Although Hawkins doesn't regret the surgery, her recovery process did come with a heap of emotional struggles and depression as she learned to get used to being an entirely different person. “You're used to commanding so much space in the physical universe and suddenly you are half of that in less than a year," she tells R29 in an email. "Your brain can't catch up that quickly.”
The negative mental-health effects of weight-loss (a.k.a. bariatric) surgery are something experts are growing increasingly concerned about. Most recently, a study published in the Annals of Surgery in April of this year found that while people who'd undergone gastric bypass were able to reduce their reliance on medications for things like asthma and diabetes, their use of psychiatric medications increased two-fold.
Previous research has also pointed in this direction: A JAMA Surgery study published earlier this year found that the risk for self-harm, including suicide, increased in a group of Canadian patients after bariatric surgery. Another study, published in JAMA in January, looked at over 50,000 patients who underwent weight-loss surgery since 1988; although the majority of patients in the study didn't have psychiatric issues, the rates of mental illnesses were higher within this group compared to the general population. For depression, the rate was doubled.
"We can’t pretend that this is not an issue," says Aaron J. Dawes, MD, surgery resident at UCLA and lead author of the JAMA study.
We can’t pretend that this is not an issue.
Patients who go into the bariatric-surgery process with an established need for therapy, will usually return to that, says Amir Ghaferi, MD, assistant professor of surgery at the University of Michigan. "But for patients who may have new diagnoses pop up [after surgery], there is no rigorous or routine method for treatment."
We live in a society that often paints losing weight as the ultimate solution to every problem. Our obsession with shows like Biggest Loser, before-and-after Instagram transformations, and countless ads for weight-loss supplements only strengthens the idea that this change can be a quick, simple fix. So it's no surprise that, after what is often a lifetime of weight-based stigma, many bariatric-surgery patients may come to believe their lives will become better quickly and all at once.
However, after surgery, things don't usually pan out that way. Instead, Dr. Ghaferi says that with surgery, patients may lose 50-70% of their weight in about a year. But "even with that amount of weight loss, most people don’t get down to a 'normal' BMI," he explains. "A lot of people are still classified as overweight."
Generally a patient will be warned about these realities in some way, as part of making sure they give informed consent. But in a series of recent focus groups in his clinic, Dr. Ghaferi says he's found that most people may simply hear what they want to hear during this process. "For a lot of the dangerous or bad stuff," he says, "patients may minimize it and say, 'That won’t happen to me.' It’s [normal] human behavior." That mindset — plus patients' high standards for success — may set them up for severe disappointment.
No one is really sure how exactly to address that disappointment, but one thing that could help is if surgeons had more explicit discussions with patients about the potential mental-health effects.
Suddenly I was someone else — physically and emotionally — and not at all prepared for it.
And, to make things even more difficult, Hawkins says the recovery process necessarily meant she was denied her go-to coping mechanism: comfort food. “Suddenly I was someone else — physically and emotionally — and not at all prepared for it,” she says.
"This is a life-changing operation," adds Dr. Dawes, "and we need to be treating it as such." But, he continues, the actual surgery is just one part of that life change. And following up with patients after surgery has proven to be challenging. Dr. Ghaferi says that although surgeons ideally want to follow up with you for the rest of your life, in reality, most patients drop off the radar after a year. So surgeons frequently have to rely on patients and their primary care providers to notice mental-health problems (with notoriously limited success).
“If I'd had the chance to be in counseling or therapy, if any kind of follow-up system beyond checking my vitamin levels had been put in place,” Hawkins says, “I could've saved so much of that time learning how to be OK with myself and all my post-surgery flaws.”
For patients who may have new diagnoses pop up [after surgery], there is no rigorous or routine method for treatment.
Still, it's clear that we need to be doing a better job of accounting for patients' emotional and mental states at every stage of weight-loss surgery. "For patients that have diabetes, for example, and are having bariatric surgery, we focus on how that might affect surgery and the patient's health and recovery," says Dr. Dawes. "We feel like the same amount of time and energy needs to be spent on mental-health conditions."