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The following is a guest post by Joseph Rauch
The burden of weight loss surgery is heavier than the discomfort, bodily risks and cost of the procedure itself. People who consider and undergo weight loss surgery cope with issues that impact their mental health and relationships, not only their bodies and wallets.
Roughly 25 percent of candidates have a mood disorder — usually depression — and 17 percent suffer from binge eating disorder, according to an analysis of 68 studies. Compare these numbers to the average 6.7 percent of people who have depression and 2.8 percent with binge eating disorder.
A history of fat shaming, bullying, low self-esteem and difficulties in dating usually contribute to depression in candidates for weight loss surgery. There are also some candidates who experience shame and hopelessness because the diets and exercise routines they tried weren’t enough to reduce their weight. As for binge eating, it is often a method of using food to cope with negative emotions rather than expressing them or finding a healthy treatment such as psychotherapy.
Candidates also tend to deal with anxiety and stress leading up to the surgery. Therapist Louis Carfizzi was afraid he wouldn’t wake up from the surgery and became unsettled at the thought of losing a part of his body or being unable to eat the foods he had enjoyed since childhood.
“Having your body mutilated is a very scary thing,” Carfizzi said.
Like most people who complete weight loss surgery, Carfizzi’s physical and mental health generally improved several months after the procedure. Nonetheless, he had to grapple with regrets about the surgery. The lifestyle changes were difficult.
“Your body changes after the surgery,” he said. “You no longer have an appetite, and the appetite you do have is focused around different food then you're used to eating.”
Carfizzi has not experienced depression following the surgery, but not everyone is so lucky. About 13 percent of bariatric surgery patients experience an increase in depression, according to a study Yale University conducted. It is possible that changes in mindset and lifestyle contribute to this risk of depression.
For about a year after her surgery, therapist Chani Coady was doing well. Then she suddenly became depressed. The struggle to adapt to her new life finally took a toll on her mental health.
“I couldn't eat my emotions, so I had to find new coping skills when I was stressed or anxious,” Coady said.
It was also difficult for her to feel happy consistently. When she lost weight one week, she felt happy. Then she became upset for not losing more weight.
“I felt like my emotions were competing with one another,” she said.
Now that she had lost weight, people were more attracted to her and gave her more attention. It was a strange transition she wasn’t sure how to feel about. Her self-esteem fluctuated wildly.
“Mentally I went from someone who felt invisible in a crowd to someone people actually wanted to speak to,” she said.
Citing her experience as a therapist, Coady said divorce is another issue people often face before and after weight loss surgery. Sometimes couples disagree about whether the surgery is a good idea. The change in lifestyle and mindset can put strain on relationships as well.
Coady also mentioned transfer addiction after weight loss surgery: the risk of patients substituting food addiction for addiction to something else, usually drugs or alcohol. In rarer cases, patients become addicted to exercise because they develop a hypervigilant tendency to reduce weight and maintain their new body.
Even patients who succeed in keeping weight off and developing a healthy lifestyle often deal with shame and low self-esteem. They feel inadequate because they needed to resort to surgery to reduce their weight. Sometimes people they know comment on their surgery and imply they are lazy because they couldn’t succeed or didn’t try using only diets and exercise.
Traditional, in-person psychotherapy is the most popular way of effectively navigating the mental health issues surrounding weight loss surgery. It can reduce symptoms of depression, assist in treating eating disorders and decrease the risk of transfer addiction.
Candidates can find therapists who, like Carfizzi and Coady, have undergone weight loss surgery and might be able to more easily express empathy. There are even types of therapists who specialize in weight-related issues, including “bariatric psychotherapists” who primarily work with bariatric surgery patients.
Insurance guidelines in many states suggest weight loss surgery candidates see a mental health professional for a pre-surgery psychological assessment. Some doctors encourage patients to take the assessment and work with an in-person therapist before and after the procedure.
The problem is in-person therapy isn’t necessarily a practical option for someone preparing for or recovering from weight loss surgery. If the patient has obesity that affects his or her mobility, commuting to a therapist’s office can be difficult.
In-person therapy is expensive, too, usually costing between $75 and $150 per session. The average cost of weight loss surgery ranges from $14,000 to $23,000, and the insurance coverage varies. Even after dropping that kind of money, no patient is happy about tacking on hundreds of dollars a month for therapy.
If patients want to save money or avoid the commute to an office, online therapy is a great option. It usually costs a fraction of traditional therapy and allows patients to — at any time they want — work with a therapist from home, the hospital and anywhere else.
Therapist Jennifer Reynolds works with a weight loss surgery patient via Talkspace, a service that allows people to anonymously connect with therapists online by using live video or sending text, video and picture messages. Her client has made lots of progress, Reynolds said, and has commented on how the online modality has helped her.
Reynold’s client is one of dozens of weight loss surgery candidates and patients who have relied on Talkspace to provide the kind of therapy they needed. The unlimited texting therapy option is especially helpful for people who are feeling an intense amount of shame and don’t want the therapist to see their face or body. The ability to constantly communicate helps therapists keep these clients accountable for post-surgery lifestyle changes as well.
Weight loss surgery patients experience a harrowing journey full of mental health struggles. Fortunately there are mental health treatments and advances in technology that make it easier for them to find a space where they can overcome shame, avoid judgment and adapt to their new lives.
You can follow Joseph Rauch on Twitter @jrauch64.
