Weight Loss Surgery provides a tool. It isn’t the end of what we do

Does having weight loss surgery increase your risk of suicide or self-destructive behavior?

This is the issue raised in recent article of JAMA Surgery, where patients were followed for several years and found that “self- harm emergencies” increased after surgery. Most of those patients had previously been diagnosed with a mental health disorder prior to surgery.

So the ratio of self harm of 1.54 though – how does that compare with other risks of self-harm from mental illness?

It turns out that if you are prescribed a common anti-depressant, your risk of self-harm over that of those who had bariatric surgery is insignificantly higher.

In other words- when comparing the risk of self-harm of patients who have undergone weight loss surgery with those who have simply been prescribed medication, the risk is essentially the same.

Does that mean weight loss surgery is a therapy for mental illness – no. Nor does it mean that weight loss surgery is a risk for mental illness. It means that people who have mental illness have a risk of self-harm – a small risk.

But looking at some other studies:

The University of Chicago has a series of papers following weight loss surgery patients that show there is less depression, a greater sense of self-worth, and have better controlled depression among patients who had lost weight.

While patients are screened for mental illness prior to weight loss surgery, it is not weight loss surgery that is a marker for increased risk- it is those patients who have prior mental illness. Of the patients in this study who had done harm to themselves 93% had a prior history of mental illness, and for 7% it may be that their first encounter with a behavioral health professional was in the screening process we do for weight loss surgery.

Finally, mental health is a chronic condition needing chronic treatment. In other words, we need to do a better job throughout our medical system for mental health, not just prescribe and forget. Weight loss surgery might be the first place some people encounter a behavioral health worker, and to engage with them. Those patients should be encouraged to continue with their mental health professionals for treatment, and monitoring of their issues, and know there is a place they can reach out to if they feel a need for support.

In the Nuka system of health care in Anchorage, there is a primary care panel that not only includes a primary care physician, but a mental health specialist. That mental health specialist is there every visit to help assist those patients with resulting decrease in mental health visits to the emergency room, including those for self harm.

Weight loss surgery is not an increased risk for mental illness, but it may be a place where we can first encounter those who need help, and encourage them to continue to see someone to follow up with them.