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Binge Eater to Bulimic: How Weight-Loss Surgery Can Trigger Eating Disorders

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Weight-loss surgery was supposed to be Chevese 's salvation -- a last

resort in her battle against obesity and binge

eating<http://abcnews.go.com/Health/Diet/obese-health-care-bariatric-ambulances/\

story?id=7981746>.

Instead, her 2007 lap band

procedure<http://abcnews.go.com/video/playerIndex?id=6759318>catapulted

her into full-blown bulimia.

" I had always struggled with binge eating, and my relationships with food

didn't change just because of the lap band. Even though binging is really

painful when your stomach is restricted like that, I would still binge

knowing that I would throw it up. I felt like finally I could be bulimic,

like this was what I wanted all along, " says , 43, of Soverna Park,

Md.

knew she had a binge eating disorder going into surgery, but after

experiencing cardiac complications attributed to a lifetime of yo-yo

dieting, she was desperate to lose weight. Instead of solving her overeating

problem, however, the surgery only changed its form: for 18 months following

the surgery regularly binged and purged.

Only after going into intensive therapy to cope with the binging

<http://abcnews.go.com/video/playerIndex?id=6759467>behavior she had

experienced since age 5 did , who now runs the Binge Eating Disorder

Association, build a healthy relationship with food and her body.

When multiple traditional diet methods fail, weight-loss procedures such as

the band are seen as a last hope for getting obese patients to eat more

healthfully and lose weight. For an underrecognized minority of patients,

however, the surgery only triggers a different kind of disordered eating.

For , it was bulimia, for others, it's anorexia. For one fellow

patient in 's community, the anorexia was so severe that it ultimately

took his life.

Sixty percent of individuals seeking treatment for obesity have some kind of

eating

disorder<http://abcnews.go.com/Health/MindMoodNews/teens-eating-disorders-signal\

-psych-problems/story?id=13084923>,

usually binge eating, according to a 2007 Harvard study. It is these

individuals, who already have an unhealthy relationship with food and their

bodies, who are at most risk of developing further eating disorders

post-surgery, says Lilenfeld, a psychologist and president of the

Eating Disorders Coalition at Argosy University in Washington, D.C.

Lap band or gastric bypass surgery is not likely to create an eating

disorder where there wasn't one, she explains, but " the most likely thing is

that people had untreated or unsuccessfully treated binge eating disorders

before surgery will continue to have problems after surgery. The problem is,

it becomes physically challenging and potentially dangerous to binge like

this because of the structural changes in the stomach, " she says.

On the other end of the spectrum, patients who used to overeat now overshoot

with their weight loss, severely limiting their caloric intake to the point

of malnutrition and anorexia.

" I've had a number of patients go from very obese to very underweight, so

much so that they need to be rehabilitated with intravenous nutrition, " says

Dr. Kirby, a gastroenterologist at the Cleveland Clinic who treats

patients undergoing bariatric weight-loss surgery.

Because there are so no statistics on how many of these patients experience

eating disorders post-op, it's difficult to gauge the scope of this issue

and there is much debate over its prevalence between the surgeons who

perform the procedures and the therapists who treat eating disorders down

the line. Dr. Mitch Roslin, a bariatric surgeon at Lenox Hill Hospital in

New York, has performed thousands of bariatric surgeries and he says he only

sees one or two cases a year of eating disorders, but psychologist Lilenfeld

believes it's much more common than that.

*Binge Eating: Hiding an Eating Disorder*

Technically, those with diagnosable eating disorders are not advised to

undergo weight-loss procedures, but because each hospital and insurance

company has different psychological screening requirements, many patients

with mental health problems slip through the cracks.

In some cases, psychological screenings consist of asking only a couple of

basic questions that don't even address eating disorders or mental health

concerns, says Dr. Seppinni, a therapist who specializes in treating

obesity. " Then after the surgery, most doctors fail their patients in terms

of follow-up. There are some group sessions with other patients, but that's

about it. "

In 's case, however, her health insurance had relatively rigorous

requirements for surgery approval, including an eating disorder screening

and a letter from her therapist. But for those who are desperate to get the

surgery at all costs, she says it's relatively easy to get around these

requirements by answering the questions " right, " as she did.

Because of insufficient screening or deception, Lilenfeld says about a third

of all patients who undergo weight-loss procedures are believed to have

" severe binge eating disorder " going into surgery, though not all of these

patients will go on to develop other eating disorders post-op.

* Anorexia/Bulimia After Surgery: Medical or Emotional?*

One of the reasons that true anorexia and bulimia may not be recognized

after bariatric surgery is that the symptoms of these eating disorders can

mimic some of the expected adverse affects of the surgery.

In the months following surgery, the stomach has to heal and slowly expand,

which makes eating difficult and sometimes painful. Patients who eat too

much will sometimes throw up because it's the only way to relieve the pain

in their stomach, not because they are compulsively trying to get rid of

calories. Similarly, the indigestion, diarrhea and acid reflux that can

occur post-op leads some patients to avoid eating altogether just because

eating becomes an unpleasant experience. These patients will become

malnourished and resemble anorexics, but the psychological aspect of the

disorder is not there.

It is important to distinguish between these medical reasons for

anorexic/bulimic behavior and true, psychological cases of eating disorders,

says Seppinni, who has traveled the country interviewing people about their

experience with obesity, weight loss and bariatric surgery. In true cases of

eating disorders, it's about the addiction to overeating getting transmuted

into another addiction. For some, they become compulsive exercisers, for

others, alcoholics, for still others, anorexics. " You take away the coping

strategy they've been using all their lives, and the addiction has to go

somewhere else, " she says.

The " loss " of binging as a coping strategy was palpable for following

her surgery. " I lay in bed and cried for a week because I couldn't eat.

Eating was the way I soothed myself my whole life. As soon as I could binge

again, even though it was extremely painful, I did, " she says.

LINK<http://abcnews.go.com/Health/w_DietAndFitness/bariatric-surgery-eating-diso\

rders-lap-band-made-bulimic/story?id=13802938>

--

Ortiz, MS, RD

*The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

Check out my blog: mixture of deals and nutrition

Join me on Facebook <http://www.facebook.com/TheFrugalDietitian?ref=ts>

Join Crowdtap: Earn gift cards, try out products, support your charity…All

for FREE!!! <http://thefrugaldietitian.com/?p=21973>Polo Shirt with your

logo: $2.95 shipped Great Father’s Day

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* " Nutrition is a Science, Not an Opinion Survey " *

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