Suicide and Weight Loss Surgery

[fabfatgrl 10]

A Tragic Risk of Weight-Loss Surgery - Well - Tara Parker-Pope - Health - New York Times Blog

October 17, 2007, 11:01 am

A Tragic Risk of Weight-Loss Surgery

A review of thousands of patient records has turned up a previously unknown risk associated with a popular weight loss operation — suicide.

In bariatric surgery, the stomach is made smaller so as to speed weight loss. The risk of dying from bariatric surgery is about 1 ipercent, most studies show, and complications strike up to 40 percent of patients. In addition to being overweight, these patients often have health problems like diabetes and heart disease, so it’s no surprise they also have higher death rates from natural causes.

But a review of nearly 17,000 weight-loss surgeries performed in Pennsylvania from 1995 to 2004 has yielded a surprising finding. Of the 440 deaths in the group, 16 were due to suicide or drug overdose, according to the University of Pittsburgh researchers who reviewed the data. Based on the suicide rate in the general population, no more than three suicides should have occurred in the group, the study authors say. More troubling is the fact that another 14 of the drug overdoses that were reported likely include some suicides, suggesting that the real suicide rate was even higher. “There is a substantial excess of suicide deaths, even excluding those listed only as drug overdose,'’ the researchers noted.

In August, The New England Journal of Medicine reported a review of nearly 10,000 bariatric surgery patients by Utah researchers, who compared them to a control group of obese people who had applied for a state driver’s license. Although the surgery patients had a 50 percent lower risk of dying from disease compared to obese people who hadn’t undergone surgery, their risk of dying in an accident or suicide was 11.1 per 10,000 people — that’s 58 percent higher than the 6.4 per 10,000 rate in the obese group. The study suggested the suicide risk was twice as high for surgery patients than for those who had not had surgery, but the finding wasn’t statistically meaningful.

Nobody knows why bariatric surgery patients appear to be at higher risk for killing themselves. Some research shows a link between obesity and depression, so the typical surgery patient may already be at higher risk for depression and suicide before the operation. It’s possible that depressive symptoms may worsen in patients who have unrealistic expectations about the results of surgery or who struggle not to regain weight after the procedure.

The study authors say the 7 percent death rate from suicide and drug overdose in the Pennsylvania case review signals the need for better mental health follow-up for patients who have undergone weight-loss surgery. While most weight-loss surgery programs require some psychological evaluation before the procedure, many programs and doctors are lax about follow-up after the surgery, and patients themselves often opt to skip follow-up counseling.

[green 6]

This is a very interesting article. Thanks for posting it.

[Marimaru 7]

It might be interesting to compare this to some numbers about the percentage of suicides that are big people. That number might tell us if this is really all that out of the ordinary as far as that goes.

I have to say I would not be surprised to find it was the same or a little higher among weight loss patients vs people who're still big. We've all heard from people who truly thought that getting thin would solve all of their problems.

[Daisalana 33]

I would not be that surprised, while reading it the first thing that came to mind.. someone who has WLS is desperate, are we not? We have tried everything, some people their whole lives. Finally, they are doing something major, last attempt.

And if it doesn't work? I can see someone who has a history of instability or hopelessness, feeling like that's the last straw.

Just my 2 cents. If Lap-band doesn't work (which it is thus far!), I would do RNY. If RNY didn't work, I wouldn't be suicidal. And honestly if I can just stay below the weight that makes my back hurt (which seems like around 295lb was the cut off), I'm a happy camper.

Everything else is gravy.

[LauraD 2]

I think the sentence "unrealistic expectations about results of the surgery" says a lot.

Also, unrealistic expectations about what changes weight loss will bring to your life.

I think many overweight people believe that once they lose the weight, they will automatically be happy; and when that doesn't happen it would have to be a pretty crushing blow.

[Suzzzie. 3]

They way they referred to "making the stomach smaller" makes me think that they were targeting the suicide rate of bypass patients.. Anyone else get that impression?

Either way, it's horribly sad.

[WASaBubbleButt 41]

I can't help but to wonder about bypass patients. They are the ones likely to regain after intestinal tissue begins to regrow and they are back to absorbing fat and calories again.

If I did all that to my body, lost a ton of weight, got a taste of "thin" for a bit, then regained, I might be a bit frustrated too.

[Jachut 487]

Yes, I'm thinking weight regain or lack of loss after you've had surgery would be enough to make anyone seriously depressed.

As would finding out all your issues are not resolved by weight loss. You're not suddenly stunningly beautiful with lots of money and great hair and men wanting to date you. YOu're just you, only thinner. If you werent happy with you in the first place, that's a hard thing to face.

Or realising you never will feel "perfect". You still see the fat person or you still dont like yourself, that'd be awful.

Or more importantly losing your only coping mechanism for dealing with things you cant face - food.

So those stats dont really surprise me at all.

