Bariatric surgery can be life-changing if you’ve struggled with significant obesity over the course of years or decades. There are different approaches to the surgical intervention of obesity, and each one has a different track record, and different challenges post-surgery. Experts know that bariatric surgery has a more optimal outcome when:
- The person commits to pre-surgical lifestyle changes
- The person has a support group available before, during, and after surgery
- The person receives lifestyle counseling before and after surgery
- The person understands the kind of new lifestyle commitment at home and away from home – dietary and exercise – that will be necessary to support better surgical outcomes
- The person believes in this surgical approach as offering the best therapy for their diagnosis of obesity
- The person has the surgery at a medical center of excellence with a multi-disciplinary team that specializes in bariatric surgery
If all those factors have been addressed, the likelihood of significant and sustained weight loss after surgery has a better chance. Still, the rates of weight regain are well known, and any complicating issues can thwart a positive long-term outcome. Polly Hume, a nursing professor and researcher, examined the impact that childhood abuse might have on recovery outcomes from bariatric surgery.
The 2016 Adverse Childhood Experiences or ACE study (CDC-Kaiser Permanente) focused on how childhood abuse and neglect can affect adult health. Statistics suggest that among the 78 million American diagnosed with obesity or morbid obesity, 6 million have been identified as likely having suffered from physical, sexual, or verbal abuse as a child.
This study helmed by Hume and published in August 2018 Obesity Surgery was based on the ACE study findings that a significant number of patients who undergo bariatric surgery have a past history of physical or sexual abuse. The goal of the Hume study was to see how this past “vulnerability” might impact weight loss – possibly causing an effect of malnutrition due to inadequate food intake post-surgery. The theory was that past abuse history might cause less optimal food intake post-bariatric surgery.
The study looked at 189 patients who had biliopancreatic diversion with duodenal switch bariatric surgery between 2009 and 2010 at a facility in Omaha, Nebraska. Part of the screening included asking patients if they had ever experienced abuse of any kind (obesity risk has been clearly linked to abuse issues). Among the subjects, 49 reported a history of physical or sexual abuse. Nearly 73 percent of that sub-group experienced abuse during their childhood years, and more than 6 percent experienced abuse during childhood and adult years.
As part of the bariatric surgery procedure, a feeding tube was inserted. The goal was to see how long these subjects would need the feeding tube to remain, in order to maintain optimal levels of nutrition post-surgery. Among the subjects who experienced abuse, good weight loss goals were achieved but feedings tubes remained in place, on average, 17 days longer than among the other subjects.
We know that “adverse childhood experiences” like abuse, parental conflict, mental illness or substance abuse can affect brain development in childhood. As adults, these individuals have a higher risk of smoking, alcohol abuse, heart disease and other chronic illnesses associated with dangerous, chronic levels of stress. Chronic high levels of stress provoke general inflammation in the body. Individuals with a history of abuse also have higher rates of eating disorders, depression and obesity.
This study suggests that surgeons and the support team who manage the pre-operative and post-operative care and management of patients who undergo duodenal switch bariatric surgery recognize that the person may need additional nutrition education and mental health counseling before surgery and after surgery, if they have a past history of abuse. Addressing this particular vulnerability might help to ensure a better outcome for this group of patients.
It’s interesting to note that any patient with obesity choosing bariatric surgery could be exposed to some level of malnutrition post bariatric surgery, so nutrition support is critical for all patients. Though experts typically worry about excessive regain of weight months or years later, optimizing dietary needs so individuals avoid nutritional deficiencies and too rapid a pace of weight loss should be a focal point of the bariatric surgery program.
There will be a next phase to this study, assessing gastric bypass surgery subjects to see if they too have difficulty maintaining nutritional status post-surgery, without a feeding tube.