Can Weight Loss Surgery Increase the Risk of Suicide?

For people who are morbidly obese or who have health problems due to being overweight, weight loss or bariatric surgery can be a highly effective way of losing weight and improving health.  But can it lead to a higher risk of suicide in some patients?

Typically involving reducing the size of the stomach using gastric bands or removing and/or resectioning parts of the stomach and small intestine, weight loss surgery has an extremely high success rate with many patients reporting losing sixty percent or more of body weight within three years of the  procedure .   The U.S. National Institutes of Health recommends weight loss surgery for patients with a body mass index of 35 or greater if they also have health problems linked to weight such as Type 2 diabetes or obstructive sleep apnea.  

Here in Canada, weight loss surgery is becoming extremely common with more than six thousand operations being performed between 2013 and 2014, a sharp rise from the 1,600 conducted in 2006.  Despite the medical benefits associated with weight loss surgery, a new research study suggests that the psychological costs for people who have the surgery but fail to lose the hoped-for weight can be far higher than has been previously realized.   Conducted by a team of researchers at the Institute for Clinical Evaluative Sciences (ICES) located in Toronto, Ontario, the study followed more than eight thousand adults who underwent bariatric surgery between 2006 and 2011 to measure risk of suicide or self-harm attempts.   

According to their results, which have just been published in the latest issue of the Journal of the American Medical Association-Surgery, one hundred and eleven patients had one hundred and fifty-eight self-harm emergencies during the three-year period follow-up.   The most common form of self-harm was intentionally overdosing on medication with half of all attempts leading to hospitalization.   Patients most likely to harm themselves following unsuccessful weight loss including those over age 35, have preexisting mental health issues,  have low incomes, or  who live in a rural area.

"Bariatric surgery in many cases is an extremely successful operation," said principal researcher Dr. Donald Redelmeier, an internal medicine specialist at Toronto's Sunnybrook Health Sciences Centre in an interview with CTV News.  "The average patient loses a lot of weight and some patients even get their diabetes cured."   He also states that weight loss surgery is often the last resort for many obese people and having it fail can be emotionally devastating. 

In discussing the depression that can often follow weight loss failure, Dr. Redeleier notes that  "It's a particular concern in that it doesn't show up immediately.  For the first couple of months after the surgery, there's no increase whatsoever. It mostly begins to appear in the second and third year.  And that's where we think there's a need for much greater followup, It's after the first year ... often the psychologists and the social workers have moved their interest onto other cases. That's when there seems to be some missed opportunities for intervention."



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