Monday, February 18, 2008

Suicide, Eating Disorders and WLS

I have been following the news of the death of Polly Williams. Polly was one of the four women featured in Lauren Greenfield’s Emmy-nominated documentary Thin. The film documents the experiences of young women at the Renfrew Center, a residential facility for the treatment of eating disorders.

Here's an update on Polly's death:

There has been much speculation on how Polly died, with many people naturally attributing it as the result of her eating disorder. Now her family has spoken out in a news brief reprinted in the Indy Star.

Williams died from an overdose of sleeping pills, a suicide that was “a direct result of her internal battle with the eating disorder,” said her sister, Bebe W. Reed. “She said she could not fight the fight any longer.”

Doing just a quick search of the internet, shows there is a correlation between ED and suicide. Granted it is kind of a case of the chicken or the egg, but it is still linked:

A study reported in the Journal of Eating Disorders in March 2004 indicates that women with eating disorders (like anorexia, bulimia, or overeating) who attempted suicide usually were suffering from depression before the onset of their eating disorder.

67% of the patients with an eating disorder and a history of suicide attempts suffered from depression before the onset of the eating disorder, and only 3% of the patients with an eating disorder and no history of suicide attempts suffered from depression before the onset of the eating disorder.

The study thus indicates that the eating disorder may be secondary to depressive illness for those who have been or are suicidal.

Some past research, which did not include suicidal individuals, has indicated the opposite -- depression occurred as a consequence of the eating order. And this still is probably the case for non-suicidal patients.

Additionally, women in the suicidal group had a higher rate of anxiety disorders.

Women with eating disorders and a history of depression are at a high risk for suicide and need to be closely monitored.

You are probably asking yourself what that has to do with WLS.

One, I already believe strongly that most WLSers have a history of ED. Whether it is pre or post op is anyones guess.

Two, in an earlier post on mental health and WLS, I reported that mental illness is present in many of those seeking WLS:
Overall, 66.3% of subjects had a lifetime history of at least one axis I disorder and 37.8% were currently diagnosed with such a disorder. The most common lifetime axis I disorder was major depressive disorder, seen in 42% of subjects. Binge eating disorder was the most common current disorder and had a prevalence of 16.0%.

A lifetime history of an axis II disorder was noted in 28.5% of subjects, the most common being avoidant personality disorder, which was seen in 17.0%.
In a second post on mental health and WLS, I reported that a recent study shows 1 in 5 potential surgery candidates fail to meet psych eval pre-op guidelines:

The most common reasons people were not allowed to go through with the procedure included overeating to cope with stress or emotional distress, having an eating disorder, and uncontrolled mental problems, such as depression.

Most patients who were deferred from bariatric surgery after their initial psychological evaluation were referred for psychiatric treatment. The researchers write that they will conduct a future study to look at how many of these patients accepted psychiatric referral and went on to have the surgery.

"The goal of the psychiatric evaluation is not to keep patients from having the surgery. Rather, the goal is to determine if there are any problems that might interfere with the success of surgery, and have the patient get treatment for these problems," says researcher Mark Zimmerman, MD, of Rhode Island Hospital, in a news release. "In so doing, the patient is more likely to have a positive outcome from surgery that is delayed to allow time to address the problems."

The final reason I feel this is all related has to do with the latest research on actual deaths seen after WLS. Sandy Szwarc, BSN, RN, CCP gave a took an in depth look at the findings.

There was an especially disturbing and unexpected finding in this study. Dr. Kuller and associates found that among the bariatric surgical patients there had been “45 deaths from traumatic causes including 16 deaths (4%) due to suicide and 14 due to drug overdoses (3%) that were not classified as suicide.” To help readers realize how extraordinarily high these suicide death rates were, the authors wrote that according to the U.S. Vital Statistics, there are approximately 7 suicides for white women and 25 for men for every 100,000 people in the population of the same age as these bariatric surgical patients. Translating these figures, the researchers had anticipated an estimated two suicide deaths would have occurred among the women and one suicide among the men during this study.

Instead they saw more than five times the expected numbers of suicides, not even counting the drug overdoses. “There is a substantial excess of suicide deaths, even excluding those listed only as drug overdose,” they wrote. “The large number of deaths due to suicide and drug overdose, in excess of what we expected, is also a cause for concern. Most of them occurred at least one year after surgery.”

Dr Livingston’s review also noted that the frequency of suicide and drug overdoses “was unexpected.” The higher suicide rates were especially significant among those 25 to 34 years of age, with death rates of 13.8 and 5.0 per 1000 persons per year for men and women, respectively, nearly ten times the rates of 1.3 and 0.6 per 1000 persons per year in the general population.

How does it all go together? I really don't know. But it is something to think about.

If you find yourself feeling suicidal or are concerned for a friend, don't hesitate to reach out for help.

Call 1-800-SUICIDE / 1-800-784-2433
Call 1-800-273-TALK / 1-800-273-8255

  • Call to speak with someone who cares
  • Call if you feel you might be in danger of hurting yourself
  • Call to find referrals to mental health services in your area
  • Call to speak to a crisis worker about someone you're concerned about

If you feel you may have an eating disorder, seek help in some of these places.


Medusa said...

Fantastic post, Bama.

Polly Williams's last words, which she posted in her journal the night she took her own life by overdosing on sleeping pills, are haunting:

"So...I am off to bed. Yawn! Yep, I am sleepy. :-)"

Bama, I had no idea the incidence of suicide after WLS was so high. It's absolutely shocking.

