When Is Weight Loss Surgery the Wrong Choice?

[finallyfree! 84]

This is a difficult topic as one size does not fit all. I also worry when I see a very young person have wls and wonder how they will maintain it for the next 70 years. However, the young ones are more worldly and more knowledgeable then when I was their age, but are they more mature? Less responsibility etc. I have lived with obseity for 30 years, should i have had it when i was younger, well only the dreaded old stomach stapling existed, so I am glad I didnt get that. So many expectations when young, finding a partner, finding a job, suceeding in a career, family putting their 2 cents worth in, not to mention the the brutal media, it is a really tough time. Not everyone wants to be self-aware and evolve themselves and they will have the toughest time at any age. I dont have a definate opinion but I am wary that this is a life decision and once done is done. I wish everyone the best with the choices they make.

[gowalking 10,790]

I just don't care for the 'tone' of the article blaming WLS on her spiral down. It presumes that if she didn't have the surgery, she wouldn't have gone through all the other addictions and issues.

As I've said many times, food is an addiction and abuse of it is self destructive like any other type of addiction. Who's to say this woman wouldn't have done this with or without WLS.

I agree with VSGAnn....the blame is misplaced.

[VSGAnn2014 12,992]

@@Cervidae ... great post!

[KristenLe 5,980]

It's a crap shoot in some ways. I am not convinced that psych evaluation actually find the"poor candidate".

If it was done properly AND the person was honest - it should identify concerns. A good program wouldn't perform surgery until those were addressed. The Psych Eval should have to be performed by someone qualified in Bariatric Surgery. I think often it's just done to get the insurance to approve and not with the intent to make sure the patient will be a good candidate. I've read and heard people say they were alcoholics at the time of surgery. That should have been a red flag if anyone was evaluating. Like most things - money talks in alot of medical practices.

[IncredibleShrinkingMan 437]

This brings up two very important issues, @@Alex Brecher.

Her poor candidacy is unrelated to her age. The turmoil surrounding her life both before and after surgery should've been a clear red flag, and perhaps psychiatric evaluations are not quite what they are today, and more people like her could fall through the cracks and into an ill-advised surgery.

That said, I think two things are unreasonably stringent...first, that there is a very strong presumption against surgery on anyone younger than 18...obesity and its devastating effects start and become very hard to reverse much before then, so why shouldn't the surgical option become available as needed? Must we wait until there are quasi-irreversible effects on health to allow somebody the most sophisticated option available, provided he/she checks out fine in other respects? Second, and in a similar vein, why is the standard 40 BMI or 35 with a co-morbidity? This disease is vicious and destructive long before an individual reaches either of those two standards, and even more uncontrollable once they are reached...therefore, there is a greater risk that in order to become a qualified candidate, you have to reach a point at which there may be less you can do than you could when you were, oh, say an innocuous 10 lbs overweight but clearly struggling with food.

This is another reason the psychological evaluation is important. It should not just weed out people with too many problems to be prepared for surgery, but should also be an inclusive tool, in other words, identify people who do not qualify strictly by numbers, but who are headed in a direction that makes surgery a very good, and potentially life saving option, even for a mildly overweight teenager, particularly when there are already some failed diet and exercise attempts under the person's belt.

[Alex Brecher 10,516]

Alex if I can ask how much weight did you have to lose? I'm 245 and 5 9 and getting the bypass on the 27th through BPMexico. I know I need to lose 70 or 80 pounds . I am using the surgery as a inducement to change my eating permanently. I've lost weight five or six times in my life before , ate healthily, exercised, then quit and got fat again like the young lady did. This time my thoughts are I will take this very serious step and I will have a physical assistance to losing weight as well as my mental determination. Is that correct thinking? Do people needing to lose 70 to 80 also succeed with bypass? Just curious

100Lbs give or take 5-10Lbs (depending on the day )

[vixsummer 10]

My mother thinks I'm too young for such a permanent surgery, and I'm 32. [emoji13] we can't win, can we? Haha

[Heather I 500]

I love Bariatric Pal, but the site continuously crashes on me! Ugh. I get a repost 2-4x because it reloads and refreshes.

Anyway, it forces me to be brief! LOL.

I think this girl was an emotional mess to begin with and age and surgery had nothing to do with her lifestyle choices and outcome. There are DEFINITELY mature young adults who have been burdened with obesity who can adopt a new lifestyle with help from WLS.

This young lady has major issues to begin with. Losing weight and gaining male attention doesn't translate into crazy promiscuity, drug and alcohol abuse to excess, and other dangerous behavior for most WLS patients, no matter what the age.

I think she has an addictive personality, and first it was food, then sex, then drugs and alcohol. I wouldn't be surprised if later there's kleptomania or hoarding, you know? Just moving down the line of obsessive, destructive behavior.

I certainly hope the worst of her "obsessions" is working out and staying fit now, but WLS probably gave her the best shot at still being alive at the age she is at given her previous weight. She has been given many gifts; WLS, and then surviving a very dangerous lifestyle for several years.

[Cervidae 2,389]

@@Heather I - I couldn't agree more!

