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    Struggling With a New Body continued...

    "Many of these people have struggled with obesity their entire lives, and in a very short period of time, they literally develop these new bodies," Conason says. "Patients will walk by a mirror and say they don't recognize themselves. Their weight loss changes how family and friends relate to them. They're getting different kinds of attention, and it's a lot to adjust to. For many patients, bariatric surgery often lifts their depression, but other patients may struggle with their new bodies."

    Erik Dutson, MD, is the director of bariatric surgery and executive medical director of the Center for Advanced Surgical and Interventional Technology at the UCLA Health System in Los Angeles. He says that surgeons are aware of some bariatric surgery patients being at risk for substance abuse.

    "It's referred to in our circles as addiction replacement, which isn't unique to bariatric surgery," Dutson says. "If they're using food in this way and they undergo bariatric surgery, they can't go back to eating the way they did, and the brain's reward system becomes starved."

    Mental Health Care Critical After Weight Loss Surgery

    Bariatric surgery patients are screened by mental health professionals before they undergo the procedure. During this evaluation, they are advised to avoid alcohol, because it can damage the gastrointestinal tract lining. Patients must be tobacco-free for three consecutive months prior to undergoing the operation. If someone is identified as having an eating disorder such as bulimia, says Dutson, the patient is referred for longer-term therapy.

    "It's possible patients aren't always forthcoming during the pre-surgery evaluation," he says. "But in my experience, by the time patients want bariatric surgery, they're in the mentality mode of, 'I need to get this taken care of.' Those circumstances push people toward honesty."

    The positive body changes that follow weight loss surgery offer a psychological boost. But adjusting to the post-surgery world has its ups and downs, says Kelli Friedman, PhD, director of psychology at the Duke Center for Metabolic and Weight Loss Surgery in Durham, N.C.

    "There's not a lot of scientific study on this topic, but like this study, we also think that two years after the surgery appears to be a particularly vulnerable time for patients," she says. "Many surgery centers have the presurgical psychological evaluation and offer follow-up care, but we need to do a better job at long-term follow-up care, not just a few months after surgery."

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