More threads by David Baxter PhD

David Baxter PhD

Late Founder
Obesity & Bariatric Surgery: Complications of Unresolved EDs
by Jane McGuire, Eating Disorder Hope
December 28, 2017

An individual who has bariatric surgery often struggles with emotional and mental issues after the procedure. For those who have unresolved eating disorders, the concerns can be even more profound.

Complications such as cross addictions, physical difficulties, and emotional problems can and do arise.

When an individual is a candidate for bariatric surgery, it is recommended that there is a multidisciplinary team consisting of surgeons who are trained in bariatric and metabolic surgery, a nutritionist, exercise physiologist, mental health professional and that the facility meets the ASMBS approved quality standards. [1]

This is to protect the individual and prepare the individual prior to, during, and following the surgery.

In 2013, 179,000 bariatric surgeries were performed in the U.S. alone. [2] Obesity can have many physical, emotional, and economic consequences for many individuals.

At John Hopkins eating disorder treatment facility, they are seeing individuals with preexisting and new eating disorders emerging after gastric surgery. [3]

Head physicians at this facility recommend that there are careful and thorough assessments both prior to and after surgery for sufferers.

Consequences of Surgery
Often after surgery, a common consequence is vomiting due to plugging of the stomach pouch by certain foods but can also develop into a way to weight control measure and develop into bulimia or anorexia.

Currently, bariatric surgery is the most effective treatment for severe obesity. [3] Eating disorders can complicate the effectiveness of surgery. Treatment post-surgery includes dietary interventions that are different from those with eating disorders.

Bariatric individuals require different treatment from those with eating disorders due to the physical body changes that have happened because of surgery.

Surgery changes the size of the stomach so regular meals cannot be eaten, and those who have lost a significant amount of weight and developed anorexia, treatment cannot include the typical weight gain regime.

Changes Make a Difference
The main focus is helping individuals change behaviors and thoughts that are automatic or disordered.

Eating disorder patterned behaviors can grow in severity and intensity left untreated, and treatment focuses on behavior change. If it is left unaddressed, it may change the effectiveness of the bariatric surgery.

Binge eating disorder (BED) is a disorder that is most often accompanied by obesity. One in three individuals who struggle with weight loss have BED. [4]

It typically includes repeated binge episodes with consuming large quantities of food in a short period of time.

There is usually a sense of loss of control over eating and shame and guilt immediately following the binge episode. Co-occurring disorders such as depression, bipolar, and substance abuse are also mutual with BED.

In the morbidly obese, bariatric surgery is seen to be more effective than weight-loss traditional methods. [4]

There are often various symptoms of mental health disease, destructive eating behaviors, and body image issues.

Often after surgery, there is difficulty in absorbing vitamins and minerals which can lead to deficiencies in iron, calcium, B, D, and other vitamins. Surgery can also affect the ability to absorb lactose and protein which can change mood and behavior.

Lack of these essential minerals and vitamins can lead to malnutrition.

In a study where individuals had been on a liquid fasting diet (can lead to malnutrition), were given a supplement with amino acids, decreased binge eating by 66% and reduced food cravings by 70% as compared to those who were not taking supplements. [4]

Cross Addictions
Cross addiction is becoming more common among those with bariatric surgery where one addiction is replaced with another. From the number of weight-loss surgeries completed annually, it is estimated that 5-30% develop a cross addiction. [4]

Often when a person’s physical body is changed, and the food is now not a coping mechanism, other areas such as shopping, drinking or substances, gambling, and high-risk behaviors take its place.

Trauma can also play a role in cross-addictions within this population. Being overweight can serve as a safety factor in individuals who have experienced childhood trauma or abuse.

With surgery and weight loss, they may feel vulnerable and be uncomfortable with changes in their body and social attention it may bring.

Preparing for surgery is essential. If you do have a history of trauma or abuse, it is critical to make an appointment with a trauma therapist to start addressing these concerns.

Also, through treatment, working on gaining new healthy coping skills, identifying triggers, and stressful events. Working on anxiety that can occur after weight-loss surgery regarding fear of weight gain occurring again. [5]

Being able to be aware of how bariatric surgery can affect those with unresolved disordered eating can help you adequately prepare for life after the procedure.

Knowing that having a therapist, nutritionist, and supportive individuals to meet with on a regular basis can help you throughout your recovery process.

Remember that how you stay within your recovery process is essential and knowing you have professionals and loved ones to help you through.


  1. Who is a Candidate for Bariatric Surgery? (n.d.). Retrieved November 10, 2017, from Who is a Candidate for Bariatric Surgery? | American Society for Metabolic and Bariatric Surgery
  2. Schroeder, R., Harrison, T. D., & McGraw, S. L. (2016, January 01). Treatment of Adult Obesity with Bariatric Surgery. Retrieved November 10, 2017, from Treatment of Adult Obesity with Bariatric Surgery - American Family Physician
  3. Psychiatry Newsletter – Bariatric Surgery and Eating Disorders. (n.d.). Retrieved November 10, 2017, from Psychiatry Newsletter - Bariatric Surgery and Eating Disorders
  4. Obesity Action Coalition ? Weight-loss Surgery and Cross Addiction: A Look at Binge Eating Disorder. (n.d.). Retrieved November 10, 2017, from Obesity Action Coalition Weight-loss Surgery and Cross Addiction: A Look at Binge Eating Disorder
  5. Wolfson, P. (2015, July 17). Eating disorders a new concern for gastric bypass patients. Retrieved November 10, 2017, from Eating disorders a new concern for gastric bypass patients | WTOP
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