Depressing isn't it?
Realizing that you are depressed doesn’t always have to be depressing. Writing about depression is often depressing because it is not certain how the article will turn out? Will it be a downer to read? Will it turn readers off immediately?
Lately I have encountered a number of patients who are two years or so past their bariatric surgery, have had remarkable weight loss and are now concerned about experiencing symptoms of depression. We check blood work and find no apparent metabolic reason as to why the individual is having this experience such as low iron, low thyroid, etc. So we ask, “Why are you depressed? You no longer have diabetes, hypertension, sleep apnea, etc., etc. why would you be depressed?” Why do we automatically believe that an individual who looks good and has good labs should be problem free? Why don’t we look at what could be going on with this person and question emotional well-being? Are we just surgery oriented? Do we only focus on the physiology of our patients? Are we forgetting the phenomenal metamorphosis these individuals are going through?
In the book, Caring for the Surgical Weight Loss Patient, Gaye Andrews, PhD., and Diane LeMont, Ph.D., report the work of Patrick Mahlen O’Neil and Mark J. Jarrell, “Treatment of the Seriously Obese Patient”. O’Neil and Jarrell (1992) found the psychosocial issues for the obese to include painful psychological characteristics, destructive eating behaviors, body image distress, and emotional problems related to weight loss. When compared to normal-weight subjects presented with a list of self-defeating and/or pessimistic self-statements, the clinically obese were described as more self-critical when they deviated from their dietary plan. Although as LeMont and Andrews report, that even though some studies on obese individuals who have had weight loss surgery suggest that psychosocial improvement can be a benefit of weight loss the emotional consequences may or may not be positive. Even after significant weight loss, some patients continue to experience psychosocial distress, as they are unable to fully integrate and experience the changes that are occurring. It was also noted that many psychosocial problems do not emerge, or become apparent, until months after weight reduction has occurred. In a study at East Carolina University (Hildebrandt, 1998) it was found that patients with pre-existing psychological issues demonstrated “favorable improvements” at 6 and 12 months postoperatively, by the 24th and 36th month follow-up, however, “patients demonstrated a return to the preoperative state of mental health.”
In an article on the Role of Psychological Distress in the Pathogenesis of Disease, Beyond Change March 2000, Dr. Cynthia Buffington reports that studies show marked improvements in obesity-associated depression and anxiety and in overall quality of life following obesity surgery. Some individuals remain depression-free for years following their surgeries. Still others have improved levels of depression and anxiety temporarily, followed by a deterioration of such improvement over time. One study found the amelioration of depression and anxiety following gastric bypass, retrogressed at, or around, two year post-surgery. Interestingly, this is the approximate time other investigators have found that eating abnormalities often resurface and weight regain occurs.
One of our patients wrote about her experience before and after obesity surgery. Jonnie detailed from the beginning exactly what she did in order to prepare herself for surgery, everything she thought was proper to do in preparation for what was to come. What she had not prepared herself for was what I frequently refer to as the “aftermath”. Jonnie did know the office staff was there for her all along. She had support from her family, friends, her psychiatrist and therapist. For all of those who supported her through all of the tough times it was actually her inner strength that led her to the eating disorder clinic. Jonnie had written various articles about her recovery in Beyond Change in the past but it was this particular article in which she has shared her life with everyone. Her initial weight classified her as super morbidly obese, the following months of weight loss, lessened her ability to cope in many ways and she lost her self-awareness and plunged into a depression that would render most individuals powerless. She lost a total of 222 lbs. but what she didn’t lose was the ability to be proactive in her own emotional recovery.
As depressing as all of this information may seem we would hope that it would still be enlightening to the readers. Perhaps the professional and lay person might be able to develop be an acute awareness of the problems that may surface during the recovery period of obesity surgery, one, two, three years or perhaps more. To those who treat the morbidly obese in any setting it is important to keep in mind that weight loss is not the only focus of the recovery process. To those who have or are suffering with the disease of obesity we would hope this information will stress the necessity of becoming proactive in your health care, physiologically and psychologically because weight loss is not the only focus.
We cannot expect to treat obesity quickly nor can we expect to remedy the problems it has generated for years overnight. It takes, support groups, vitamins and minerals, individualized therapy, metabolic monitoring, patient cooperation, surgeon and staff support and understanding, eating disorder clinics, exercise specialists and nutritional counseling. Sometimes it just takes realizing the fact that weight loss can be depressing.
If you have been lost to follow-up and feel you need emotional and physical support please contact us here at Beyond Change. We will find help for you.