Eating disorders a new concern for gastric bypass patients

WASHINGTON — A new type of patient is showing up for treatment of eating disorders — people who had gastric bypass surgery.

“About eight to 10 percent of our patients are post-surgical,” says psychologist Janelle Coughlin, who works with the Johns Hopkins Eating Disorder Program.

Coughlin — who is also director of obesity behavioral medicine at Hopkins — says some develop an eating disorder after weight-loss surgery, while others acquire it before.

Before bariatric surgery, the problem is often binge eating. After surgery, which reduces the amount of food a patient can eat at a sitting, some find themselves eating bits of food all the time.

But Coughlin says post-surgical patients can also develop bulimia and anorexia — continuing to lose weight until the number on the scale is dangerously low. They either fret over every mouthful or take the vomiting that sometimes occurs after gastric bypass surgery and turn it into a habit.

Coughlin says the problem points to a need for enhanced pre-surgical screening and post-surgical follow-up, noting there is now an effort to make sure primary care physicians, nurse practitioners and others who see post-bariatric surgery patients in a clinical setting know the signs of trouble.

One thing that she says must be addressed is “the anxiety that comes after surgery over the fear of gaining weight.”

Coughlin, who leads a support group for bariatric surgery patients, says they tell her, “you can’t go into surgery and think it is going to change your mind.” She says getting over that fear and learning to cope is essential.

The American Society for Metabolic and Bariatric Surgery says 193,000 operations were performed in 2014. Coughlin says it’s still the most effective treatment available for severe obesity, and while a minority of patients develops eating disorders, most do just fine.

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