How Weight Loss Surgery can affect Mental Health

Losing weight and recovering physically are usually the main priorities after weight loss surgery, but it is important to be aware of your mental health too.

Research has actually shown that the risk of mental health disorders can increase after weight loss surgery. One recent study found that obese teenagers who underwent bariatric surgery were more likely to experience negative changes in their mental health than those who did not. The reasons for this are complicated and are probably linked to the more extreme and rapid physical changes that take place after surgery. It is important to note that more people experience an improvement in their mental health after weight loss surgery than will see it get worse. However, you should be aware that having bariatric surgery could have a significant impact on your mental wellbeing. 

Common Mental Health Issues After Surgery 

Anxiety, Guilt and Shame: These are common experiences for a bariatric patient after surgery.  They can find themselves with enhanced anxiety and fear relating to their health and fear of following the new lifestyle habit incorrectly leading to failing to lose weight or weight regain. Guilt and shame can come from how they feel about themselves for being in the situation where they needed surgery instead of being able to lose weight through other ‘traditional’ weight loss approaches. After time these strong emotions can reduce and disappear when weight loss success is experienced and confidence grows.  But until then this needs to be managed and emotions need to be regulated.

Grief and Loss: When food has been such a constant source of pleasure and comfort throughout life for many people choosing surgery, grieving food, missing the life they had, and regretting the surgery itself, are very common thoughts and feelings post operation for some patients. However, those who feel regretful state this feeling goes away after month 5 post-surgery. They also state that they regret not having done the surgery sooner, and that once your new eating regimen has become a habit, the grief subsides too.

Nutritional changes: Nutritional changes after bariatric surgery may contribute to the development of depression, destructive eating behaviours and body image issues. Changes from weight-loss surgery cause difficulty in absorbing vitamins and minerals and can lead to deficiencies in iron, calcium, several B-vitamins, vitamin D and other vitamins and minerals. The surgery can also affect the ability to absorb protein and cause lactose intolerance. Difficulty absorbing protein can affect mood and behaviour because the amino acids found in protein are what the body uses to make the “feel good” chemicals in our brains – serotonin, dopamine, and epinephrine.

Depression:  Most people approach the surgery with a positive attitude. Thoughts about future weight reduction, health benefits, and improved quality of life are dominant while awaiting surgery. After surgery however, reality does not always live up to the preoperative fantasy, and some patients do experience depression.  There are a range of reasons for low mood after bariatric surgery:

• Food Can’t Be Used as a Coping Mechanism: Many people who are struggling with obesity use food as a coping mechanism, which is a reason why weight loss may be difficult in the first place. Those who use food as a coping mechanism feel that food is not just nutrition, it is happiness when you are sad, excitement at holiday events, and a reason to go out with friends. When you go through weight loss surgery, it is advised to not use food as encouragement or as a comfort measure. There has also been to be a correlation between post-bariatric depression and the number of eating disorders that can occur.

• Life Isn’t Automatically Easy After Surgery: Unfortunately, a lot of people who have metabolic and bariatric surgery expect life to automatically be easier when they wake up after the surgery, and this is not the case. Post-op, you still must adapt to healthy eating and exercise to see long-term weight loss results. Surgery doesn’t automatically make your relationship with food better; it doesn’t automatically make you thinner and it doesn’t always make life easier. It is a great tool for tackling obesity-related health conditions and quality of life. It also can help the weight come off a bit quicker than it would have before surgery, but you still must work at it. You will also go through a recovery period as your body heals to get used to the way your new stomach works.

• The Results of Extreme Weight Loss:  The most significant weight loss is typically seen within the first year after weight loss surgery. But what follows that? Weight plateaus are a normal occurrence as the body tries to protect your organs and slow down weight loss. However, the result of weight plateaus and the loose skin that follows extreme weight loss has been shown to result in higher risk of body dissatisfaction, low mood, and depression.

