Eating Disorders
Gastric Bypass Won't Solve Key Problem

Lifelong addiction to food - depression and self-hatred - may not disappear

(November 16, 2003) -- Life was good for Teresa Maciel as long as she was eating.

Cheetos, burgers, pizza. You name it, she ate it.

She ate when she was happy. She ate when she was sad. She ate when she was hungry and when she was full. Eventually, the mother of three from Waterbury, Conn., weighed nearly 400 pounds.

So two years ago, at age 39, the 5-foot-8 Maciel took a drastic step.

She had her stomach surgically reduced to the size of an egg. A few weeks before the operation at the Hospital of St. Raphael in New Haven, Conn., she and a hospital social worker talked about her decision.

"We met for about an hour. He was very nice," Maciel said.

He asked questions about her life and why she wanted gastric bypass surgery, also known as bariatric surgery. But, Maciel said, he barely touched on her lifelong addiction to food.

Glossing over those issues with bariatric surgery candidates is common, and that worries mental health professionals, particularly as the procedure has become such a moneymaker for hospitals and surgeons. Advocates say not enough is being done to psychologically screen morbidly obese people such as Maciel, who are lining up in increasing numbers each year for bariatric surgery.

"These surgeries are seen as a last alternative. There is nothing left for them, and if they fail, some become suicidal," said Margo Maine, a psychologist at the Institute of Living in Hartford, Conn., who has written two books on eating disorders. "The increase in depression and self-hatred is immense; there is a tremendous psychological risk."

Maine said she has seen people eat their way around the surgery. One woman regained more than 100 pounds by grazing on high-caloric and fatty foods.

"Food is like any addiction. Money, sex, gambling. You have to understand the dynamic that brought you to this place," said Mary Ziller, a social worker in Norwalk, Conn., who counsels people with eating disorders.

Ziller says hospitals need a standardized evaluation to detect untreated eating disorders, depression and psychological problems in patients. And hospitals and insurance companies should require patients to enroll in pre-op and post-op support groups, she said.

Most insurance companies require patients to have a psychological consultation before the surgery. But who conducts it can vary.

Maciel has lost 167 pounds since her surgery and is still slowly losing weight.

"It's like my mind isn't telling my stomach it's hungry all the time," she said.

She has taken up bungee-jumping and hikes in the woods with her children, and she attends a support group twice a month to stay focused.

Maciel said she couldn't find a support group after her surgery. Then she ran into Liza Branch of Ansonia, Conn., a mother of two who also had had the surgery. With no training in psychology, Branch set up a network of support groups in Connecticut, called the Journey.

Dr. David Giles, a surgeon at the University of Connecticut Health Center, said he carefully screens the 40 patients a year he typically operates on. He said the surgery shouldn't be measured only in terms of weight loss.

"Some of these folks end up in counseling, depressed for weeks or months because you have broken their relationship with food," he said.

Pounds melt off most patients during the first year after bariatric surgery because the stomach fills up with just a few bites. Many patients say they vomit if they eat fatty foods and that they aren't constantly hungry.

But they still have to diet and exercise to keep the weight off. About 15 percent of people regain some or all of the weight after the surgery. Some burst their staples by stretching the pouch. Others replace their addiction to food with something else.

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