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Gastric Bypass Elevates Suicide Attempt Risks: Patients Most Vulnerable Within Three Years After Weight Loss Surgery

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A much higher risk of self-harm showed among gastric bypass surgery patients than before their weight loss procedure, a new study found.

Researchers at the Sunnybrook Research Institute in Toronto, Canada, studied more than 8,800 individuals – 81 percent of them women – and tracked self-harm emergencies three years before and after they underwent the operation.

Led by Junaid Bhatti, PhD, and published in JAMA Surgery on Oct. 7, the research team recorded 62 incidences of self-harm in the three years before the surgery, but this rose by 54 percent in three years following the operation, with 96 reported cases.

The research “underscores the unique vulnerability of patients” going through bariatric surgery and forces a look at why suicide rates are over four times higher in this group than the general population, according to Amir Ghaferi, MD, and Carol Lindsay-Westphal, PhD, from the University of Michigan.

Intentional overdose emerged as the most common way (72.8 percent) of inflicting self-harm among the subjects, while self-hanging accounted for 20.9 percent. Patients older than age 35, rural dwellers and low-income ones, also tended to be more vulnerable to suicidal behaviors.

All study subjects lived in Ontario, with all adults within 18 to 65 years old. They underwent the surgery from April 2006 to March 2011, while the data on self-harm were based on hospital emergency visit.

Bariatric surgery should be deemed a treatment, not a cure, argued Craig Primack of the Scottsdale Weight Loss Center in Arizona.
According to Primack, a patient subset in his practice believes that many of their problems – including a bad marriage and poor job – are rooted in their weight issues.

“[W]hen they get down to a specific weight then everything will be OK,” he said, but added that people “literally stall” once they realize they will not achieve their goal that their thought the weighing scale would fix.

Australian doctor Tania Markovic, director of metabolism and obesity services at Royal Prince Alfred Hospital, highlighted the “unrealistic expectations” of patients after surgery as a potential factor in the increased risk for self-harm.

“If a patient has unrealistic expectations about how their life will change following surgery this can be problematic,” said Markovic, although bariatric surgery can be “very effective” in disease control and typically results in improved well-being and quality of life.

He echoed national recommendations for a multidisciplinary team’s management of bariatric surgery patients, from dietary care to psychological support. He added that this is particularly important for those with a history of mental issues, who surfaced with the highest rates of self-harm.

Photo: Tony Alter | Flickr

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