A Canadian study conducted by the Sunnybrook Research Institute and published in October by JAMA Surgery has found an increased risk of self-harming behaviors among patients who have undergone weight-loss surgery. The study of 8,800 bariatric-surgery patients revealed that 111 eventually engaged in acts of self-harm, including attempts at suicide and suicidal ideation.
The study, which followed participants for three years before and three years after surgery, found that participants’ risk of receiving emergency care for self-harm behaviors increased by 54 percent following a bariatric procedure.
Ashutosh Kaul, MD, FRCS, FACS, professor of Surgery at New York Medical College and director of Minimally Invasive Surgery at Westchester Medical Center, says that, as with all operations, there are risks associated with bariatric surgery, “including bleeding, leaks, pulmonary embolisms, strictures, and vitamin deficiencies.” Still, he maintains, bariatric surgery often “leads to sustained significant weight loss and resolution or marked improvement in obesity-associated diseases like diabetes, hypertension, sleep disturbances, [and] high cholesterol.”
There is currently no consensus on what may be driving this correlation, although there are several theories. Donald Redelmeier, MD, MSHSR, FRCRPC, co-author of the study and professor of Medicine at the University of Toronto, believes the link may lie in the surgery’s failure to meet with a patient’s expectations. “People often think there is nothing else they can do, and they give up hope,” Dr. Redelmeier told The Wall Street Journal.
Dr. Kaul suggests that the link may be “due to increased stress and anxiety after surgery which leads to…worsening of prior mental-health conditions.” He also believes that “procedures that potentially increase rates of absorption may lead to more rapid increase in alcohol or other substance levels, resulting in either intoxication or disinhibtion, leading to self-harm.” In addition, he says that “certain hormone levels are altered after these surgeries and that these changed levels may lead to depression and suicidal behaviors.”
Follow-up after surgery is essential, says Dr. Kaul, who cautions that “It is important for people considering bariatric surgeries to be aware of these studies to better understand the risks, benefits, and therapeutic alternatives of various procedures.”