When Eating Disorders and Bariatric Surgery Overlap
Katy Harvey, RD, CEDRD
Debra (not her real name) walked into an appointment at her doctor’s office, dreading the conversation that would inevitably come up about her weight. “I see that you’ve gained some weight in the past year, Debra,” the doctor said, “And your blood pressure is still high. Have you ever considered bariatric surgery?”
Debra’s heart sank. “Bariatric surgery? That’s a pretty big step to take and it sounds kind of scary,“ she thought. She had been trying so hard to diet and lose weight this past year, but it seems like every new diet she tries gets shorter and shorter. And her weight keeps getting higher and higher with each diet. “Maybe I should just have the surgery. I’ve failed at everything else. And if my doctor is saying I should do it, then it’s probably a good idea, right?”
Little did Debra or her doctor know, she didn’t have a weight problem. She had an eating disorder.
Debra went through with the surgery. She initially lost a lot of weight pretty effortlessly. Then a couple of years after the procedure, she started regaining it. Fast forward another year and she was nearly back to her pre-surgery weight. She was humiliated and devastated. “I’ve literally tried everything,” she thought, “If surgery can’t fix me, then what will?”
That was when Debra, after a long night of internet searching, stumbled across a clinic that treats eating disorders. After reading their description of clients who have eating disorders in conjunction with bariatric surgery, she knew she had found the right place and her journey toward healing began.
[Let me be clear before we go any further: This isn’t an article about whether I’m for or against bariatric surgery. That’s a complex discussion for another time and place. This is about the intersection of bariatric surgery with eating disorders, and the lived experiences of those who are dealing with this reality.
Eating Disorders and Bariatric Surgery Collide
The worlds of eating disorders and bariatric surgery usually seem miles (even universes) apart. But here are some important facts:
It is estimated that anywhere from 15-26% of people seeking bariatric surgery have binge eating disorder (Mitchell 2015, Marek 2014).
Many more people go on to develop an eating disorder, or sub-clinical disordered eating, after bariatric surgery.
Binge eating disorder is more common than anorexia and bulimia combined. People with BED are often referred for bariatric surgery rather than eating disorder treatment.
You can see the problem this creates. If someone having bariatric surgery actually has an eating disorder, the surgery is likely to create more problems for them. AND the surgery doesn’t address the underlying emotional issues at the core of the eating disorder, especially the body shame.
The medical community needs to start recognizing that their proposed solutions to “weight issues” are at best unhelpful, and at worst outright dangerous.
Eating disorder professionals work constantly with clients who have followed their doctor’s recommendations for bariatric surgery, only to find that the surgery didn’t “fix” their issues. In fact, it often creates more problems.
Consider it this way: bariatric surgery certainly isn’t brain surgery - meaning that no matter what physiological benefits a person ~might~ experience, the surgery doesn’t have the power to treat an eating disorder, which is a serious psychological illness with very real ramifications.
“But I HAVE TO lose weight to be healthy.”
This is a huge misconception. The process of dieting and weight cycling (the yo-yo’ing up and down of weight) is actually more detrimental to the body than maintaining a stable weight, even if that weight is at a higher BMI than what is labeled as “normal.”
Most people who have bariatric surgery have done years, even decades, of dieting. In fact, many times they have dieted themselves up to their highest weight. And while the surgery does usually produce some weight loss, it is possible to re-gain the weight (another form of weight cycling) which takes its toll on the body, as well as a person’s psyche.
Recovery is Possible
An untreated eating disorder can be far more detrimental to your physical and mental health than is being in a larger body. With effective eating disorder treatment your body will find the weight it is meant to be at. You will learn to accept that this is the natural weight for your body. Accepting your natural weight doesn’t necessarily mean you will like it - but you can choose to call a truce with you body and treat it with respect and dignity.
If you have an eating disorder and have had bariatric surgery, don’t fret. Recovery absolutely is possible. In this short ebook I have created a step-by-step guide to getting started. You deserve the richness of a life free from the misery that your turmoil with food has caused.
Katy Harvey, RD is a Certified Eating Disorder Registered Dietitian (CEDRD) from Kansas City. She has an outpatient private practice where she helps individuals heal their relationship with food, exercise and their body. She also blogs at Katy’s Blog.