• You Might Have to Miss out on Social Events: After having bariatric surgery, it is nearly impossible to eat as much food as you did before. The stomach has been adjusted to no longer be able to hold the same capacity of food. Your alcohol consumption will also be altered because of the way your body will now metabolize alcohol. It is absorbed into your bloodstream quicker and can have effects on the body even after a few sips.  It also isn’t recommended to eat and drink at the same time. The guideline is to only drink 30 minutes before or after any meal. This means that you are very limited in how much you can eat and drink. So, social events look a little different after surgery, and although its nothing a little adaptation can’t fix, some patients find this daunting and embarrassing and can isolate themselves from friends and families to escape the events.

Neurodivergence: Currently screening for neurodivergence does not take place before surgery, and the bariatric journey process is developed for a neurotypical brain not a neurodivergent one. There can be at times difficulties with diet for some neurodivergent adults:

• Potential issues around fixed patterns of food
• Food textures, smells, and tastes.
• Food having to be presented in a certain way, possibly not touching other foods on the plate.
• Hyper-fixation on foods then complete disgust at the same food.
• Boredom and simply forgetting to eat or drink.

Neurodivergent individuals may experience symptoms that increase their risk of disordered eating, such as sensory sensitivities or trouble connecting with bodily hunger cues – these can continue or escalate post-surgery.

Body dysmorphia: Body dysmorphia exists for some who are on the journey toward significant weight loss.  The very nature of weight loss surgery (and the diet and activity changes that come with it) mean that a lot of patients will naturally become more focused on their physicality.  They will be closely monitoring food intake, exercise, weight, measurements, etc.  The focus is literally on improving one’s physical body.  Given those circumstances, it is not a big leap to enter body dysmorphia territory if left unchecked.

Body dysmorphia can manifest differently at different stages of the weight loss process.  During the early stages, patients may experience anxiety if their weight plateaus for several days, or slightly increases at times.  These fluctuations are normal and to be expected but nonetheless can cause a lot of distress.  During the latter stages of weight loss, patients may become self-conscious about excess skin.  They may see it as more severe and unsightly than it appears to others.

Disordered Eating: Disordered eating behaviours (DEBs) are associated with poor weight outcomes following bariatric surgery, a desperation to lose the weight and a fear if weight regain.

Cross Addiction: Cross addiction is loosely defined as exchanging one drug of abuse (such as food) for another (for example, alcohol). Some individuals who undergo weight-loss surgery develop disordered eating and other addictions, including gambling, drinking, smoking, drug use and may be more prone to shopping or sexual addiction after surgery.

Caring For Your Mental Health 

Bariatric surgery and the resulting weight loss will have a big impact on your mood, energy levels and relationships. It is important to take good care of yourself to ensure that these effects are as positive as possible: 

• Make sure that you know what to expect after the operation. Be aware that your feelings and relationships could be affected in both positive and negative ways.
• Remember that losing weight is a slow process and that you should be making permanent changes to your diet and lifestyle.
• Identify any anxieties or emotions that drive you to overeat and find a better way to tackle them. For example, pick up a new hobby to prevent boredom or try relaxation exercises to reduce anxiety.
• Talk to someone about your positive and negative feelings. Friends and family members can make great listeners, but you might also want to join a weight loss group in your area or online.
• Tell your family when you need help. It’s particularly important to get support from the people you live with, so make sure that they understand what you need even if it’s just a hug or help preparing healthy meals.
• Ask your GP or obesity specialist for help if you’re struggling or feeling low after weight loss surgery. They may recommend a therapist or other options to help you to cope.

Here at Bariatric Support, we appreciate that post-surgery aftercare is crucial for achieving your desired bariatric results, which is why we are doing everything we can to make professional support available to you in the most affordable way possible.  If you have any further questions about mental health issues or feel you might benefit from therapy please check out the Centre for Bariatric Support Directory: https://directory.centreforbariatricsupport.com or email: [email protected]