[catzintj 1]

when you dont stuff your emotions with food and numb out, then the emotions are stirring and cause lots of anxiety. the anxiety can lead to destructive behavior as you try to escape it. smoking , drinking and drugs may be used to escape . emotions cant hurt you but how you deal with them can. my biggest problem is anxiety and not sleeping. i try to get lots of sleep but need sometimes to take drugs. i like the medication since it takes away the stress and anxiety. the more sleep and execise i get the less anxiety i have. so maybe people get really depressed since they dont have a way to suppress the anxiety and then they have suicidal intentions..... this is sad to me..... if im upset i tell myself that this will pass and tomorrow is a new day. i always make lists of my goals and how to reach them. this usually puts my life in perspective and cheers me up. if people have an attitude of gratitude then they usually can see that they dont have it as bad as many other people and i think that makes you able to bear burdens better.........everyone is different but i think we all go through some changes mentally and spiritually along with the physical. it is good to have some support from friends and family.

[green 6]

For some people overeating is their preferred form of substance abuse, and substance abuse is often a coping mechanism used against such emotional ills as depression. Those in the counselling biz call this self-medicating. When you remove the coping mechanism without the support of therapy, friends, and the appropriate medication such people can find themselves suddenly feeling very alone and very sad - sad enough to kill themselves. I know a little bit about this because I am a depressive and because of this I have done a lot of reading on the topic.

LBT is a great support group and does assist us with coping with the loss of the comfort of food as well as with weight loss. I know that this group has certainly helped me during my year of weight loss and continues to help me now that I am at goal. :ranger:

[Topdownbug 0]

Green - how much did you lose and how long did it take?

Honestly, I'm quite happy with my life now (w/out weight loss surgery) but I know I could enjoy much more of life's joys if I had more stamina and energy. That's my main reason for wanting to lose weight. I have a great life - now it'll be even greater.

I can see how someone who is counting on WLS to change them from sad to happy might have to have some counseling and help.

[green 6]

Green - how much did you lose and how long did it take?

Honestly, I'm quite happy with my life now (w/out weight loss surgery) but I know I could enjoy much more of life's joys if I had more stamina and energy. That's my main reason for wanting to lose weight. I have a great life - now it'll be even greater.

I can see how someone who is counting on WLS to change them from sad to happy might have to have some counseling and help.

I was one of the lower BMI people and lost 50 lbs in 10 months. The last time I had my weight checked - I don't own a scale - I weighed 149 lbs and I am 5'6" tall. My BMI is now in the upper range of normoloid.

As for the depression problem, I have been suffering from this since I was a teenager. I have been off and on meds and been seeing various kinds of counsellors ever since I was 18. At the present I see a psychologist for talk therapy and a psychiatrist for drug monitoring. Depression is a big genetic problem in my family. Both my brothers have suffered from this as well as my only nephew and one of my two nieces. In fact, this niece is grossly overweight and has serious problems with depression. She has been treated for this since she was a teenager and she is now in her early 30s.

Weirdly enough, my energy levels have never, ever been affected by my weight but whenever I am slammed by depression it is difficult for me to even bathe myself or brush my teeth. Now, that's is low energy!!!

[kacee 3]

I would venture to state that a large percentage of obese people are depressed. The eating can definitely be a sign of depression...as it is a panacea for most of us....an emotional crutch. The bigger we get, the more depressed we get, the more we hide in food. I don't think this is any surprise at all.

[ingyrob 1]

I have been reading the "Why am I Fat" thread. A lot of people who have posted have had very unhappy childhoods, relationship

and marriages with sexual, physical and emotional abuse. I can see that being slim might not solve the fall out from the horrors they have lived through and that nothing will; so I can well believe the high suicide rates. But as Marimaru has said, it would be interesting to know how many suicides there have been by people who are very big and have not had surgery.

I often think when I read stories of abuse "don't let the abusers get the better of you, live your life", but realise that I have not been through anything like what they have been through, so have no right to say that. My heart does go out to them though

[Cleda 0]

Green - I'm was really interested in your post regarding a history of chronic depression. I've been on every anti-depressant at one time or another and know the utter exhaustion that can come with depression.

I don't expect surgery to fix everything - just hoping to lose 60 to 75 lbs so that I have more energy for my 10 year old and to eliminate weight as a reason for various aches and pains as I age.

I don't go to the dr much because they just tell me to lose some weight and try to keep my stree levels down. Sure, I'll get right on that after I mow the lawn, get the pets to the vet, have my child evaluated for ADHD while working my exhausting but low paying job!:rolleyes

Growing up my sister was the fat one. She's probably 350 or more now. When I zoomed by 200lbs a few weeks ago - something I would have thought impossible when I was in my 30s - I knew I didn't have the resolve to do this on my own.

Now I just have to get someone to go along with me for the surgery!

thanks for listening.