[byebyebmi 100]

I personally think it's hard to blame the psychiatric evaluations on instances where the wrong person gets WLS. Most programs only require candidates to meet with the evaluator for one session, and even though I believe MAJOR problems would probably be detected, and I don't doubt that the evaluators are mostly competent, I wonder if anyone can truly assess a person's mental health in an hour. If someone wants the surgery and doesn't understand their own mental instability or the fact that they are overall a bad candidate, they can answer however they please and be cleared by the therapist. I have suffered over the years with OCD, anxiety, panic attacks, depression, etc in varying degrees at different times. I am also educated, articulate, a business owner and a good conversationalist. There is no way the man who did my psych evaluation could truly understand the mental health risk I was taking by having the surgery. I was well aware that the health anxiety from this could spark some major panic, or that the hormone fluctuations afterwards could have me on more of an emotional roller coaster than others. Fortunately since I am aware of those things I made sure I had proper medication, a therapist and a supportive group of friends & family. However, if someone is doing WLS for the wrong reasons and just wants to be skinny or find a husband and isn't concerned with a lifestyle change, being healthy and doing it for themselves then I doubt that would be the type of person who would assemble the necessary support team. Then when the surgery is done and they are left without any emotional first aid kit, they end up like this woman with transfer addictions, no healthy coping skills and no personal responsibility for why those things are happening. And of course, they blame it on the surgery. Anyone of any age considering the surgery needs to take a look at their emotional and spiritual situation and be completely honest with themselves. No one knows us better than us, and if something doesn't feel right it usually isn't. Plus, if for some reason someone finds its not the right time and they could benefit from counseling then its just a temporary pause and they are doing themselves a great service. I think everyone of every age contemplating/getting WLS should have a regular or semi-regular therapist before and after. As I think a few others mentioned, sometimes people wont realize mental or emotional issues until after the surgery, and since its permanent those people only have two options: get help or fall apart. And if they already have that person in place they will be well equipped to tackle the problem and have a real chance at being a great success story.

[Katrinakit 139]

I think the worst candidate for surgery would be a person who is unwilling or unable to make the necessary changes. I don't see anything wrong with a young person getting this surgery. However, I DO think that she would not have lost that weight the second time without it. So now she has overcome addiction AND lost the weight. Sounds like she is winning to me so how can she regret something that helped enable her to win? I don't think she is really thinking it through. She just wants something to blame.

[OKCPirate 5,323]

I'm going to make a generalization (and I hate generalizations, because I am ridiculously libertarian), I will bet she was dependent on someone else to pay for the surgery. I think self payers should be exempted from psyc evaluations. I did my own internal work with my own counselor in making the decision, and I don't need the stamp of approval of someone I barely know.

BTW, please don't think that mental health people are better at predicting behavior than others. (see Psychiatric expertise in the prediction of ‘dangerousness’ is not established and clinicians should avoid ‘conclusory judgments in this regard.’'" https://lackofresultswamh.com/disability-and-violence/psychiatric-drugs-cause-violence/

[CowgirlJane 14,261]

I am skeptical of psychological evaluation because of my own experience. Some mention how bad NUTS are and I am biased toward how bad most psychologists are.

I was seeing this lady who was an expert in eating disorders and weight iasues. I pour out my life story , every painful detail of my childhood and she came to the conclusion that I was withholding because I was too " at peace " with these things to weigh 300#. She had no concept of the obesity disease process. I was 300# because I had been overweight for many decades and at some point. .being fat is the reason you remain fat.

That was the most useless counselor I ever encountered. She did write my evaluation even though she was rabidly anti WLS. She was asked to address a few simple questions - was I capable of understanding and following instructions and did I have realistic expectations. She could not deny that I met those criteria.

In my view, I was a miserable hot mess; but I had determination on my side.

My basic thought about the article is people need to take some personal responsibility. Blaming a life saving surgery for your poor mental health is ridiculous.

Sent from my SAMSUNG-SGH-I337 using the BariatricPal App

[KristenLe 5,980]

@@CowgirlJane I was lucky to have a Psychiatrist who was part of my Bariatric Team. I think that would be helpful to many. I asked for additional counseling for emotional eating so I can get all the tools I can before surgery. That psychologist is also part of the Team (as is the Nutritionist). I'm realizing after reading alot of these threads that what I considered overeating is nothing compared to some others. I have alot less issues than I thought - but they need to be dealt with prior to surgery. I'm glad I have a team of folks working with me on the same goals.

[VSGAnn2014 12,992]

Our opinions of professional and medical services are often based on our own limited experience with only a few professionals -- or maybe even a single person. And our experiences with our NUTs, psychologists, surgeons, bariatric practice office managers greatly influence our views of all others who have those job titles.

If you had unsatisfactory experiences with one or two NUTs (like I did), chances are you don't think too much of the whole lot.

If you have had satisfactory experiences with a single psychologist (like I have), chances are you think (like I do) that others will find them helpful, too.

Likewise, if your surgeon was a brilliant cutter but lacking in bedside empathy or nutritional counseling skills, you may opine that all surgeons present like yours does.

Just sayin'. Our limited, anecdotal experiences do not define how everyone in that industry works.

Now if I could actually find a good NUT ....