Can Gastric Sleeve Surgery Help Hinder Binge Eating?
Local experts weigh in on whether the procedure can actually help.
If a surgery could cure alcoholism or heroin addiction, wouldn’t it be celebrated as a breakthrough? Even if it weren’t 100-percent effective, the procedures would be embraced as new hope in the battle to end suffering and save lives. So why is bariatric surgery any different?
Because people blame obese patients for their food addictions, says Dr. Richard Ing, a surgeon and medical director of the Bariatric Center at Bryn Mawr Hospital. “There is a huge bias against people who suffer from food disorders,” he says. “They are thought to be lazy and much, much worse.”
Cathy Copley-Henderson knows that shame all too well. By the time she was 41, her 5-foot-8 frame held 264 pounds. That’s when she realized she had an eating disorder. “I fit myself into the binge eating category,” Copley-Henderson says. “My whole world revolved around food. It consumed me.”
Dr. Michael Pertschuk, medical director of the Eating Disorders Program at Brandywine Hospital, explains the hallmarks of binge eating disorder. “It’s a loss of control in regards to food,” he says. “It is recurrent behavior associated with emotional distress.”
Binge eating is not clinically defined as a food addiction. Different neurochemicals are at work, Pertschuk says. “But it is a compulsive behavior,” he says. “Binge eating disorder shares characteristics with people who have OCD and have to compulsively count or engage in other activities.”
Not everyone who is overweight has binge eating disorder, and not all binge eaters are overweight. Binging isn’t about overeating on Thanksgiving or a chocolate craving. In fact, binge eating isn’t about a specific food. “It’s about the act of eating,” says Mark Kooser, an eating disorder therapist at Brandywine Hospital. “Patients with binge eating disorder will eat whatever they can get their hands on, whether it tastes good or not.”
For example, when Copley-Henderson was 12, she ate an entire pot of vegetables that was meant to be dinner for the seven people in her family. “I ate all of it,” she says. “It was about volume.”
Copley-Henderson’s binging got worse after her parents divorced and she was forced to move back and forth between them, attending three different high schools. “Eating became my solace,” she says.
In 2014, Copley-Henderson enrolled in the bariatric surgery program at Brandywine Hospital. A friend had lost significant weight after having gastric sleeve surgery, and Copley-Henderson thought it would work for her.
Although now defunct, Brandywine’s program was similar to those at other hospitals, including Bryn Mawr. Ing says patients who apply for surgery are thoroughly interviewed about their medical history and their efforts to lose weight without surgery. A lot of that information goes to justify the surgery to insurance companies, which set a high bar for covering bariatrics. “Everyone agrees that bariatric surgery shouldn’t be your first attempt at weight loss,” Ing says. “But I often have to get on the phone with the insurance company to fight for these patients to have this surgery.”
Getting approved is only the first step. Two weeks before the surgery, patients are put on a liquid diet of 1,000-1,200 calories per day. It reduces the size of the internal organs surrounding the stomach, giving surgeons more room to maneuver. Ing says the drink is a specially formulated meal replacement that contains vitamins, nutrients and minerals. “I wanted to chew my arm off,” Copley-Henderson says. “It was grueling.”
So is recovery from the surgery. Less invasive than gastric bypass, which re-pipes the stomach’s plumbing, and more restrictive than lap bands, the sleeve reduces the stomach to two-thirds its former size. After a one- to three-day hospital stay, patients have a six- to eight-week recovery, with physical limitations. During that time, patients progress from a liquid diet to soft foods to normal foods. Within six to nine months, patients can lose an average of 50-60 percent of their excess body weight.
But the sleeve is not a magic cure. “It has to be combined with a healthy diet and the right supplements,” Ing says. “Patients also need to exercise on a regular basis. If they don’t do that, patients either don’t lose weight or gain it back.”
Pertschuk and Kooser remain skeptical about bariatric surgery because it doesn’t address the psychological changes needed for long-term success. “Support groups and one-on-one therapy are important so people understand their behaviors,” Pertschuk says. “Not being able to stick with a diet is how they became obese in the first place. Does the surgery automatically correct that? No.”
Copley-Henderson fully agrees. Two days after she returned home from her surgery, she felt the urge to eat. “It wasn’t out of hunger,” she clarifies. “It was all in my mind. It actually caused me pain. I held my hands to my head because it hurt to resist that behavior and almost physically change my mind. It was a turning point. After that moment, my mind and my body aligned.”
Copley-Henderson went to support groups, and she followed her doctor’s orders to a T. She drank a protein shake every day, gave up soda, ate fruits and vegetables, and adopted what’s known as a “clean” diet, with no preservatives or additives. In one month, she lost 40 pounds. Within one year, she lost 100 pounds. Now, two years after her surgery, Copley-Henderson has lost 106 pounds—and kept them off.
What if she had adopted these healthy behaviors without the sleeve? Wouldn’t she still have lost weight? “I couldn’t do it without the sleeve,” Copley Henderson insists. “I tried different diets starting at age 15. So after a lifetime of battling my body, I knew that I needed help, and I got it.”