In Australia, more than 90 percent of bariatric surgeries occur in private clinics. Sadly, these facilities are not mandated to check patients for eating disorders prior to administering the procedure. Health professionals have raised alarms about this hands-off approach. They flag important concerns that patients may be at increased risk for the subsequent development of eating disorders post-bariatric surgery. Experienced experts, such as Stefania Franja, a psychologist who specializes in eating disorders, know that pre-operational psychological evaluations are crucial before any of these drastic surgeries.
Stefania Franja has counseled thousands of patients pre- and post-bariatric surgery. She emphasizes that those who identify with this demographic face serious mental health distress. We know that the bariatric population is super vulnerable,” she said, underscoring the perils of poor pre-surgical evaluations.
Studies underscore that psychological effects of bariatric surgery not only appear, but are profound. Patients with eating disorders have greater risk for negative outcomes following the surgery. Individuals like Jess, who underwent gastric sleeve surgery—a non-reversible procedure that removes approximately 80 percent of the stomach—have shared their experiences regarding the lack of psychological support before and after their surgeries.
A Call for Change
Jess had become bulimic and a compulsive exerciser soon after Jess underwent the surgery. She took these steps because she was afraid to regain weight, but she was never screened for an eating disorder prior to surgery. She wrote candidly about her guilt. Who, after spending hundreds of thousands of dollars on surgery with her family, still loathes the way she looks. Jess’s case is hardly the exception. Many patients are left dealing with body image issues even after they have lost a substantial amount of weight.
Experts like Natalie Spicer, head of clinical and support services at the Butterfly Foundation, advocate for mandatory psychological screenings prior to bariatric surgery. Spicer hopes that patients will be treated as more than just numbers or possible contributions to a profit margin, but as holistic people. “We really need to view patients as whole people,” she said. They aren’t just an arbitrary metric used for greenwashing either, or as a number on an old-school dashboard.
Franja has expressed similar thoughts, arguing that screening would do more to prepare patients for what they might experience after surgery. Now, patients are experiencing skyrocketing levels of depression and disappointment despite having reached their weight loss goals. She pointed out that unlike other patients, there’s no continuity of follow up care for them.
As we’ve entered into 2023, the alarm around these issues has intensified. Legislation recently passed requiring psychological evaluations for patients seeking certain cosmetic surgeries and procedures. For these surgeries, advocates are now demanding that the same standards be enacted universally.
The Mixed Evidence on Mental Health Outcomes
Nick Williams, the incoming president of the Australian and New Zealand Metabolic and Obesity Surgery Society (ANZMOSS), was quick to recognise the important takeaway. He noted the evidence related to mental health outcomes post-op is clarity. He explained that while many patients enjoy greater mental well-being in the aftermath of surgery, not everyone passes through the door to recovery.
A new study has just been released and the numbers are shattering. It indicates that three quarters of deaths by suicide happen in the first three years after having bariatric surgery. Read together, these findings point to a truly alarming lack of mental health assessments prior to such invasive, sometimes irreversible, procedures.
Stefania Franja believes that proper screening could lead to better mental health outcomes by encouraging patients who experience negative effects after surgery to seek support. She continued, “The surgery [could have] fixed my stomach, but it didn’t fix my head.” This further underscores the gap that many patients feel upon reconciling their physical change with their mental health comfort level.
Many patients do not realize they have an underlying eating disorder until after their surgery. Franja shared stories from her practice of clients who were surprised to learn that they had an eating disorder. They cheered, “I’m just really awful at dieting!”
Personal Experiences Highlight Systemic Issues
Chontelle’s experience with bariatric surgery illustrates these systemic issues. She described feeling dismissed during her consultations: “It felt like it was out the door, ‘Thanks a lot and see you later,’” she said. She remembered a time when she was weighed in front of other staff as a way of further humiliating her. I think I heard somebody say, “How much?” In response, my surgeon shot back my weight. Then I listened as they high fived each other, laughed and walked away.
Chontelle’s story shows us the cost, often emotional, that may come with the weight-loss journey—especially when we don’t prioritize mental health. She emphasized the importance of having conversations with a professional who understands the complexities of eating disorders: “Being able to talk to someone and actually articulate what’s going on inside your head is so helpful because there’s so much shame and embarrassment [that comes with eating disorders].”
These testimonies distill a broader narrative playing out in the bariatric community. Together, they inspire us to take a more empathetic and holistic view of patient care. By focusing on the psychological impacts of these physical changes, healthcare providers may better prevent the many risks that come with weight-loss surgeries.
