BED and psych clearance

[Nepenthe44 188]

Does anyone have experience getting cleared for surgery with a recent history of binge eating disorder? Or know what the official definition of remission is?

My bariatric program reached out to my psychiatrist, who apparently said I'm not a candidate for WLS because of a history of BED that's in "partial remission". During our last meeting a few months ago, I was still having small binges about once a week. Since then, I binge less than once a week (a BED diagnosis requires binging at least once a week for at least 3 months) and my binges are getting smaller and smaller over time.

I haven't received any notice from my bariatric program or my psychiatrist (I found this out by reading a chart note about the phone call between the two), so I'm not really sure what I should be doing. (Other than the obvious of not binging and continuing to work on my diet and exercise behaviors, like I was doing anyway.)

Edited September 15, 2022 by Nepenthe44

[kcuster83 1,504]

There was a woman in another forum I am a member of who was an untreated binge eater. She was required to have extra sessions with the therapist but she was eventually approved. I wish I remembered who she was so I could try to connect you with her.

Good luck

[KimA-GA 540]

i have BED but made big strides before the bariatric surgery process started and eve tho I am still in a new reality my psych eval wasn’t too concerned.

I strongly suggest no matter what you look into why you binge with a therapist or in another therapeutic manner BEFORE surgery.

I had circumstances come together which made me able to face my demons and am now better for it.

BED goes so far beyond food. Food is only a symptom, not the real problem.

feel free to reach out anytime in PM or on here (anyone/everyone) anytime!

[Nepenthe44 188]

22 minutes ago, KimA-GA said:

i have BED but made big strides before the bariatric surgery process started and eve tho I am still in a new reality my psych eval wasn’t too concerned.

I strongly suggest no matter what you look into why you binge with a therapist or in another therapeutic manner BEFORE surgery.

 I had circumstances come together which made me able to face my demons and am now better for it.

BED goes so far beyond food. food is only a symptom, not the real problem.

feel free to reach out anytime in PM or on here (anyone/everyone) anytime!

I appreciate the offer.

I've been in therapy focused on BED for half a decade and think I have a good understanding of what's going on with me and I've gone from severe/extreme BED 15 years ago to moderate a decade ago to mild (as of my last meeting with this psychiatrist) to not meeting the diagnostic criteria at all now. I've lost a greater percentage of my body weight before surgery than research indicates a person with BED should expect to lose after surgery.

It's more than a little irritating that having self-awareness of the disorder and thus being in active treatment is putting me at a disadvantage when it comes to getting WLS compared to the significant fraction of people who get surgery who have it and are unaware of it and thus have never been diagnosed or treated.

Like, if my psych meds were prescribed by my PCP, I wouldn't even be having this problem. But now I have a black mark on my record with this program and I can't just go to another one.

[KimA-GA 540]

10 minutes ago, Nepenthe44 said:

I've been in therapy focused on BED for half a decade and think I have a good understanding of what's going on with me …

great job with the hard work (and it’s soo hard)… just keep on and things will fall into place…

also talk to you out psych about his opinion of your recovery. maybe there is more he sees or he isn’t really seeing your whole picture.

i am only about 9 months in “remission” (seven at the time of psych eval) … this past week has stress tested me and the “worst” thing i did food wise was turn to an extra serving of sugar free Jello and ate it in a stress snit… it is freeing not to be held back due to the compulsion anymore…

Edited September 15, 2022 by KimA-GA

[ShoppGirl 4,801]

Just try to be patient is my suggestion. It is unfair that you seem to be being held to a higher standard for having admitted to your previous diagnosis but I’m confident they are really just trying to keep your best interest in mind and that’s why they are being so strict. It’s just another hurdle you have to get through but you WILL get through it. Perhaps your regular therapist can help by talking to the person who says you have mild BED rather than saying you are in remission. Do you still see them??

[fourmonthspreop 510]

I'm not sure there's an official definition all surgeons use. I think it's up to the individual assessment and the say of your mental health providers. If they don't give the green light, the doc definitely won't either. I was diagnosed with an eating disorder and bipolar a couple months before my surgery. The surgeon told me that excludes me from being a candidate but I begged and swore I was doing the work and would continue to for the rest of my life. We came up with a plan where I'd be on a supervised eating plan for a minimum of 3 months (actually we went to about 6 months and I believe I was officially approved after 5 months). Along with the plan came nutritional visits twice a month and while he didn't give me a weight loss goal, I had to be losing weight steadily, their recommendation was .5-1 lb a week. And then with that he said I needed to be in therapy (which I already was) so i gave him my psychologists info and continued working on my eating patterns with her and provide evidence of that. Then finally I had to pass their psychological evaluation. I also had to provide proof I was adhering to my antipsychotic meds.

I ended up losing 30 lbs in 6 months which was a good sign, found the cause of my binging, and developed my coping mechanisms by using them daily. I'm 6 months post op now and have lost 100+ lbs. I did not binge after my surgery, in fact the physiological changes coupled with the intensive therapy, it's not something my body or brain craves anymore.

Sometimes my brain wants to eat things because it remembers how good they tasted but it's never in excess and I feel like I can really taste things now.

I did binge once during the pre op diet but it was a mini binge brought on by fear and hunger and I got right back on that horse.

It's possible to have the surgery with BED. It's a big mountain to climb but work on finding your ideal treatment team specifically for surgery support and show the doc and your program that you're ready by sticking to a routine, being open about your victories and failures with your team, and giving it your all!

I am personally a strong believer that weight loss surgery also might really help treat BED but I understand it has to be controlled especially in the early stages of post op life as it can put you in harms way.

Best of luck!

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