework!
Comment by vickiemlly on Nov 29, 2010 at 04:02pm
I had lap band surgery last April and I will not go to the doc. for follow up because I am not making any progress. I have put the weight back on that I lost initially, which was only about 20 lbs. I am so discouraged. My appetite is still a problem... I want to eat all the time.... I so wish I would have had the by-pass or sleeve.
Comment by cassiegrl on Oct 13, 2011 at 08:25pm
one thing i wonder if they account for is that i dare say a lot of us are depressed before surgery and/or that might have lead to the over weight to begin with and poor eating habbits (not all mind you but a lot)... I know from having a personally difficult time post-op with my antidepressants that meds dont effect you the same... in fact mine made me appear to be bipolar... i am not off them and doing fine... but not much study has been done for dosing and the effects of anti depressants on post-op... do that take that into account... and 2 do they account that we can no long eat away our problems and emotions... so if not treated correctly (thats where the research on meds comes in) then the depression gets worse... leading to high suicide rates... i wish we would start to see more pharmalogical companies doing research on the absorbtion and theraputic levels for meds for post-ops and then of course comes getting insurance companies to accept those prescribing guidelines, i dont know how many times i had to fight the insurance that i had to have a different dose because of absorbtion...
Comment by a1971jewel on Oct 13, 2011 at 08:53pm
"Follow-up should be ongoing through three years post-operatively." Why only three years? I'm five years post op, and I still see my bariatric surgeon for follow up annually. It's my understanding that I should do so indefinitely. If we're talking about long term sequelae and complications and nutritional maintenance, those certainly don't magically stop at the three year mark, and warrant ongoing surveillance.
Comment by angelsbare on Jan 23, 2012 at 05:04am
At the time of my suicide attempt which I started mentally detoriating as my complications got worse, I was under the care of my surgeon, a psychiatrist and a psychologist. I was also 7 1/2 years post op at the time in 2008. While I appreciate and understand the sentiment expressed by Mary Jo, when someone is suicidal, we aren't thinking rationally. In my head I was in a lot of physical pain, I failed the people I loved the most because I got stuck emotionally, and was in a dissasociative state. I told my parents, and my psychiatrist and therapist I was suicidal and no one believed me. I had no support system as all my friends were functional, working,in serious relationships and raising kids and all seemed to be "too busy" at once even though I was always there FOR THEM. This is why on both Facebook and OH I've been very open about my suicide attempt. I did not get diagnosed with BPD2 until I was suicidal.I always blamed because I was heavy my whole entire life, my depression issues on my weight. Which were nothing compared to the depression that came when my physical health detoriated and I could not properly raise my children. Morale of my story? Lots. 1st of all a surgeons office or a surgeon, they are surgeons, not psych professionals. While my surgeon will not do rny on people with an MH history because of the issues I've had with complications sets, anymore, I wasn't diagnosed as being bipolar until 7 1/2 years post op. Secondly, if you feel this way, tell someone until they believe you. I didn't want to end up in the system, I truly wanted to die but I told the people I love the most (with the exception of my kids, of course) so they could have a chance to say goodbye. That's irrational behavior. Someone should've saw it in me, but I couldn't see it in myself because I was too mentally and physically sick and tired to be able to. Be supportive of people who struggle in the community as far as peer support. I cannot believe how much shaming goes on here. I didn't have that issues as I didn't at my sickest belong to any wls support group, after my suicide attempt and everything I lost there is nothing anyone could say to me online that could match what I've been through but you never know the mindset of someone else. Be very mindful of your words. There is truth that because I lived through my attempt, I saw the damage once I was no longer in a dissassociative state of what I did to the people I love the most. I'm still dealing with the ramifications of what I did and what I put the people I love the most, through. If you are in crisis seek help immediately. If something feels wrong on the inside seek help from a qualified psychological team which may mean both a psychiatrist for med management and psychologist, but if you are in danger of hurting yourself immediately, go to an ER of a hospital that has both a medical and psychiatric services available. I don't write very well given everything I've been through physically and emotionally. I'm glad this finally was put out here.
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