Risk of Suicide Attempts after WLS article

[gowalking 10,790]

Here's the link to the article below. Just curious what you guys think.

I think that there are lots of reasons why someone would want to harm themselves and there isn't specific data as to why...just that there's a possible correlation.

My take on this is that food and overeating for many of us is a symptom. It's our drug of choice rather than alcohol or heroin. But just like someone in treatment goes through psychological help, so should some folks who have food issues as well. Obviously not everyone...but enough of us. I was banded in January of 2013 and a year and 100 lbs. later, found myself so very unhappy that I went into therapy. Now, I had other issues, but it started with the weight and still involves how my weight is and will always be, a huge part of my life. I feel like I have to be vigilant like anyone else dealing with an addiction.

http://www.medpagetoday.com/PrimaryCare/Obesity/54035

[CowgirlJane 14,261]

It is an interesting topic. I suspect that you are very right that there is a deep emotional component for some of us. Perhaps it is timing, support structures around you etc.

When i was 22, I lost 60# to becomes slim and attractive. I nearly lost my mind.... i had no idea how deeply it would impact me emotionally. I regained that weight lickedy split, i think as a survival mecanism. I am more mature, clearer on myself as a person, and so was able to come up with much healthier coping mecanisms this time around!

I can imagine a person who has severe issues/depression just not being able to handle the loss of food for comfort and the fatsuit shield. I am pretty much over it now, but it shocked me to learn how much I have leaned on it over the years.

I haven't seen a counselor in a while but decided to go back last week. She said a few things that really hit home... one of them was this "I admire how you have left behind your food addiction and are now working on the real things that need to be faced." I am not sure I buy into food addiction, but I certainly had very disordered eating and used food to soothe and comfort myself. I hid my true self behind the fatshield in many ways that I didn't even recognize at the time.

[Sajijoma 1,324]

For many of us, isn't out weight a form of self harm? I mean, I know for myself at least, that although I was battling with weight problems, my "bulk" of my weight all came on after traumatic events that led to me basically punishing myself for what my weight had done by adding more weight. I didn't realize that is what I was doing, but it was. What would I have done to punish myself had food not been an easy option? I don't know. I'd like to believe I wouldn't have gotten to a point of suicidal thought and actions, but there's no way to know for sure. I think having a place to talk about these problems even if it is over the Internet with strangers who can sympathize and offer words of encouragement could definitely decrease the odds of an event like this happening and why support groups in general are so very important to the overall process.

[VSGAnn2014 12,992]

I'm so not impressed by that research.

There's as much variation in risk ratios between the cohort of WLS patients who live in rural areas and all other WLS patients as between all WLS patients and those who haven't had WLS.

I say move everybody downtown.

Seriously, some of these studies are so badly designed I just want to jack-slap the researchers. It sometimes seems they're thinking: "We have no frickin' idea what this means, but we went to the trouble of collecting data, so let's publish anyway."

[OKCPirate 5,323]

@@gowalking - Thanks for pointing out this article. This actually tics me off. It stigmatizes all of us. But what they are pointing out the same results that happen to those few who win the lottery. They have problems too: http://www.thedailybeast.com/articles/2010/02/19/lotto-death-curse.html.

Sudden good fortune is a blessing or a curse. It depends. And when I look at the whinny videos of people who have had WLS but eat crap and then bemoan their magic wand didn't work it really makes me mad. Well that's not completely true, I feel for them.

But when people who self soothed through food are suddenly cut off of their only source of pleasure, what do you think is going to happen? You don't think anyone can see that? The morbidly obese are killing themselves. They don't have the coping skills, no support network what do you think is going to happen? But bunching me and the vast majority in that group with the crap stat "twice as likely to commit suicide" which is what everyone takes away from the story stigmatizes a potentially life saving procedure for many.

If they broke it down into demographically true numbers you will find that those who are in the group that kill themselves are probably no more likely to hurt themselves as others in that demographic.

So I'm ticked at JAMA again.

[gowalking 10,790]

I actually oversee data for a living so I am acutely aware that almost any data can be manipulated to achieve the results one is hoping for. I know this article can be misleading and statistics can be skewed. I was more curious as to what others on this site think of the article and if/whether some of us are at risk.

Again...some folks get the surgery and live happily ever after but I know that for me, the past nearly two years has been focused on how to cope and deal with my issues without turning to food. Band or no band, I know I can gain every single pound back if I start to self destruct. I've done it before, and I know I can self sabotage again.

[OKCPirate 5,323]

@@gowalking - When I dug deeper into the numbers, I think this is total crap. They are comparing apples and oranges. They were damn lazy. They have huge gaps. They don't know if the population of self pay (since this data from Canada where a very large segment of the population would rather self pay than wait for socialized medicine). If you add in the self pay WLS patients, that would lower the percentage of self-harm down to the population at large.

There is no control for demographics. He's comparing unemployed self-soothing fat people to the total population and saying this proves the surgery will make you four times more likely to kill yourself. Sorry, total and complete BS. However on FOX news or CNN the headline will be "Have stomach surgery? You will probably kill yourself." Absolutely irresponsible.