Thanks for digging into the research and educating us all about the strong correlation between mental-health/eating disorders and suicide.

My blog: Medusa

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Rachel said...

I'm not familiar with the rates of EDs amongst those who are pre- or post-op WLS. But I have heard of a number of women who have compulsive overeating or BED seek out WLS as a cure-all to their emotional relationships with food. The most famous of which is Star Jones. WLS will not cure an eating disorder; it only makes it all the more dangerous should one binge, purge or both.

Anonymous said...

My daughter was not a good candidate fir WLS, but threatened to kill herself rather than remain fat. After some unexpected complications, she continually uttered cryptic statements about her impending death. Although she doesn't "gloom and doom" as much since grandchildren started arriving, I firmly believe she is a victim both of depression and of malnutrition. I didn't realize so many others were the same.

2BIG said...

Thanks for sharing about the hige suicide rates for post WLS patients and for the info on deferals.

Anonymous said...

Why have your posts become so negative about WLS?

WLS saved my life and you have stated in earlier posts it saved yours too.

Is it what you are going through right now?

You may be having some minor setbacks, but the over all picture is you have lost over 200 pounds. That is worth it in the long run. You no longer have a host of serious problems associated with morbid obesity. You should be thankful for that. Not trying hard to spread gloom and doom about obesity surgery.

There are thousands of very satisfied people who have had WLS. Just look at the support forums on the web. Sure there are some things you just have to deal with, like taking your supplements and exercising. Following the rules. It is so worth the small sacrifices though.

I am 3 years post op and have had no complications whatsoever. I'm looking forward to a long and happy life. A whole lot longer than it would have been had I stayed obese.

I think some may have a few complications. But there are alot more of us who are doing just fine.

Even if this research is true, I would rather die younger as a thin person, than live longer being fat.

Rachel said...

Even if this research is true, I would rather die younger as a thin person, than live longer being fat.

Hey anonymous: Given the long-term "success" rates around WLS, you just may very well get your wish.

I used to think the same way, too. Of course in my case, I didn't have WLS, I had anorexia. Yes, that is truly how fucked up your "logic" is.

vesta44 said...

anonymous #2 - not everyone is doing well post-WLS. I had a friend who died from it 10 years ago. She should never have been allowed to do it, she was a multiple personality and had more issues than I can list. She started regaining weight after her first VBG (she had gone from 400 lbs to 160 and had gone up to 175), so they went in and redid it (she had also had a massive ventral hernia repaired before her 1st VBG). When they did the 2nd VBG, they didn't remove the mesh that had repaired her hernia and her intestines got tangled in it and started to die. She had to go back in and have almost half of them removed. She ended up with short gut syndrome (you eat and you immediately shit it out), malnutrition, and myocarditis (which is what ultimately killed her). How she passed the psych test is beyond me, but maybe it was because she had been a nurse and had been dealing with the mental health system for so many years that she knew how to manipulate her answers to give them the results that would let her have the surgery.
I suffered from depression (I was on Prozac at the time) and they still let me have a VBG. Mine didn't work. I don't know if the staples came undone or my pouch stretched, but I lost weight for a while, then I started regaining. I'm currently 27 lbs heavier than I was when I had the VBG 10 years ago, and the mobility issues I had before the surgery are a lot worse now than they were then (and the 70 lbs I lost didn't improve those issues at all). I followed all the rules, did what I was told, and it still failed.
I've been fat all my life, just less fat at times than I am now (personally, I don't think 175 lbs at 5' 9" is fat, but that's what the BMI would have said back in 1975). And for me, I'll take being fat and happy and healthy (and I am healthy, other than arthritis and fibromyalgia, which aren't caused by being fat) over being thin and possibly plagued with more problems than I now have. I don't think I'm shortening my life any by staying fat since all of my grandparents were fat and lived into their late 80's/early 90's. My parents are fat and they're both still alive and kicking at 73 and 74. So being fat isn't an automatic death sentence, what the killer is is all the stress fat people have to deal with on a daily basis. Stress from being told our fat is going to kill us, from not being able to find decent, trendy clothes that fit properly, from being discriminated against in jobs/housing/schooling/etc/etc. Stress from being told we're worthless/ugly/stupid/smelly/gluttons just because we don't meet some asshat's idea of thin beauty.
If you'd rather be thin and die young than be fat and live a long life, that's your choice, no one is saying you can't do that. But WLS is not always a solution for the problems fat people face, and saying it is does a disservice to fat people who are pushed into this without being given all the information they need to make a decision on whether to have this surgery or not (I sure as hell wasn't told everything I needed to know 11 years ago, and I didn't have the internet back then to do any research, I had to rely on what the doctors told me).
WLS is not a magic bullet that will make you thin and cure all your ills, but that's how it's being marketed. It's a personal decision that each individual has to make, but I think it's important for those of us who have bad experiences with it to get the word out that things can go wrong, horribly wrong, and have for some people.

Just Jen said...

Ah, WLS, ED and depression. A toxic combintation with which I struggle. Before WLS, I never would have said I had an eating disorder. If only I wasn't fat,everything would be ok. But now, 2-1/2 years post-op, I'm on my second round of treatment for bulimia in under 6 months. Don't get me wrong...the surgery did exactly what it was supposed to: I lost weight. Lots of it. But, even though they told me it wouldn't fix my head, I wasn't prepared for the drastic changes and emotional stripping that comes with shedded pounds. I'm an educated, professional woman who spent months researching WLS before moving ahead with it. And never, ever did I read anything about eating disorders and WLS. No one talks about it. But it's there.