Weight gain after bariatric surgery can have devastating psychological effects.
How Sustainable Is Weight Loss After Bariatric Surgery? I explore that problem in my video of the same name. Most gastric bypass patients end up regaining some of the fat they lost in the third year after surgery, but after seven years, 75% of patients followed up at 10 US hospitals maintained at least a 20% weight loss.
A typical trajectory for a person who starts gaining weight up to 285 pounds, for example, would be to lose more than 178 pounds two years after bariatric surgery, only to regain up to 207 pounds. This has led to “grazing” behavior, where compulsive eaters may go from binge eating (which becomes more severe after surgery) to eating smaller amounts frequently throughout the day. In a group of women who were followed for eight years after gastric bypass surgery, nearly half continued to describe episodes of disordered eating. As one pediatric obesity expert explained, “I’ve seen many patients put chocolate bars in the toothbrush and cream, just to get past the barriers that have been put in by the technology. [e.g., a gastric band].”
Bariatric surgery advertising is filled with fairy tales of “happily ever after” cherry-picked results, as one ad review put it, a “Cinderella-romance happy ending.” This may contribute to the finding that patients often overestimate the amount of weight they will lose through the procedure and underestimate the difficulty of the recovery process. Surgery causes drastic changes in eating habits, which require small bites, which are chewed completely. Your stomach goes from the volume of two softballs to the size of a tennis ball in a fixed stomach and half a ping-pong ball in case of a gastric bypass or band.
As you can imagine, “weight regain after bariatric surgery can have a devastating effect psychologically as patients feel they have failed the last choice”—their last resort. This may explain why bariatric surgery patients face a higher risk of depression. They also have an increased risk of suicide.
Being overweight alone may increase the risk of suicidal depression, but even at the same weight, those who undergo surgery appear to be at greater risk. For the same BMI (body mass index), age, and gender, patients who undergo bariatric surgery are almost four times more likely to harm themselves or attempt suicide compared to those who do not undergo surgery. Most convincingly, so-called “mirror image analysis” by comparing the pre- and post-operative events of patients has shown that the likelihood of serious self-harm increases after surgery.
About 1 in 50 bariatric surgery patients end up committing suicide or being hospitalized due to self-harm or attempted suicide. And this only includes confirmed suicides, excluding hidden attempts such as drug overdoses that are considered “undetermined intent.” Patients undergoing bariatric surgery may have a higher risk of accidental death, although some of this may be due to changes in alcohol metabolism. When people who had undergone gastric bypass were given two shots of vodka, their blood alcohol level exceeded the legal driving limit within minutes due to the changes in their bodies. It is unclear whether this contributes to the 25% increase in alcohol problems noted in the second postoperative year.
Even those who succeed in losing excess weight and keeping it off seem to struggle. Ten years out, although quality of life related to physical health may improve, general mental health may deteriorate significantly compared to pre-surgery levels, even among those who have lost the most weight. Ironically, there is a common perception that bariatric surgery is for those “cheats” who take the easy way out by choosing a “low-effort” way to lose weight.
Losing weight may not erase the stigma of being overweight. Research shows that “for some, knowing that someone was once fat will lead to them being treated as fat all the time.” And there may be a strong anti-surgery bias beyond that—those who choose the scalpel to lose weight over diet or exercise are rated more negatively (for example, considered more physically attractive). One can imagine how being a victim of discrimination even after joining the “group” can reduce psychological well-being.
There can also be unexpected physical effects of severe weight loss, such as large, hanging patches of excess skin. Besides being heavy and uncomfortable and interfering with movement, skin flaps can cause itching, irritation, dermatitis, and skin infections. Getting a panniculectomy (removing the “apron” of hanging skin belly) can be expensive, and its complication rate can exceed 50%, with dehiscence (breakage of the surgical wound) one of the most common complications.
“Even if surgery appears to be consistently successful,” wrote the founding director of Yale University’s Prevention Research Center, “there is a need to rely on the reorganization of the natural body composition of the intestines as an alternative to better use of the feet and forks.” [exercise and diet] it seems to be bad social behavior.”
In the Middle Ages, hungry peasants dreamed of gastronomic utopias where food rained from the sky. The British called it the Kingdom of Cockaigne. The scholars of the Middle Ages could not have predicted that most of their descendants would not only live there forever but would cut out parts of their stomachs and intestines to combat this abundance. Critics have pointed out the irony of the deliberate surgical modification of healthy organs to malabsorption—malabsorption—especially when it comes to surgery on children. Bariatric surgery for children and adolescents has become widespread and is performed on children as young as five years old. Surgeons defend the practice by saying that growing up overweight can leave “’emotional scars’ and lifelong social disabilities.”
Proponents of preventive medicine may argue that bariatric surgery is the proverbial “ambulance at the bottom of the cliff.” In response, pediatric cesarean section advocates have written: “It is often suggested that we should focus on prevention.” Yes, I agree.
A strong case can be made that the benefits of bariatric surgery far outweigh the risks if one remains overweight, which is estimated to shave up to a dozen or more years off a person’s life. Although there is no data from randomized trials yet to support it, compared to obese people who do not undergo surgery, those who undergo bariatric surgery are expected to live significantly longer on average. It is no wonder that surgeons have been placing special operations as a matter of life or death. This is a false dichotomy, however. The benefits outweigh the risks only if there are no alternatives. Is there a healthy way to lose weight without using an operating table? That’s my book How not to eat it’s about.
Doctor’s Note
My book How not to eat focuses only on sustainable weight loss. Check it out at your library or pick it up wherever you get your books. (All proceeds from my books are donated to charities.)
This is the final part in a four-part series about bariatric surgery, including:
This blog contains information about suicide. If you or someone you know is showing signs of suicide, please get help. Go to for more information.
