This story is part of a partnership between MedPage Today and VICE News.
Many people who undergo weight-loss surgery would say the procedure helped them get healthier, feel more confident, and even earn a bigger paycheck. But for a few, it's ended — or almost ended — in tragedy.
Alex Brecher, who founded a web community for people who've undergone bariatric surgery, told VICE News he remembered receiving a panicked message from one of the site's 264,000 members: another member had confided that she was thinking of committing suicide.
"I have to credit 911," said Brecher, who underwent weight loss surgery in 2003 and founded his website 12 years ago. "They [got] to her within minutes with just an IP address and were nice enough to call me back to let me know that she was on the way to the hospital and okay."
Studies over the last several years have shown that although suicide is rare, rates are up to four times higher among people who have had bariatric surgery compared with the general population. However, the reason for these increased rates — and whether this population may be more prone to suicide attempts regardless of surgery — remains a topic for debate.
The latest study in this growing body of research was published this month in JAMA, the Journal of the American Medical Association. Researchers in Canada found that patients' risk of self harm specifically increased after bariatric surgery compared with before it, highlighting the possible role of the surgery and its aftermath in these patients' actions.
"It forces the patient to change their lifestyle following surgery," said lead study author Junaid Bhatti, of Sunnybrook Health Sciences Centre in Toronto, explaining that these changes can lead to stress and mental health concerns. "If he or she eats sugary foods following surgery, it will lead to gastrointestinal symptoms. So, the patients need to be prepared for these adjustments."
Bhatti and his colleagues studied insurance and ambulatory care data from 8,815 people who'd undergone bariatric surgery between 2006 and 2011, looking for instances of self-harm emergencies three years before and three years after weight loss surgeries. They found 158 emergency room visits for self-harm events among 111 patients.
A total of 37 patients' records had these events during the pre-op period, 63 patients had them in the post-op period and 11 had them in both pre and post-op periods, according to the study.
Bhatti concluded that patients had a 54 percent higher risk of self-inflicted harm after surgery than they did before it, and his results were statistically significant. The mean rate of self harm was 2.33 events per 1,000 patients annually before surgery and 3.63 events per 1,000 patients annually after.
Although the rates were low, Bhatti said studying them is "justified."
"It helps in improving information provided to a patient before treatment and may save lives," Bhatti said, likening self-harm to a rare side effect for doctors and patients to watch out for.
Studies on this topic have garnered mixed reactions from the community of patients who've undergone such procedures, with some discussing their own mental wellness challenges after surgery and others dismissing the studies outright.
Kirk Shelley, a 52-year-old political consultant, underwent the surgery a year ago, and told VICE News he wasn't happy with the study, fearing it would spread fear and stigma.
"I'm 90 pounds down and having a great time," he said, adding that he reached out to the study author to share his concerns. "My income has gone up and my life has improved dramatically with the weight loss."
Brecher said he's only known one former bariatric patient who has attempted suicide, but that he was unsurprised by the most recent findings.
"Although my own personal experience was completely positive, I have seen many others who have struggled post-op," Brecher told VICE News.
He added that he's also seen similar studies before. Indeed, a 2013 systematic review of nearly 30 studies concluded that suicide rates were four times higher among bariatric surgery patients than in the general population. Eight years ago, a study published in JAMA Surgery reported that although researches had expected only three suicides among 17,000 bariatric surgery patients, they found 16.
Echoing ongoing discussions on BariatricPal.com forums, Brecher said increased suicide attempts among patients after bariatric surgery could be due to replacement addictions, the loss of food as a self-soothing tool for dealing with stress, and the realization that a lower body mass index won't solve every problem. He also said being a post-op patient can come with increased social pressures to deal with stigma that weight loss surgery is an "easy out."
"Obesity carries a lot of burden," said Dr. John Morton, president of the American Society for Metabolic and Bariatric Surgery (ASMBS), noting that there is a high incidence of depression among bariatric surgery patients. "Even though the surgery gets rid of diabetes and sleep apnea and improves life expectancy by 40 percent, it's not always really able to get rid of depression, which is an organic disease. Even if the body improves, it may still may carry forward."
In Bhatti's study, 93 percent of bariatric patients who had self-inflicted emergencies had been diagnosed with "mental health disorders" before surgery. All of the patients with mental health disorders had anxiety diagnoses, and some also had depression or alcohol abuse in their health records.
In the United States, patients are given a psychological evaluation before surgery, and follow-up appointments assessing the patient and his or her wellbeing are supposed to continue regularly for the rest of the patient's life, Morton said.
An estimated 193,000 people underwent bariatric surgery last year, according to the American Society for Metabolic and Bariatric Surgery (ASMBS). It's considered the only proven way for morbidly obese people to lose weight and keep it off, and it carries a mortality risk of 0.1 percent, putting it on equal footing to gallbladder removal surgery and hip replacement surgery.
Follow Sydney Lupkin on Twitter: @slupkin
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