The American Society for Metabolic and Bariatric Surgery (ASMBS) estimates that nearly 200,000 people undergo bariatric weight loss surgery each year in the United States. Almost a quarter of those surgeries are Roux-en-Y gastric bypass (RYGB), a procedure that involves cutting the stomach to create a small pouch and rerouting a portion of the intestines. It is the second most popular weight loss surgery because, despite being more invasive than some others, it is considered to be the most successful. “Success,” when we talk about bariatric surgery, is usually defined by the number of pounds lost, changes in body mass index (BMI), or drops in clothing sizes. Psychological aspects of success tend to be neglected in the enthusiasm surrounding weight loss. This seems ironic given that it is often psychological factors motivating patients to seek surgery in the first place. But when we consider some of the emerging research about the psychological risks of weight loss surgery, in particular RYGB, this neglect is downright dangerous.
I was recently taken aback by an article published on the popular medical news website Medscape. The headline read “Stable Weight Loss 12 Years After RYGB; 50% Had Diabetes Remission” and the article summarized a new study supporting the long-term success of RYGB. Buried midway through the article was this sentence:
“There were however, seven suicides in patients who underwent bariatric surgery but none in the other patients.”
Why isn’t this the headline of the story?
This is not the first study to document an increase in the risk of suicidal thoughts and behaviors following RYGB surgery.
In 2016, Backman et al. published a study using Swedish registry data for all patients who underwent primary RYGB between 2001 and 2010 and found that patients who underwent RYGB were nearly 2.85 times more likely to make a suicide attempt than the general population reference group. This study only looked at hospitalizations, so we aren’t even talking about all of the people who had thoughts of suicide but didn’t seek treatment or people who made non-lethal suicide attempts that didn’t require hospital care. Had those people been captured in this study, the rates would have likely been much higher.
Another study (Bhatti et al., 2016) found that intentional self-harm emergencies, including suicide attempts, increased 50% following gastric bypass surgery. Again, this study only looked at suicide attempts that resulted in emergency medical care. Intentional self-harm and a history of suicide attempts are the strongest predictors of future suicidal behavior; these non-lethal suicide attempts often pave the way for future attempts with higher lethality. Nearly all of the patients (93%) in this study who engaged in self-harm behaviors following surgery had a prior mental health diagnosis.
Despite the fact that more and more research points to an increased risk of suicidal behaviors following weight loss surgery (and there are a number of additional studies not discussed here), this is seldom discussed with patients prior to surgery and few medical professionals who have long-term continued post-surgical care screen for suicidal ideation. In fact, the ASMBS lists increased risk of suicide under its “bariatric surgery misconceptions,” minimizing the documented risks. While increased risk of suicide occurs in a minority of patients who undergo bariatric surgery, it is a risk that can be deadly and should not be minimized.
Some of the warning signs for suicidal behavior include:
• Threats to hurt or kill self
• Looking for ways to kill self; seeking access to pills, weapons or other means
• Talking or writing about death, dying or suicide
• Acting reckless or engaging in risky activities, seemingly without thinking
• Feeling trapped – like there’s no way out
• Increasing alcohol or drug abuse
• Withdrawing from friends, family or society
• Anxiety, agitation, unable to sleep or sleeping all the time
• Dramatic changes in mood
• No reason for living, no sense of purpose in life
The National Institute for Mental Health (NIMH) offers this free suicide screener that medical professionals may want to integrate into their standard visit for all bariatric patients.
If you or a loved one is struggling with thoughts of suicide following bariatric surgery, please know that you are not alone and help is available. The suicide prevention lifeline offers free telephone counseling 24/7 at 1-800-273-8255.
Dr. Alexis Conason is a clinical psychologist specializing in the treatment of psychological issues related to bariatric surgery, overeating disorders, body image dissatisfaction, and sexual issues. She is the founder of The Anti-Diet Plan, a mindfulness based program to help you stop dieting and start eating in attunement with your body. Sign up for her free The Anti-Diet Plan 30-day starter course today. Follow her on Twitter and like her on Facebook.