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Interview. Bypass, sleeve, ring: “We see more suicides” after surgery to lose weight

Health insurance reimburses bypass surgery and hospitalization up to 70%. (©Illustration/Adobe Stock)

In 2017, Éric resorted to bypass, an operation that reduces the stomach. He lost 60 pounds. Today he regrets his choice and the pleasure of eating.

“There is a real disconnect between my mind and my body. I want to eat, but my body fills up too fast. I know that eating too much hurts me, but it makes the frustration more tolerable. Today I regret the operation, ”she recently explained to our newsroom. strasbourg news.

The 50-year-old man went through a major depression and returned to his “bad” eating habits. His stomach is full as soon as he finishes his entree, so he tries to snack, without much success, and very often gets nauseated.

This testimony, among others, highlights the well-identified problem of the psychological management of these operations, “because few psychologists/psychiatrists have experience in this area, and in particular in eating disorders,” he explains in news.fr Professor didier quilliotof the multidisciplinary obesity surgery unit of the University Hospital of Nancy.

News: Bariatric surgery is experiencing a real madness in France, is it a “French” peculiarity?

Didier Quilliot: Since 2013, more than 40,000 patients undergo surgery each year, yes. There was a Covid-19 effect with fewer interventions in 2020, but in reality there are between 40 and even more than 50,000 interventions that are carried out each year.
France is clearly one of the countries that performs the most bariatric surgery in the world if we relate to the general population and the obese population, because we are a country quite preserved by obesity at the moment.
In France, we have been operating since around 1995, so we have some perspective. And the return touches, of course. Health insurance reimburses bypass surgery and hospitalization up to 70%. However, the intervention can obviously only be reimbursed if the medical advisor has agreed to the operation.

What are “techniques”?

QD: The High Health Authority (HAS) has validated three of them: the sleeve gastrectomy, the gastric bypass in Y and the gastric ring. In summary, gastric bypass, like sleeve gastrectomy, essentially works by reducing the sensation of hunger, reinforcing satiety and satiety. Bypasses consist of a reduction in the size of the stomach associated with a bypass of part of the stomach and small intestine.
As a general rule, we eat when we are hungry, but sometimes we eat for other reasons… which we often define as gluttony but which actually hide a form of compensation, or processing of our emotions.
Patients eat when they are stressed, anxious when they don’t feel well, when they can’t control their emotions… The surgery has a braking effect, but the psychological component can persist, and that is the whole difficulty.

The General Inspectorate for Social Affairs, Igas, had pointed out in 2018 a “poor supervision” of obesity surgeries in France. Have “safeguards” been put in place since this report?

QD: Keep in mind that surgery is a possibility. On average, with these operations patients gain six years of life expectancy and nine years when there is diabetes…
But are we operating on the “right” patients? Probably not. Type 2 diabetics or prediabetics, patients at high risk of complications, should be the main beneficiaries. However, today it remains difficult to convince diabetologists to consider bariatric surgery, and gastric bypass in particular, as first-line treatment.
In France, doctors (endocrinologists, diabetologists, nutritionists) have been slow to get involved in bariatric surgery. Initially probably due to lack of evidence, lack of skills and investment in the field by surgeons. Multidisciplinary teams have been slow to establish and are often not yet sufficiently structured.

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Does the weak point refer mainly to psychological care?

QD: Yes, because few psychologists/psychiatrists have experience in this area, and in particular in eating disorders.
The High Authority for Health (HAS) regularly reminds us that surgery is a second-line treatment for obesity, that is, after the failure of well-conducted medical, nutritional, dietary and psychotherapeutic treatment for six months to one year, and patient concerns whose body mass index (BMI) is greater than or equal to 40 kg/m2, or whose BMI is greater than or equal to 35 kg/m2, associated with at least one comorbidity likely to improve after surgery.
If successful, it helps with significant and persistent weight loss. However, this heavy act should only be carried out after a shared medical decision, with clear information about the existing techniques, their advantages and disadvantages, their consequences, complications and the need for medical follow-up throughout life… But there is still work.

The risks are known, they must be prevented and managed, in particular nutritional risks. And this requires mandatory regular monitoring, which is still too poorly organized in France. Apart from the risk of deficiency, the main risks are switching to another addiction (alcohol, drugs, substances, gambling, shopping, sex, etc.) or developing other psychological disorders, such as depression, thus we have observed three to four times more suicides after these operations. Surgery alone may not be enough.

Obesity surgery leads to lasting weight loss with certain and visible repercussions in the daily life of obese people, but this intervention can also call into question the deepest part of themselves, since it goes from one part to change them physically, and on the other hand by preventing them, in part, from managing their discomfort through food.
The need, clearly identified, is to care for patients in a multidisciplinary manner and insist on psychological care. In fact, eating disorders are very often linked to old psychological traumas. It is essential to prevent any risk of relapse or compensation of the food addiction symptom by another equally devastating one.
But the lack of trained psychiatrists today poses a real problem.

Currently, 30% of psychiatric posts are not filled in public hospitals, according to the French Federation of Psychiatry.

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