When Obesity Surgery Is a Family Affair

It's a puzzle that Snyder -- who says he also puts his patients through a rigorous pre-screening process -- has given some thought.

When it comes to the increased risk of accidents, he says, that may be due to the increased mobility of people who drop large amounts of weight. As can be seen in the accompanying slide show of the Espinosa extended family, losing weight can inspire people to try new, and inherently risky, activities.

"This suggestion of perhaps increased risk for suicide and/or risk-taking behavior needs to be explored with further clinical studies," Courcoulas said in an email. But in the absence of such data, experts can be asked to speculate.

Even with intensive psychological screening, Snyder says, it may be that in some prospective patients there is a difficult to detect "psychological element" that makes some people more prone to fatal depression.

Having gastric bypass surgery means changing your entire lifestyle forever, he says, and it is no easy task to determine who is mentally strong enough to commit to such a change.

Frank Espinosa says that Snyder had him commit to losing 25 pounds on his own before he could have the surgery.

"It was a test," Espinosa says. "He wanted to see if I had what it takes to stick to the eating program."

Gastric bypass patients, whose stomachs are surgically reduced to the size of an egg, are only able to eat the tiniest of meals. If they attempt to eat more, they will initially experience sickness and vomiting, but if they continue to try and eat like they did before, or even like a normal person, their stomachs will eventually stretch.

"Some people think it's a fix. It's not. It's just a tool," Espinosa says. "It works if you use it correctly and respect it. It's a miracle to me. My life has totally changed."

The grandfather, who says he used to have a hard time making it up a flight of stairs, is planning to take his son-in-law, son, and two grandsons to Canada on a 28-mile backpacking trip through the wilderness.

Yet not all patients are as grounded and determined as Espinosa, and those are the ones surgeons say they must be on the lookout for. In order to understand why a comparatively large percentage of bariatric patients try to commit suicide, it is first necessary to examine the population, Snyder says.

"I look at simple things like depression," he says. "Eighty-nine percent of my patients have depression when they come in. After, the number drops to 25 percent -- about the same as the general population."

Out of that quarter, some will choose to take their own lives, but doctors are not sure why.

One possible answer, says Snyder, is that those people are unable to adjust to their new identity.

"You and I and everyone have built our lives on a bunch of tenets of who we are, including what our bodies look like," Snyder says. "After surgery, that changes very quickly."

Another reason may have to do with unrealistic expectations. In Espinosa's case, his life was indeed completely turned around by simply losing weight. But other patients may have more complicated problems to deal with.

Snyder says that when you "spend your whole life struggling with weight, as humans we want everything to be instantly cured and that's not going to happen."

He says patients should take advantage of the services most reputable bariatric practices have in place post-surgery.

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