Issues from Eating Disorders and Weight Loss Surgery

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Eating disorders and weight loss surgery often go hand-in-hand. Sometimes people with eating disorders will undergo weight loss surgery. However, other times people who have had the surgery will develop disordered eating behaviors in order to cope with physical complications. This post will examine the relationship between eating disorders and bariatric surgery.

What is Bariatric Surgery?

Bariatric surgery is an umbrella term for three potential weight loss surgeries. These procedures are typically performed for people who are severely obese. However, people struggling with sleep apnea, high blood pressure, high cholesterol, and diabetes may also have this operation [1].

These surgeries may include making the stomach smaller or making changes to the digestive tract so that someone eats less or alters the way their body absorbs energy from food [1].

Weight Loss Procedures & Eating Disorders

Research has focused mostly on people who had disordered eating before surgery. What we know from that research is that people who have struggled and obsessed about their weight usually expect that the surgery will end their long-time struggle with weight and negative body image [2].

However, while the surgery can create lead to drastic weight loss, this doesn’t mean that someone’s body image is going to improve. Changes on the outside doesn’t necessarily mean there will be emotional changes on the inside.

Research done in 2020 studied the emotional and psychological experiences of women who developed restrictive eating behaviors after bariatric surgery [2]. This research was one of the first studies to dive into this phenomenon. The results from this study will be further explored in this post.

Some Statistics & Facts about Bariatric Surgery & Disordered Eating

  • About 200,000 people have weight loss surgery every year
  • Binge eating disorder is common in people seeking bariatric surgeries
  • Binge eating is seen in 6-69% of people following surgery
  • 74% of people seeking this type of surgery are women
  • 88% of women who had weight loss surgery wanted body contouring after losing weight
  • Grazing is a disordered eating behavior that is common in approximately 19-59% of people who have undergone these procedures [2,3,4]

Common Problems after Weight Loss Surgery

Physical Side Effects

According to research from 2012, there are common physical symptoms that may show up after surgery. These include:

  • Intense discomfort after eating sweets
  • Nausea
  • Cramping
  • Fatigue
  • Involuntary vomiting
  • Plugging, which is when food gets stuck in the upper digestive tract
  • Malnutrition due to food restriction

Behavioral Side Effects

Some disordered behaviors that may emerge after weight loss procedures include:

  • Chewing and spitting out food in order to avoid food getting stuck in digestive tract
  • Grazing, which is a disordered behavior where someone mindlessly eats or snacks
  • Binging
  • Vomiting to accelerate weight loss
  • Severe food restriction [3].

Weight Stigma & Surgery

One of the lingering issues that people dealt with after surgery was the impact of weight stigma [2]. Weight stigma is the discrimination that people experience for being in a bigger body.

Research participants talked about how even if they lost weight, they still experienced anxiety and shame related to having been in bigger bodies. These discriminatory experiences contributed to restrictive eating behaviors. Some examples of restrictive eating behaviors include calorie counting, purging, or laxative abuse [2].

Even though the participants in the study had lost weight, they still felt emotionally like “the girl who ate all that food” [2]. This shame fed into them engaging in disordered behaviors to try and prevent future weight gain. This disordered cycle was supported by negative beliefs about food and low self-esteem.

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Negative Body Image

One of the common concerns among people who started restricting after surgery was negative body image. This was largely found in people who had excessive sagging skin after drastic weight loss [2]. The excess skin was perceived as unattractive by the women in the study. This was found to contribute to disordered eating because it triggered their fear of gaining weight [2].

While some doctors praise the benefits of weight loss surgeries, it’s important to be aware of the connection between eating disorders and these types of procedures. Bariatric operations are not the solution to negative body image. In some ways, these procedures come with their own risks for disordered eating as a way to manage their fear of regaining weight and negative body image.


Resources:

[1] Public Education Committee. (2021, May). Bariatric surgery procedures. American Society for Metabolic and Bariatric Surgery. Retrieved September 15th, 2021 from https://asmbs.org/patients/bariatric-surgery-procedures

[2] Watson, C., Riazi, A., Ratcliffe, D. (2020). Exploring the experiences of women who develop restrictive eating behaviours after bariatric surgery. Obesity Surgery, 30, 2131-2139.

[3] Eating Disorder Therapy LA. (2016, January 10). The reality of bariatric surgery: A life-changing procedure with potential for eating problems. Retrieved September 15th, 2021 from https://www.eatingdisordertherapyla.com/the-reality-of-bariatric-surgery-a-life-changing-procedure-with-potential-for-eating-problems/

[4] Conceição, E., Orcutt, M., Mitchell, J., Engel, S., LaHaise, K., Jorgensen, M., Woodbury, K., Hass, N., Garcia, L, & Wonderlich, S. (2013). Characterization of eating disorders after bariatric surgery: A case series study. International Journal of Eating Disorders, 46(3), 274-279.


The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published October 4, 2021, on EatingDisorderHope.com
Reviewed & Approved on October 4, 2021, by Jacquelyn Ekern MS, LPC

About Samantha Bothwell, LMFT

Samantha Bothwell, LMFT, is a licensed Marriage and Family Therapist, writer, explorer, and lipstick aficionado. She became a therapist after doing her own healing work so she could become whole after spending many years living with her mind and body disconnected. She has focused her clinical work to support the healing process of survivors of sexual violence and eating disorders. She is passionate about guiding people in their return to their truest Self so they can live their most authentic, peaceful life.