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Post-Surgery Weight Regain: Mental Health



sharma-obesity-mental-health1Regular readers will appreciated the importance of mental health factors both as a promoter of weight gain as well as an important barrier to weight management.

It is therefore no surprise that in our systematic review of weight regain after bariatric surgery, published in Obesity Surgery, we found substantial evidence for the role of mental health factors both in failure to lose adequate amounts of weight or to regain any weight lost.

Out of the sixteen studies included in the review, all studies that examined this factor, implicated uncontrolled mental health issues as an important cause of weight regain.

These included, binge eating disorder, depression and addictive behaviours (alcohol and drug use).

In fact, there was a linear relationship between the number of reported psychiatric diagnoses and the magnitude of weight regain. Overall, patients with two or more psychiatric conditions were approximately six times more likely to either lose no further weight or regain weight than patients without psychiatric problems.

At least one study reported that 80 % of patients identified pre-operatively with an eating disorder, and who did not receive any treatment pre-operatively, had recurrent feelings of binge eating at 6 months post-operation. In addition to binge eating, some researchers describe a new sub-clinical disorder described as “grazing” (consuming multiple small meals with feelings of loss of control with eating), the incidence of which appeared to increase after surgery and was associated with an increased tendency for weight regain.

Interestingly, one study found that completion rates of behavioural modification therapy increased to 91% when performed post-operatively, compared to 14 % when done pre-operatively.

Nevertheless, it probably makes more sense, when possible, to address mental health issues prior to undergoing surgery.

In summary, our review finds ample evidence that a wide range of mental health problems can lead to maladaptive eating, which if unregocgnised and untreated will prove a persistent impediment to surgical weight loss.

This is why extensive mental health assessments and interventions both prior to as well as following surgery should be a routine part of bariatric care.

If you have experienced specific mental health issues to be an important factor in weight gain after surgery, I’d like to hear about it.

@DrSharma
Edmonton, AB

ResearchBlogging.org
Karmali S, Brar B, Shi X, Sharma AM, de Gara C, & Birch DW (2013). Weight Recidivism Post-Bariatric Surgery: A Systematic Review. Obesity surgery PMID: 23996349 

 

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6 Comments

  1. Exactly I have this grazing issue not so the bing eating one but the grazing I have been holding steady at a weight after surgery but have not lost as much as everyone seems to think I should. Stuck very stuck there was little to no mental health help before during or after surgery at all I know I am doing it but I still do it. So I know it is a problem. Help!!!

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  2. I had adjustable gastric band surgery nine years ago. Although it was successful initially and I lost a lot of weight, I have regained much of that weight over the last seven years. At present, I am about 20kg lighter than I was when I had the surgery. I attribute much of the loss of control to an ongoing battle with severe treatment resistant major depression. It is very difficult to remember and adhere to the rules of post-band eating (e.g. no drinks with meals, getting enough vegies/fibre, restricted eating of high-carbohydrate foods) when you are fighting for your sanity. I’ve found that some of the medications that I take (particularly the atypical antipsychotics) seem to induce cravings to eat sweet foods which I didn’t have when I was well. In general, my motivation to follow the post-surgery rules and to exercise is inversely correlated with how sick I am.

    Despite the effect of my mental illness, I am still glad that I have the band. I suspect that I would be larger than I was without it by now if the band wasn’t there providing some limit on what I can eat. My surgeon told me that the band wouldn’t fix my depression, I understood that. What I didn’t know at the time that I had surgery was that I was going to face a severity of illness that would decimate my ability to consciously control how I thought and that negative depressive thinking makes it very difficult to do the right thing with respect to making the most of having a gastric band.

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  3. Before surgery I did not think I had an eating disorder. Now I am certain I always have had one. Two and a half years out, I am a clinical success, but never got to the goal (very reasonable goal, not normal BMI, but in the mid-high OW class) that I wanted to. I have had a bit of bounce back, not too much, but enough to make me terrified that it will continue.

    I have come to recognize that I struggle with anxiety and depression, and they manifest in compulsive and addictive behaviours. For the first time in my life, as I struggle to control grazing I feel drawn to drink. I feel lucky that I was able to recognize that slide quickly and am working to ensure it doesn’t become a problem. But the sysyphean journey of mass weight loss feels tenfold harder when you come to full terms with the idea that there will never ever be a time in your life when you are not struggling for control with either your mind or your body.

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  4. @ K

    Your situation is not uncommon after gastric band surgery, I had a similar experience.
    A University of Minnesota study published in JAMA revealed that mild to moderately obese patients with Type 2 diabetes had more improvements in their blood glucose, cholesterol and blood pressure after they underwent gastric bypass surgery, than patients who made lifestyle changes with medical counseling.

    This may sound good but the complications and the return of the weight showed me that the results were only temporary.

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  5. You are 100% spot on. I had a RNY gastric bypass in 2006, i had no follow up appt at all, just a hosp appt at 3 months post op, stopped loosing weight about 10 months post op and have now regained it all back again. I was sent home with a sheet of paper about eating, no dietician appt, nothing. I finally saw a dietician 2.5 yrs post op but it was waaaaaay to late by then, she told me she couldnt help me, i needed more help than she could give. I was concerned before the op that it wouldnt ‘cure’ me as i was fully aware my problems were in my head not my stomach but no one seemed concerned. No one could answer my question ‘would the bypass slove my eating problems, would i stop wanted to eat all the time?’ and it turns out i was right to be worried, ive never had dumping syndrome, can eat as much junk as i like but struggle with healthy food. I now have to have iron, calcium and B12 supplements but im still hugely overweight. epic failure! Im now being seen by the NHS eating disorders unit for my disordered eating and i feel as if im finally in the right place. If id have been sent here first THEN had a bypass im sure id be a healthy weight now.

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  6. I had the bypass 12 years ago. I lost close to 100 pounds and then started gaining slowly. I am now 20 lbs away from the weight I was before surgery. I have had multiple knee surgeries that have kept me immobile for months. This past year I had ankle surgery that left me non weight bearing for 10 weeks. I am able to eat all the time with no problems. I have osteoporosis and have to take calcium daily and B12 injections but the weight is all back. Any advice as to what I can do to get back to losing. I have joined an exercise class but the weight is plateau. I have been wanting to go speak with the surgeon that did my gastric bypass if he would consider doing the sleeve. Any advice. HELP!

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