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.
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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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