Consultation experience, eating disorders and mental health.

[fourmonthspreop 509]

Hey there. I wanted to just see what other people's experiences were with their consultation, especially those with either eating disorders or other mental health diagnoses.

I was recently diagnosed with bipolar disorder and have been on meds for about 2.5 months. My mental state has improved a lot and I have more cognitive ability to make good choices for myself.

When I went in for my consultation for gastric bypass, I was incredibly candid with my doctor. I told him about how I've lost 70 lbs in the past by fasting and extreme workouts but sadly I gained it all back plus some because of the binge restricr cycle. I went on to talk about my rocky relationship with food and he stopped me short and asked me "has anyone ever told you that you have an eating disorder?" He then said that people with eating disorders can't have weight loss surgery and that I'd need to work out my problems before getting surgery. He's giving me 14 weeks to get my sh*t together so to speak but ultimately said it's up to me to get to a place where I've mended this relationship with food. I'll be on their diet plan during this period (have already started making conscious efforts and studying BED recovery on my own).

So my question is this: when I told him about my struggles with my mental health and eating patterns he seemed to make it a point that if you have those issues, you don't qualify. While I understand that having untreated symptoms means you can't get surgery, I can't understand what being in control means if you have to still meet the BMI requirements?

Besides wanting him to truly understand my history with food, don't most people going for weight loss surgery have moderate to severe disordered eating or mental health problems? Is he just testing me to see if I can show him I've worked on my problems? Or is it really that weird and rare that someone with mental health problems and a history with binge and restrict is going for a weight loss consultation? I thought thats what it's about?

I know you stay on their diet plan and get used to that as kind of your new life but I can't understand what's "in control" enough to show the doctor I'm ready but still obese?

If anyone wants to give me some advice and share their experiences telling their doc about their eating behavior and mental health struggles , I'm all ears.

I can't stop thinking about it. I'm really working on self compassion and not trying to beat myself up. He made me feel that I'm not mentally healthy enough to even get help when I have been feeling stronger than ever with my new medication. Any insight and experience appreciated!

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[lizonaplane 1,612]

I have bipolar disorder and the surgery center's psychologist is requiring that my psychiatrist speak to her to ensure that my bipolar disorder is "stable" before I have surgery. Obviously, I will still have bipolar disorder and still be on meds.

I also have done some restrictive eating and a small amount of over exercising/vomiting in the past, but it was more than two decades ago, so they didn't think it was an issue. I think the best thing for you would be to work with a therapist trained in eating disorders during this time while you are preparing to have surgery. You won't be "cured" of your disordered eating patterns but you could get them in better control - this means being aware of when your emotions are getting out of control and having better ideas than running to food to soothe yourself.

I can't see your weight, but I will say that when I saw a therapist for weight issues, I didn't lose any weight at all in several months, so I don't think you have to worry about not qualifying for surgery because you lost weight from treating your eating disorders. I also think that if you don't treat your disordered eating, you will not be successful after surgery long term, based on what I've seen people here say.

[fourmonthspreop 509]

I have bipolar disorder and the surgery center's psychologist is requiring that my psychiatrist speak to her to ensure that my bipolar disorder is "stable" before I have surgery. Obviously, I will still have bipolar disorder and still be on meds.
I also have done some restrictive eating and a small amount of over exercising/vomiting in the past, but it was more than two decades ago, so they didn't think it was an issue. I think the best thing for you would be to work with a therapist trained in eating disorders during this time while you are preparing to have surgery. You won't be "cured" of your disordered eating patterns but you could get them in better control - this means being aware of when your emotions are getting out of control and having better ideas than running to food to soothe yourself.
I can't see your weight, but I will say that when I saw a therapist for weight issues, I didn't lose any weight at all in several months, so I don't think you have to worry about not qualifying for surgery because you lost weight from treating your eating disorders. I also think that if you don't treat your disordered eating, you will not be successful after surgery long term, based on what I've seen people here say.

Yeah, that makes sense. I suppose I was just taken back as I feel like I've made good progress with my mental health and have internalized getting better. I am already working with a psychiatrist and counselor too. I totally agree that the eating disorder needs to be controlled before surgery too. I'm going to keep working at it, even before my dietician visits in August. I have already lost 5 lbs (not much, albeit a change from gaining) since really trying to get a grip on my mental health.

Thanks for sharing your experience and wishing you the best!

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[Sleeve_Me_Alone 656]

I do not have BPD or an ED, but I do have severe depression and GAD which have played a HUGE role in my weight issues. Personally, I did 18 months of therapy (and meds) before I considered WLS. I have been 10)% honest with my PCP, therapist, the surgeon, and my husband so that I have the support and accountability I need. I knew I needed to get my head right and deal with some of the things that caused me to have such a disordered view of food and my body, before I could do anything else. I think there are a couple of things at play here: 1) the Dr. wants to make sure you are stable and responding well to your new treatment because WLS is a major life changing event. If your mental health is not at its best, you risk some serious issues. Its so, so important that your heart and mind be ready for surgery or it could very negatively impact your mental health long term. 2) I would guess that he's wondering if having your BPD treated might change the outcome of your weight loss efforts. You've never tried to lose weight with controlled BPD before now; it was undiagnosed and therefore no telling how it impacted your weight loss. As you said, you've had success before regain, but it sounds like some of the patterns you experienced may have resulted from the untreated BPD. You might find that with your new treatment regimen, its easier to lose weight at a healthy, manageable pace and that WLS is no longer needed. Or conversely, you may find that it makes no difference and confirms that WLS is the right next step. And 3) I'm sure he wants to make sure that there is no unaddressed underlying ED at play. Many folks who seek WLS do have EDs or have had them in the past; you're absolutely right that its not uncommon, although not always the case. That being said, someone in the throws of an ACTIVE ED who is not receiving treatment and in recovery, should not be considered for WLS. This goes back to #1 - your head has to be in the right place before going through with such a major event. I know it may feel like he was targeting or stereotyping based on your BPD, but I think he just wants to make sure you are set up for success. WLS is a big deal and it wouldn't be healthy for your body or mind to do it without informed consent and the pre-work needed to get you truly ready. If you feel like this is what you want and is the right step, then stay the course. Do the diet stuff, keep taking your meds, go to therapy, and it will happen in due time. You've got this!

