Weight-loss surgery was supposed to be Chevese Turner's salvation -- a last resort in her battle against obesity and binge eating. Instead, her 2007 lap band procedure 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 Turner, 43, of Soverna Park, Md.
Turner 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 Turner regularly binged and purged.
Only after going into intensive therapy to cope with the binging behavior she had experienced since age 5 did Turner, 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 Turner, it was bulimia, for others, it's anorexia. For one fellow patient in Turner'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, 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 Lisa 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. Donald 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.