As a psychiatrist treating people with eating disorders, I find that I have specific but unexpected expertise to help people after Bariatric surgery. These procedures aimed at reducing weight induce what I have started to call surgical anorexia.
Chronic anorexia leads to poor functioning of many organ systems due to long-standing malnutrition including the gastrointestinal system. Slow digestion, an inability to tolerate many foods, delayed emptying of the stomach and poor absorption of energy and vitamins are ways anorexia can affect the GI system. Thus, poor nutrition damages the GI system and makes it more difficult to absorb the needed energy.
Bariatric surgery shrinks the size of the stomach significantly which leads to an inability to eat a normal amount of food at one time and to more difficulty absorbing nutrients and vitamins. Essentially, the surgery mimics the same GI symptoms that chronic anorexia causes. Over time, these GI symptoms lead to starvation and the same medical effects of anorexia unless steps are taken to ensure adequate nutrition. It’s not a stretch to call this surgical anorexia.
After the surgery, patients I have encountered receive minimal instruction about how to alter their diet and their eating pattern to accommodate their transformed GI system. They need to learn new foods to eat, how much they can tolerate and when to eat through the day. Nutritionists at Bariatric centers tend to give a formulaic meal plan without any detailed, individualized instruction about how to maintain a normal diet.
The end result is often a patient confused about how to eat, eating an insufficient about of food and, after a few months, experiencing symptoms of malnutrition and starvation. These symptoms include nausea, weakness, dizziness, trouble concentrating and irritability. Often patients are afraid they are sick and don’t understand they are starved. And the Bariatric programs refer patients to other doctors and don’t take responsibility for a common effect of Bariatric surgery: surgical anorexia.
In time, patients start to find ways to eat. They eat more often through the day. They eat foods that are easily digested. They start to drink alcohol which loosens the stomach muscles. They overeat or binge and purge but are able to absorb some foods. These are not constructive ways to manage food intake.
However, the longer they are starved, the more their body’s survival instinct kicks in. They start eating large quantities to assuage the starvation which leads to regaining any weight lost from the surgery. In other words, the lack of instruction after surgery means the effects of surgery are usually temporary and can trigger new disordered eating patterns.
Bariatric surgery is not the panacea people often hope it is, but many people seek the surgery after years of desperation. For those who do take this step, there are some basic facts about eating with a surgically damaged stomach that can help avoid surgical anorexia. I’ll discuss them in the next post.
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