[Creekimp13 5,840]

"history with binge and restrict" This is the problem. Binge can kill you if your stomach hasn't healed. You can literally die if the pathology is such that you cannot stop yourself.

[MoreThanWords 16]

No

[skyewolfe 92]

I ended up having an extended psych evaluation because my primary psych dr kept changing my meds and they wanted me stable with my meds before signing off on the surgery lol. I was super nervous, but I made sure I was honest.

[fourmonthspreop 509]

Thanks for sharing your experience. I'm noticing it rocks the boat so to speak when you come in with a psychiatric diagnosis too. I'm just focusing on controlling my symptoms. This surgery means so much to me, I want to prove it too. It's scary at times but having these forums helps me stay motivated as I see how successful everyone is.

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[fourmonthspreop 509]

I do not have BPD or an ED, but I do have severe depression and GAD which have played a HUGE role in my weight issues. Personally, I did 18 months of therapy (and meds) before I considered WLS. I have been 10)% honest with my PCP, therapist, the surgeon, and my husband so that I have the support and accountability I need. I knew I needed to get my head right and deal with some of the things that caused me to have such a disordered view of food and my body, before I could do anything else. I think there are a couple of things at play here: 1) the Dr. wants to make sure you are stable and responding well to your new treatment because WLS is a major life changing event. If your mental health is not at its best, you risk some serious issues. Its so, so important that your heart and mind be ready for surgery or it could very negatively impact your mental health long term. 2) I would guess that he's wondering if having your BPD treated might change the outcome of your weight loss efforts. You've never tried to lose weight with controlled BPD before now; it was undiagnosed and therefore no telling how it impacted your weight loss. As you said, you've had success before regain, but it sounds like some of the patterns you experienced may have resulted from the untreated BPD. You might find that with your new treatment regimen, its easier to lose weight at a healthy, manageable pace and that WLS is no longer needed. Or conversely, you may find that it makes no difference and confirms that WLS is the right next step. And 3) I'm sure he wants to make sure that there is no unaddressed underlying ED at play. Many folks who seek WLS do have EDs or have had them in the past; you're absolutely right that its not uncommon, although not always the case. That being said, someone in the throws of an ACTIVE ED who is not receiving treatment and in recovery, should not be considered for WLS. This goes back to #1 - your head has to be in the right place before going through with such a major event. I know it may feel like he was targeting or stereotyping based on your BPD, but I think he just wants to make sure you are set up for success. WLS is a big deal and it wouldn't be healthy for your body or mind to do it without informed consent and the pre-work needed to get you truly ready. If you feel like this is what you want and is the right step, then stay the course. Do the diet stuff, keep taking your meds, go to therapy, and it will happen in due time. You've got this!

I do not have BPD or an ED, but I do have severe depression and GAD which have played a HUGE role in my weight issues. Personally, I did 18 months of therapy (and meds) before I considered WLS. I have been 10)% honest with my PCP, therapist, the surgeon, and my husband so that I have the support and accountability I need. I knew I needed to get my head right and deal with some of the things that caused me to have such a disordered view of food and my body, before I could do anything else. I think there are a couple of things at play here: 1) the Dr. wants to make sure you are stable and responding well to your new treatment because WLS is a major life changing event. If your mental health is not at its best, you risk some serious issues. Its so, so important that your heart and mind be ready for surgery or it could very negatively impact your mental health long term. 2) I would guess that he's wondering if having your BPD treated might change the outcome of your weight loss efforts. You've never tried to lose weight with controlled BPD before now; it was undiagnosed and therefore no telling how it impacted your weight loss. As you said, you've had success before regain, but it sounds like some of the patterns you experienced may have resulted from the untreated BPD. You might find that with your new treatment regimen, its easier to lose weight at a healthy, manageable pace and that WLS is no longer needed. Or conversely, you may find that it makes no difference and confirms that WLS is the right next step. And 3) I'm sure he wants to make sure that there is no unaddressed underlying ED at play. Many folks who seek WLS do have EDs or have had them in the past; you're absolutely right that its not uncommon, although not always the case. That being said, someone in the throws of an ACTIVE ED who is not receiving treatment and in recovery, should not be considered for WLS. This goes back to #1 - your head has to be in the right place before going through with such a major event. I know it may feel like he was targeting or stereotyping based on your BPD, but I think he just wants to make sure you are set up for success. WLS is a big deal and it wouldn't be healthy for your body or mind to do it without informed consent and the pre-work needed to get you truly ready. If you feel like this is what you want and is the right step, then stay the course. Do the diet stuff, keep taking your meds, go to therapy, and it will happen in due time. You've got this!

Wow thanks for this insight! Yeah it's a tough one. I think he'd like to see how I do. He did mention regardless of surgery he wants me on their pre surgery diet - it might be good enough. One of the toughest road blocks is that my meds are incompatible with the surgery and I might need to switch. I told him they were working well but in willing to switch for surgery. He seemed like let's fight one battle at a time.

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