What Does Self-Harm Tell Us About WLS?

I have read quite a few responses to this study about self-harm after WLS surgery. This one below pretty much sums up my own opinion – that more pre-op and post-op psychological care is required and more work is required to understand the role of self-harm behaviours in those suffering from obesity. Bariatric surgery alone doesn’t fix the associated problems. This became more than clear

to me when I viewed the EASO Patients Council videos which I also link to below. I know many will relate to the on-going problems patients have even when their surgery has been deemed to be successful. Please take the time out to view one or two ….

What Does Self Harm Tell Us About Bariatric Surgery?

A recent study of self harm after bariatric surgery might be telling us more about how we care for people with obesity than it does about this surgical procedure. A new study in JAMA Surgery found an increased risk of intentional self harm after bariatric surgery. Junaid Bhatti and colleagues followed 8,815 people for three years before and after bariatric surgery. These incidents were seen in 1.3% of people in the study and the risk for such incidents went up by more than 50% after bariatric surgery.

This study is important because incidents of intentional self harm are predictors of suicide risk. The study adds to the understanding of the risk of suicide following bariatric surgery because it follows a large group of people both before and after surgery. The authors conclude:

These findings imply that more work is needed to understand why self-harm behaviors increase in the postoperative period and how these risks might be reduced.

Perhaps these findings will bring some reflection on the systematic constraints in the delivery of care to people who need bariatric surgery. As we have noted before, bariatric surgery is often inappropriately described as a last resort — positioning it as an act of desperation.

Anyone who has been through the process of seeking bariatric surgery will tell you that health plans seem to treat it as a game designed to deny access to needed care. All too often, necessary care before and after surgery must be paid entirely out of pocket by the patient. With reimbursement for follow-up care being so constrained, it is little wonder that patients are often lost to follow-up after the first year post op.

We hope that this will be a signal for more rigorous standards of post-surgical care — including its coverage by health plans — for people who need bariatric surgery.

Click here to read more from LiveScience, here to read the study, and here for more on the nuts and bolts of reimbursement for post-surgical care.

And here’s the link to the spotlight videos of some patients from EASO http://easo.org/patient-portal/patient-spotlight-videos/