A review in JAMA finds that many people seeking surgery for morbid obesity also have psychiatric issues. In this article, we address which psychiatric issues can delay bariatric surgery. For example, depression and eating disorders are common in people seeking weight loss. How serious a concern are they to your bariatric surgery program?
Hospitalization for psychiatric issues can delay bariatric surgery
First is a history of psychiatric hospitalizations. Bariatric surgery programs take these very seriously. And why is that?
Generally, you have to be at significant risk (i.e. have a plan) for hurting yourself or someone else in order to be hospitalized. Bariatric surgery programs are very concerned about this because suicide rates appear to be higher in people who have had bariatric surgery, than in the general population.
This is not to say if you’ve been hospitalized for a psychiatric disorder that you are disqualified from bariatric surgery. It is less of a concern if your hospitalization was more than five years ago. So if you’re someone who was hospitalized as a teenager and you’re now in your 50s, then I can’t imagine it would be cause for concern!
Bariatric programs are generally concerned if:
- You were hospitalized for psychiatric care within the past year.
- You were hospitalized multiple times for such care within the past ten or so years.
But, every program is different. So discuss your psychiatric hospitalization with your bariatric surgeon and your behavioral health provider.
Untreated depression can delay bariatric surgery
As we discussed in my last article, untreated depression is concerning to a bariatric surgery program. Other concerning untreated psychiatric conditions may also include:
- Schizophrenia
- Bipolar Disorder
- Severe Anxiety or Panic, and
- Personality Disorders
These mental health conditions are concerning to your bariatric surgery program. And the reason why is managing significant psychiatric illness makes it very difficult to also focus on the all of the post-operative requirements of bariatric surgery.
If you are dealing with significant psychiatric illness, then you are required to be in therapy and/or medication management prior to and following bariatric surgery.
Eating disorders can delay bariatric surgery
It probably won’t come as a surprise that eating disorders are taken very seriously by bariatric surgery programs. Eating disorders include binge eating, bulimia and purging, and emotional eating.
One of the most concerning behaviors is binge eating. Patients who are bingeing before bariatric surgery usually need to remedy this behavior in order to move forward with surgery. This is because studies show that people who binge eat prior to bariatric surgery tend to lose less weight.
Bulimia and Purging Disorder also are extremely concerning to your bariatric surgery program. Both of these disorders involve behaviors such as inducing vomiting and/or taking laxatives to lose weight. And these very dangerous behaviors are harmful to your body. You likely would be required to work with a therapist in order to understand and stop these behaviors long before bariatric surgery. In fact, you would need to be abstinent from these behaviors for quite some time before even being cleared for surgery.
Emotional eating also can be a worrisome to your bariatric surgery program. This is because no bariatric surgery will “cure” you from eating when you’re stressed or upset. So if you are someone who turns to food for emotional reasons, then your bariatric surgery program may ask you to work on these behaviors before moving forward.
Substance abuse can delay bariatric surgery
Another significant issue is substance abuse. Obviously, you are not capable of focusing on the requirements of bariatric surgery if you are actively abusing drugs or alcohol.
It is a general rule that patients must be free of substance use for one year prior to bariatric surgery. Bariatric surgery programs also will likely require you to quit smoking and using alcohol for a period of time prior to bariatric surgery. Again, this is because of the damage these substances do to your body.
And if you have a history of significant substance abuse, your bariatric surgery program will want to see that you have addressed this history adequately. This may be inpatient or outpatient substance abuse treatment programs and/or 12-step programs.
A second reason that substance abuse is a significant concern to your bariatric surgery program is something called addiction transfer. Addiction transfer is the process of changing from one addiction to another, without ever addressing the reason for the addiction. And because studies show an addiction transfer of up to 30% in bariatric surgery patients, the bariatric surgery programs take substance abuse very seriously.
Other psychiatric issues can delay bariatric surgery
Finally, there are other issues that can surface during a presurgical psychological evaluation. And I would be concerned and probably require at least a follow-up visit for theses issues:
- Lack of support. You need at least one person who is supportive of your surgery. So work on building your support system!
- Unrealistic weight loss goals. Having a goal that you are not likely to reach can cause anxiety and depression following bariatric surgery.
- Unrealistic expectations about life changes after bariatric surgery. Surgery itself will not solve every life issue. It’s what you do with your weight loss that matters.
In closing
I hope my series of articles clarifies the bariatric presurgical psychological evaluation process for you. Obviously, each program has their own guidelines so you may have a different experience.
I know presurgical patients may omit some of their psychiatric issues for fear of being dismissed from their bariatric surgical program. But I strongly encourage you not to do that (and I know that’s easy for me to say). Our goal is not to reject you, it’s to help you reach your goals. We all want you to be as successful as possible, and to that end, there may be some things to work on before undergoing bariatric surgery. So try to be as open to the process—and to the recommendations—as possible.
Wishing you freedom from food,
Kim Daniels, PsyD
“Ask the Psychologist” is a monthly column by Kim Daniels, PsyD. Content is the opinion of the author and does not constitute or is a replacement for medical advice.
