Eating Disorders and Morbid Obesity
On this episode of Bariatric Friday, Kemal Erkan and Dr. Isaias Irgau come together to discuss eating disorders and morbid obesity. This topic is especially important in the context of bariatric surgery because the anatomical changes that come with the procedure are only one part of the puzzle. Surgery does not resolve a person’s psychological relationship with food, so care must be taken to address any dysfunctional eating patterns that may be present. It is also important to distinguish that morbid obesity does not automatically mean an eating disorder is present. While these two issues can often be intertwined, it is possible to have morbid obesity without an eating disorder, and vice versa.
When an individual is preparing to undergo bariatric surgery, evaluation for eating disorders is crucial. Readiness for surgery, as well as the outcome of surgery, can be affected by the presence of these conditions. Untreated eating disorders can increase the risk of malnutrition, weight regain, mental health complications, and poor follow-up compliance. This is why patients must be screened and, when appropriate, treated for these disorders before undergoing surgery.
To distinguish morbid obesity from eating disorders, Dr. Irgau offers these explanations: Morbid obesity is a medical condition that describes excess body fat and the associated health risks, while an eating disorder refers more to the behavioral and psychological components of one’s relationship with food. They can certainly overlap, but they are two distinct diagnoses.
One such eating disorder is binge eating disorder, or BED. Binge eating disorder is characterized by recurring episodes of eating a large amount of food in a short period of time, often to the point of uncomfortable fullness. Binges may sometimes be planned, but they can also be spontaneous. Often, people with BED describe feeling as though they are not in control of what they are doing. Some symptoms include eating when not hungry, eating very quickly during a binge, eating in secret, or feeling depressed or ashamed afterward. BED often develops as a coping mechanism for stress and trauma, and it is the most common eating disorder in the bariatric population. While surgery can help reduce the amount of food a person can comfortably eat, it does not address the thoughts and behaviors surrounding the urge to binge.
So, what do providers look for when evaluating patients for eating disorders? They may look for a history of dieting and weight cycling, preoccupation with food, and secretive eating behaviors. While these are not necessarily definitive signs of binge eating disorder, they may be suggestive of the condition. Additionally, Dr. Irgau points out that recognizing these patterns is not about excluding the patient from the possibility of surgery. Rather, the team is working to identify the problem and provide the appropriate support.
Another common eating disorder is bulimia nervosa, which involves binge eating followed by compensatory purging behavior. This can pose significant risks for bariatric patients because, in addition to overeating, purging can lead to gastrointestinal damage, dehydration, nutritional deficiencies, and electrolyte imbalances. Bulimia nervosa can be difficult to diagnose in patients with morbid obesity because they may still be overweight despite engaging in compensatory behaviors. There is also often a great deal of shame surrounding the issue, and patients may not be eager to disclose their eating behaviors.
Eating disorders can also develop after bariatric surgery. Patients may experience issues on the opposite side of the spectrum, such as excessive restriction and fear of eating. Other concerns that may arise after surgery include grazing habits, body image issues, and addiction transfer. Dr. Irgau emphasizes that this is why monitoring needs to be ongoing, rather than occurring only before surgery.
Overall, morbid obesity and eating disorders are complex conditions that need to be addressed from multiple angles. With a comprehensive care team and support for both the psychological and physical aspects of health, patients are capable of achieving remission and improved outcomes.