Have you ever had a question about weight loss surgery, dieting, or just about life as an overweight person but were too embarrassed? In this ongoing column, entitled “Ask a Fat Man”, I will take reader questions about any obesity or weight loss related subject they want to ask and give an answer straight from the personal experience of being a one-year banded Lap Band patient and a life long fat man who has lost over 150 lbs with Lap Band surgery. Please note I am not a medical professional and if you are considering any weight loss surgery you should consult a weight loss surgery center in your area.
Reader John from Hendersonville, TN writes: “I read somewhere that people who have weight loss surgery have an increased risk of committing suicide. What do you know about this?”
Great question, John. There’s been a lot of research in recent years about this topic, the most recent being a 2010 study in the American Journal of Medicine. Most of the studies do find that suicide rates for weight loss surgery patients are significantly higher than those of the general public. The 2010 study cited a rate of 14 per 10,000 for weight loss surgery patients compared to 2.5 per 10,000 in the general population. So it’s a statistically significant concern, although it’s still a pretty low instance overall. The question is, why is the rate so much higher?
While I am not a medical or behavioral health professional, I am a successful weight loss surgery patient who has at times suffered from moderate to severe depression. Here’s my take on the reasons.
Change is hard
Statistically, we know that 70% of suicides among weight loss surgery patients occur within 3 years of the procedure. I don’t think that it’s a coincidence that the first three years are also when the largest portion of your weight loss happens. Change is hard and you will likely do nothing that will upend your life the way weight loss surgery will. Your entire relationship with food will change and you will quickly discover just how much of your life connects with food in some way. That much change is difficult for some people to cope with.
While the suicide rate for weight loss surgery patients is significantly higher than that of the general population, the vast majority of suicides among the general population are people with persistent mental illnesses. While I was unable to find a “per 10,000” suicide rate for people with diagnoses, my guess is that it would be a lot closer to the one for weight loss surgery patients. That’s no coincidence. The AJM study cited earlier finds that almost 2/3 of weight loss surgery patients had an “Axis I” diagnosis. Severe depression is common among the morbidly obese, who are one of the last minority groups it is still “socially acceptable” to ridicule in popular culture. Obviously, virtually all weight loss surgery patients have an eating disorder, which is often a coping mechanism for depression or anxiety.
One of the things you will likely be warned about at your psychological exam prior to weight loss surgery is the danger of addiction. Weight loss surgery patients are virtually all food addicts. When you begin to break that food addiction after weight loss surgery, there is a real danger of that addiction being transferred elsewhere. My psychologist warned me about patients he has seen ruin their lives after weight loss surgery by becoming gambling addicts, drug addicts, or sex addicts. Addictive behaviors, and the carnage it causes in lives and relationships, could be a big reason why weight loss surgery patients have a higher suicide rate.
Removing the armor
For the morbidly obese, food is armor. It is what comforts us when we’re sad, what rewards us when we’re happy, what assists us with social interactions. Food takes on an almost religious aspect. When you have weight loss surgery, you have to learn to cope with all of those things without your armor. You will have to learn how to handle depression without reaching for the box of ice cream. You’ll have to learn how to reward yourself without a trip to Ben & Jerry’s. You’ll have to learn to interact with a world of people in situations that constantly revolve around food with a limitation. Think about it. A drug addict can give up drugs forever and can remove himself from situations where he will be around illegal substances. Food addicts must continue to interact with the thing that drives their addiction on a daily basis. This is much harder than it is possible to put into words. Some weight loss patients can’t cope and, when they return to their addictive behavior, consider themselves failures and opt for suicide.
The mirror lies
One secret that they never tell you when you have weight loss surgery is that you will never see yourself as a thin person. Every weight loss surgery patient I have spoken to has said that when they look into the mirror, they see the same overweight person they always saw. They continue to interact with the world like an obese person, checking seats to make sure they’ll hold them, avoiding tight quarters, and wearing loose clothing. When you have friends and loved ones constantly telling you how great you’re doing and how good you look, it’s sometimes daunting. You don’t see what they do and sometimes you feel guilty. Some weight loss surgery patients have a fantasy of seeing themselves as a thin person, only to discover that their minds won’t allow it, no matter how much they lose.
While suicide rates are much higher for weight loss surgery patients than the general population, there are ways to cope. Every reputable weight loss surgery center should have fliers for support groups in their offices. Every reputable weight loss surgery center should be able to refer you to a local psychologist who specializes in eating disorders. If the weight loss surgery center you’re considering doesn’t have those things, find another one. It’s that important.
John, I hope this helped you out and, if you decide to go through with weight loss surgery I hope it goes well for you.
If you have a question you’d like to Ask a Fat Man, send me an e-mail or put it in the comments section of this article and I will try to answer it.