A Tragic Risk of Weight-Loss Surgery - Well - Tara Parker-Pope - Health - New York Times Blog

October 17, 2007, 11:01 am

A Tragic Risk of Weight-Loss Surgery

A review of thousands of patient records has turned up a previously unknown risk associated with a popular weight loss operation — suicide.

In bariatric surgery, the stomach is made smaller so as to speed weight loss. The risk of dying from bariatric surgery is about 1 ipercent, most studies show, and complications strike up to 40 percent of patients. In addition to being overweight, these patients often have health problems like diabetes and heart disease, so it’s no surprise they also have higher death rates from natural causes.

But a review of nearly 17,000 weight-loss surgeries performed in Pennsylvania from 1995 to 2004 has yielded a surprising finding. Of the 440 deaths in the group, 16 were due to suicide or drug overdose, according to the University of Pittsburgh researchers who reviewed the data. Based on the suicide rate in the general population, no more than three suicides should have occurred in the group, the study authors say. More troubling is the fact that another 14 of the drug overdoses that were reported likely include some suicides, suggesting that the real suicide rate was even higher. “There is a substantial excess of suicide deaths, even excluding those listed only as drug overdose,'’ the researchers noted.

In August, The New England Journal of Medicine reported a review of nearly 10,000 bariatric surgery patients by Utah researchers, who compared them to a control group of obese people who had applied for a state driver’s license. Although the surgery patients had a 50 percent lower risk of dying from disease compared to obese people who hadn’t undergone surgery, their risk of dying in an accident or suicide was 11.1 per 10,000 people — that’s 58 percent higher than the 6.4 per 10,000 rate in the obese group. The study suggested the suicide risk was twice as high for surgery patients than for those who had not had surgery, but the finding wasn’t statistically meaningful.

Nobody knows why bariatric surgery patients appear to be at higher risk for killing themselves. Some research shows a link between obesity and depression, so the typical surgery patient may already be at higher risk for depression and suicide before the operation. It’s possible that depressive symptoms may worsen in patients who have unrealistic expectations about the results of surgery or who struggle not to regain weight after the procedure.

The study authors say the 7 percent death rate from suicide and drug overdose in the Pennsylvania case review signals the need for better mental health follow-up for patients who have undergone weight-loss surgery. While most weight-loss surgery programs require some psychological evaluation before the procedure, many programs and doctors are lax about follow-up after the surgery, and patients themselves often opt to skip follow-up counseling.

In pre-surgery counseling, I was told there would be no follow-up, BUT, if I should feel depressed, should I reach a plateau, need someone to talk to, or even ask for medication, I CAN and with open arms, but it is up to me to ASK, and to ASK was stressed about a half-a-dozen times.

I wanted my surgery very badly, and I was determined not to appear depressed in any way during my counseling session. I had to pass to get to the next level.

When it comes to depression, thin people are just as depressed as large or obese people. Everyone has issues and there's no magic to solve any of them.

But when there's severe weight loss, and then weight gain after all that, I just can't imagine not being being even more determined to keep it off. But it does depend what kind of self-medication is used by post bypass patience.

BUT correctly said, food is our (my) "drug of choice". It made me feel good, it made me feel bad. We're the opposite of those who choose to starve themselves as their drug. Those who starve themselves get the "awe" media attention and "what a pity", while large people get "they just don't have any self-control" snipers.

AND not all large people are large because of over-eating.

My metabolism went wonky 20 years ago, and Synthroid for hypothyroidism helped to slow my weight gain, but it could not put the brakes on weight gain altogether. I'm up to 250mcg /day dose, (doctor's say it's high), with a metabolism that's way whacked out.

If it remains the same once I achieve my weight goal, I will be the perfect candidate to put all my weight back on again. So I not only have to be goal oriented being banded, I have a lifestyle to change and maintain forever and I hope my forever is at least 40 more years.

Green- you are so right about the coping mechanism being food. That came home loud and clear for me whenenver I discovered I had a daughter on drugs. I learned very quickly that I was no different than her. My drug of choice was food. Different substance, same problem.

She found a way out 3 years ago now, and she is my biggest supporter for the lapband. She encourages me to go forward, at the same time

warns me about what lies ahead for me with regard to relationships, warns of having expectations that don't pan out and leave me fighting depression, etc., and is helping me decide on something to focus on so I don't replace the food with something just as harmful. I have a feeling I will be depending on her alot.

Green- you are so right about the coping mechanism being food. That came home loud and clear for me whenenver I discovered I had a daughter on drugs. I learned very quickly that I was no different than her. My drug of choice was food. Different substance, same problem.

She found a way out 3 years ago now, and she is my biggest supporter for the lapband. She encourages me to go forward, at the same time

warns me about what lies ahead for me with regard to relationships, warns of having expectations that don't pan out and leave me fighting depression, etc., and is helping me decide on something to focus on so I don't replace the food with something just as harmful. I have a feeling I will be depending on her alot.

Your daughter will be a valuable resource, and helping you will help her; it makes us feel happy when we can happy someone else feel better. I believe that you will have an interesting and pleasant journey with your daughter's company. :biggrin1:

Yep, people who are going to die [morbid obesity]... some just commit suicide.

And some of them get weight loss surgery ... and they still commit suicide.

And some get weight loss surgery THINKING their lives will change... but ... they are still there, still them, and still living the same life. Then they commit suicide.

There was a thread about list 10 things you are going to do after losing the weight...or something like that. Anyone thinking their life will change... is in for a rude awakening.

The only thing that changes is:

take up less cubic inches - clothing size, seat space

pain can lessen (joint/back/etc.)

from morbid obese to not - no meds for comorbids

All underlying issues why someone got fat will still be there.

Yes, there is some hard 'head' work involved for most people and it cannot be brushed aside.