[OKCPirate 5,323]

This is the email I sent to the author's of the study:

Dr. Ghaferi,

I read about your study on bariatric surgery and self-harm with some alarm on http://www.medpagetoday.com/PrimaryCare/Obesity/54035. If I understand this, this is based off Canadian data? Was there demographic analysis of the population that did self-harm besides location, age and sex? For instance income? My concern is that you are probably looking at a specific demographic sub-set which should be compared to a like sub-set, not the population at large. Without it you are creating a new stigma for those of us who have used these procedures. If the media is misinterpreting your study for a cheap headline, well that’s not your fault. Did you all check with the Cleveland Clinic who has been doing some fantastic research on long term results of bariatric surgery?

I appreciate your attention.

[gpmed 623]

@@gowalking To answer your question about whether and why people may be at risk after WLS, the short answer seems pretty easy to me. It's a major life event and major life events cause stress. For a host of reasons (sorting out and identifying those is the hard part), major life changes put people at risk.

From day 1, I felt this was going to be one of the biggest things I do in my life, after, perhaps, having children. Assessing my ability to handle such a major life event ahead of time has helped me a lot. I considered the positive and negative ways I've reacted to major life events before, lessons learned, where my support would come from, etc. and judged myself ready. I think going in thinking there were going to be some difficult challenges helped too.

[OKCPirate 5,323]

@@gpmed - you are correct. But judging people going through a major life event, should be compared to everyone going through a major life event, not to the population at large. So I would conclude that doesn't make WLS patients more at risk than anyone else who has:

• Gone through a tough divorce
• Lost a spouse
• Lost a kid
• Yadayadayada

Now does that mean I don't recommend to everyone who is new to this site and thinking about the surgery not get a counselor and work through the WLS Emotional First Aid Kit book? No, I do. But look at this guy's conclusion "you are 4 times more likely to kill yourself if you have WLS. And I think that is just blatantly stupid and poor science. Shame on JAMA for publishing and doing the editorial. The just gave an excuse to big insurance to deny more people.*

*I'm not bitter, I self-paid for a reason. I didn't want to go through the insurance hoops and it was actually cheaper than all the co-pays.

Edited October 12, 2015 by OKCPirate

[pink dahlia 2,513]

I haven't read the article, but based on the previous posts I've got a fairly good idea of what its about ( okcpirate, I like the way you think !) so im just throwing this out there. Is there the possibility that people think with having WLS that all /most of their problems will go away ? That because they're normal weight, that life will be good or perfect ? Just curious , not criticizing. I did'nt think that way, I knew that life would still throw a few curveballs at me, I just knew that I would be able to face the curveballs in a healthier, happier and stronger mind and body than I had before WLS. Just a thought.

[James Marusek 5,244]

Here is an objective review of the study. http://acsh.org/2015/10/suicide-tries-from-weight-loss-surgery-study-fails-to-show/

[OKCPirate 5,323]

@@James Marusek - thanks...the study was actually worse than I thought. This is a great summary:

“A total of 147 events (93.0%) occurred in patients diagnosed as having a mental health disorder during the five years before the surgery.”

Whoa! Did anyone in the news bother to read even the abstract?? Almost all of the suicide attempts occurred in people who had already suffered from some form of mental health issue. The two most common types are anxiety and depression (they frequently co-exist, and a common view is that they are actually two sides of the same coin).

Here’s an alternative headline: “People who are depressed attempt suicide more often that those who are not.”

[CowgirlJane 14,261]

A tangent on this discussion that came up in my mind is that this stuff always talks about bariatric surgery. AS though the surgery itself causes "emotional health" issues. As we all know, the surgery is a tool - and plenty of people regain... so it seems like what they should study is "massive weight loss" and emotional impacts.

What I would like to know is long term studies on longevity post bariatric surgery. Specifically, do people who have WLS live longer than those who remain obese (and don't have WLS). That physical change seems like a very relevant study topic and I am not sure there are conclusive studies on it.

My personal belief is that not abusing food/not being obese can cause underlying emotional health issues to be become more obvious/acute.

Speaking for myself, I am much healthier both physically and mentally then I was before. I probably complain more now..ha... because my expectations are higher!

[OKCPirate 5,323]

@@CowgirlJane - I think you are dead on right, goes along with Dr. Primack's comments:

Craig Primack, MD, at the Scottsdale Weight Loss Center in Arizona, wrote in an email toMedPage Today that bariatric surgery should be considered a treatment, and not a cure.

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"In my practice, a subset of patients believe that many of their problems stem from their weight: (poor job, still single, bad marriage, no close friends, etc.) and when they get down to a specific weight then everything will be OK," he wrote. "When they get to that number (or close to it) and realize that they will not achieve the thing they thought their weight would fix, they stop losing weight to literally stall and not have to face the fact that when they are at their goal they still are single, still have a bad job, etc."