How a third of gastric surgery patients put ALL the weight back on
20:15 GMT, 16 July 2012
Emma suffered from depression after having a gastric bypass. She was 18.5st, left, and is now 13st
But, after the operation, I suffered a depression which led to me attempting suicide. I know now that what I have is a compulsive eating disorder. Because I couldn’t eat I started to drink — up three bottles of wine a night. I got down to a size 10, but was left with loose skin. I began to regret the surgery. and my body repulsed me. Eventually, I had a tummy tuck on the NHS, but I’m covered in scars.
I think anyone considering this surgery should have a proper psychological assessment. I had just one follow-up with the dietitian and consultant three months after the surgery.
I’m now on medication to stabilise my moods, but I’ve since put 3 st back on and I am mortified.
I can’t believe I am back where I was — constantly trying to diet.
When weight-loss surgery fails it is not only extremely distressing for the patient, but means they are still at risk of all the health problems linked with obesity, such as joint damage, diabetes, heart disease and stroke.
‘They can become a burden to the NHS again, because either they have revision surgery or need procedures like knee ops because they are overweight again,’ says Jane Ogden, professor of health psychology at the University of Surrey. ‘Weight-loss surgery is cost effective but only if it works.’
Meanwhile, results for a second operation are poor, with a higher risk of complications and death, says Mr Slater, who also practises privately for Streamline Surgical, agrees. ‘I try to avoid it at all costs. I’m always much more nervous doing it the second time than the first time.’
So what’s going wrong
Crucial to the success of bariatric surgery is that the patient is mentally prepared for the vigorous diet plan they’ll need to stick to for the rest of their lives. Their stomach will only cope with small side-dish size portions.
The amount the NHS spends each year on weight loss surgery
However, it is possible to stretch the newly reduced stomach by eating a little more each time. So experts agree patients need psychological screening before surgery, to ensure they have the willpower to resist the old temptations. And then, if necessary, they will need aftercare with dietitians and specialists to keep them on track.
‘In the first year, or two years, after the surgery, you feel like you’re walking on air. But three or four years on is a very different thing,’ says Bianca Scollen, of the support group Weight Loss Surgery Info (she herself had surgery eight years ago).
‘In a way, losing the weight is the easy part, it’s changing your lifestyle and keeping it off that’s hard.’
Some people find the sight of their new, slimmer shape is enough to keep them motivated, but for others it’s not so easy.
‘Hunger isn’t just a biological process — it can be about feeling fed up and wanting comfort, or feeling bored,’ says Professor Ogden. ‘Unless patients have changed their attitude towards food, they end up cheating — grazing, or drinking lots of water so their stomach can manage more food.’
Guy Slater agrees. ‘We get rid of the physical hunger, but some people have an emotional hunger that is less easy to get rid of,’ he says.
Under NICE guidelines, NHS patients must receive a psychological assessment before being approved for surgery, as well as regular aftercare appointments. But provision is patchy, because of waiting times for psychologists on the NHS.
Success story: Fern Britton famously lost weight after having a gastric band fitted
‘All our patients have a psychological assessment, and we turn down around one in eight of them, because we don’t feel they’re ready for it,’ says Mr Slater. ‘But this doesn’t always happen elsewhere.
‘We try to spot the people who are going to need the psychological support after their operation and try to get their GP to put a programme in place, but it’s very difficult with funding.’ It’s also vital that patients are properly prepared for the realities of life after surgery. Most patients will be left with large folds of excess skin that’s vulnerable to infection.
Some suffer depression as a result of the dramatic transformation to their body and the effect it has on their relationships, lifestyle and sense of identity.
Another risk is ‘transfer addiction’ — where, denied food, patients develop other dependencies, such as gambling and alcohol.
The NHS will only offer the surgery to those with a Body Mass Index (BMI) of 40 or above (or 35 and above if you also have a serious health condition such as type 2 diabetes or high blood pressure).
An estimated one million Britons qualify on the basis of their BMI but as a result of growing NHS waiting lists more people are going private.
One company, BMI Healthcare, has seen a 20 per cent year-on-year increase in requests.
But private providers don’t have to provide any psychological support and, often, patients are just given the option to pay extra for it.
Some providers also don’t offer sufficient aftercare, vital to protect against weight regain and, because of the risk of complications such as infections, vomiting, gastric bands that slip or leak and intestinal blockages.
The number of negligence claims against independent bariatric surgeons doubled in the two years between 2008 and 2010, according to the Medical Defence Union, the doctors’ insurers.
Common complaints included failure to obtain consent from the patient about the risks involved.
Bariatric surgery is often seen as the easy solution to a growing problem — but it won’t work unless the patient changes their mind, as well as their body.
For support visit wlsinfo.org.uk