Can Bariatric Surgery Cause an Eating Disorder?

Repeated experiences seeing post-Bariatric surgery patients are perplexing and disturbing to the clinician who treats people with eating disorders. Obesity is clearly a significant health issue in large parts of the world; however, permanently altering someone's gastrointestinal anatomy to make possible longterm starvation is a destructive and counterproductive solution. 

The grand experiment of culturally sanctioned starvation has caused multiple chronic medical problems, number one on the list being eating disorders. The result of idealizing the extremely thin has been to encourage and blindly support constant dieting and starving. 

We have learned that people have a varied but ingrained and largely genetic response to chronic starvation. The most common response is overarching hunger that usually triggers one form of eating disorder symptoms or another. 

Bariatric surgery often causes a form of binge eating. Most people can starve for 6-9 months and lose a significant of weight before the starvation response takes over and the uncontrollable urge to eat dominates one's thoughts and actions, thereby leading to binging. 

The solution, as with all eating disorders, is to start by normalizing a meal plan. Consistent nutrition signals the body and mind that the famine is over so normal body function can resume. Doing so will gradually let the starvation response subside. 

What's particularly concerning is the medical community's reaction to these cases. Uneducated in eating disorders, most doctors are perplexed by these symptoms. Bariatric surgeons continue to encourage starvation and weight loss, while the Bariatric nutritionists do not consider changing their recommendations for prolonged malnutrition. Endocrinologists encourage medications to treat the increased hunger. No one considers the effect of chronic starvation, largely because thinness is of primary importance. 

The Bariatric community needs to team up more closely with eating disorder clinicians in order to better understand the repercussions of these surgeries. Curing obesity by causing an eating disorder is certainly not a viable means of treatment.


Can People with Eating Disorders be "Treatment Dependent"?

I heard a new term in the treatment of people with eating disorders this week: treatment-dependent patients. I was flabbergasted by the judgment and blame associated with this label, especially since it came from a program well versed in the need for kindness and compassion. 

The overt message appeared to be that patients should not be dependent on their treatment to get well while the implied message is that chronicity of an eating disorder is the patient's fault. 

For those who read my blog, it's clear that dependence on treatment is a necessary part of recovery. The eating disorder serves as a constant companion, comfort and salve for all the events of daily life. Weaning oneself from such a critical part of life demands a drastic shift in lifestyle. Depending on treatment can be a bridge towards learning how to depend on close relationships in daily life while learning how to eat normally again. That dependence makes the eating disorder less necessary over time. The relationship serves as a jumping off point for independence, not a reason to remain ill. 

The chronicity of an eating disorder is not the failure of the patient. The implied message is that the person just needs to try harder or to learn to stand on her own two feet. Anyone knowledgable in eating disorder treatment knows this message only sends someone to relapse because it reinforces self-criticism and self-blame, the cornerstones of the eating disorder.

The eating disorder thoughts and behaviors become so ingrained and automatic that only sustained support to change these patterns over time will have an impact. Urging someone to just figure it out implies a lack of ability on the treatment providers to manage the illness. 
This is certainly not the first time I have heard clinicians blame the patient for her illness. Usually inexperienced therapists will state uneducated opinions which only show a lack of understanding of the nuances of eating disorders. That's not surprising since it is hard to find thorough training for treatment of these illnesses. 

However, the term treatment-dependence comes from an established and esteemed organization. When patients are blamed for their illnesses, it's time for the treatment providers to delve into their own motives to be sure they have the clarity needed for this type of work.


Surviving the Pressure to Diet, Part II

The ideas of the individual diet and the pressures to constantly diet from the last two posts open the door to a new philosophy of not just eating disorder recovery but eating in our current environment. 

The concept that there is one correct way of approaching food, body and health contradicts everything we know about the human body. Although we all have the same organs and function similarly, our genetic differences underlie a vast range of traits from appearance to personality to our unique fingerprint to organ function. 

In other words, we are each our own person. The collective attempt to universalize food choice and metabolism as if we are all the same rails against these truths about humans. 

I have written extensively in this blog (post1, post2, post3) about the societal pressures which have encouraged these falsehoods to pervade our world. The media pressure for thinness, the diet industry, the pervasive food industry and weak regulatory system (influenced largely by industry lobbying) have all weakened the clear message from science: we are each an individual human. 

And so the philosophy that will counteract these pressures has two parts: learn about your own body and life is more important than food. 

Well-being and health have many components, and one is food and nutrition. Although there are some basic facts about nutrition that matter for us all, for example eat a variety of food and eat real food, what works best is the individual diet. Learn what types of foods work best for you, the way of eating that fits your digestive system and meal sizes that help you function at your best. For people with eating disorders, there will be a period of following someone else's plan to relearn how to eat first, but others can start to learn about their own bodies right away. 

Second, despite the pressure to prioritize food, spending an enormous amount of time on food and weight wastes time better spent on living. People with eating disorders or those with disordered eating know that obsessions about food can consume one's internal world.

It's so important to make sure life--family, relationships, work, hobbies, interests--matters more than simply thinking about body and food. Life leads to more satisfaction every single time.


The Individual Diet: Just One Person at a Time

Part II of surviving dieting will come next post in order to spend a few moments on a new and crucial line of research related to both eating disorders and the societal understanding of metabolism and weight. 

A recent article explained some new findings about the treatment for obesity which turn the common notions about dieting and food choice on their head. The underlying message is that all meal plans and all foods are not equal for everyone. The variability of digestion and gastrointestinal endocrinology between people means that various foods do not have absolute value. Instead diet options need to be tailored to the individual. 

This is new, profound information for the lay person and confirms that considering all food to be equal to all people seems absurd.

We all look different. We all have different physical, intellectual and social skills and weaknesses. We all have different vulnerabilities in the world. Why would our biological response to food be universal?

The specific research quoted here focuses on the body's immediate endocrinological response to a meal. Specifically, how fast does an individual release insulin--the hormone that informs the body it is time to utilize new energy that just entered the bloodstream. The article proposes, based on clearly described data, that this variability in a biological response to food indicates that different meal plans are necessary for different people. 

It is new for any treatment plan, medical or otherwise, to approach obesity, eating disorders or even improving one's overall diet from an individual perspective. All diet advice is general, as if one person or plan can assert a diet that will help all people. More importantly, the desperation of the public to find an ultimate solution to food leads many people to follow these unreasonable expectations to their ultimate failure. 

Instead, it behooves the medical community, clinicians who treat eating disorders and the public to heed the message behind this article. The point of any attempt to improve one's health through a new diet is a personal endeavor. There is no right way. There is a meal plan that will improve one's own health, and the goal is to seek a way of eating that allows each individual to live their life fully feeling healthy and strong.