Troubled people who have weight-loss surgery are more likely to attempt suicide following the procedure, a new study suggests.
These patients were about 50 percent more likely to try to take their own lives after they lost a lot of weight, while more than nine of 10 suicide attempts involved patients with a history of mental health problems, the Canadian researchers found.
"While we are clear and confident about the medical benefits of weight loss, especially through weight-loss surgery, I think we're not as attentive to the potential psychological benefits or harms of it," said Dr. Amir Ghaferi, director of bariatric surgery at the Ann Arbor Veterans Administration Healthcare System in Michigan.
Weight-loss surgery can cause a dramatic change in a person's life, and people struggling with mental illness or depression may not be able to cope, said Ghaferi, who co-wrote a commentary accompanying the study.
The study was published in the Oct. 7 online edition of the journal JAMA Surgery.
Weight-loss surgery helps people who are morbidly obese lose weight. About 6 percent of Americans are morbidly obese, the study authors said, which is defined as a body mass index (BMI) that's 40 or higher or a BMI higher than 35 if it's accompanied with a serious health problem linked to obesity.
People who are morbidly obese often suffer from mental health problems, and previous studies have suggested that candidates for weight-loss surgery have a suicide risk that's four times higher than that of the general population, according to the researchers.
To see how weight-loss surgery might affect that suicide risk, researchers led by Junaid Bhatti from the Sunnybrook Research Institute in Toronto tracked more than 8,800 patients in Ontario for three years before and three years after their procedure.
Out of that group, 111 patients had 158 self-harm emergencies during the follow-up period, the study found. Most of the suicide attempts occurred in the second and third year after the surgery, the findings showed.
And about 93 percent of those suicide attempts occurred in patients diagnosed with a mental health disorder prior to surgery, the researchers reported. The most common type of suicide attempt was an intentional overdose, which occurred in 73 percent of cases.
The researchers said that previous studies have pointed to several possibilities for why this is so: changes in alcohol metabolism after surgery; a substitution of substance misuse for food; increased stress; and changes in the levels of hormones that might affect the likelihood of depression and suicidal behaviors.
However, this latest study did not prove that weight-loss surgeries cause an increased risk in suicide attempts among the morbidly obese.
The findings do point to the need for improved screening of candidates prior to weight-loss surgery and better follow-up care in the months after, Ghaferi said.
People must receive a mental health assessment prior to surgery, but the rules surrounding this requirement are fuzzy, he explained.
"We don't really have a good way of screening these people," Ghaferi said. "We don't have a good standard."
After surgery, patients often struggle to adapt to the way their rapid weight loss is shaking up their relationships with important people in their lives, Ghaferi said.
He gave the example of couples who are both obese.
"There's a problem when the partner who has surgery begins to lose weight," Ghaferi said. "Potentially they gain some self-confidence from that, but then their loved one begins to shun them because they're no longer alike. I've had patients say, 'My husband left me because I got too thin.'"
Doctors are rarely available to help patients through these changes, Ghaferi said.
"Bariatric surgery follow-up is notoriously poor," he said. "We try to maintain at least one-year follow-up with our patients, but it's hard. Patients fall off the radar. They move, or it's the type of operation where if they're doing well or doing poorly, they're not going to come see you."
Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, agreed that some patients with morbid obesity have problems in life that will not be solved through weight-loss surgery alone.
"These may be people who haven't been doing well in the game of life to begin with," Roslin said. "You hope that you've changed their destiny, and it turns out you haven't at all."
However, Roslin said he's against limiting weight-loss surgery only to well-functioning people with stable support systems, given that there is a chance that the surgery could improve the life of nearly any candidate.
"We know that high-risk patients don't do as well, but we live in a land of opportunity. Are we going to use outcomes as a way to deny opportunity?" he asked.