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How bariatric surgery can affect your mental health

Reviewed by Brooks Baer, LCPC, CMHP

Empty operating room with blue table

Brenda*, a 49-year-old dental assistant, fell and injured her knee during a business trip in 2015. A few weeks prior, she’d hurt her other knee in a fall as well—and both stumbles were tied to the extra weight she’d carried for much of her adult life. Feeling for the first time like she might lose her mobility, Brenda decided to do something about it.

Her husband of two decades, Ken*, was also medically classified as obese. Together they made the decision to get bariatric weight-loss surgery. In the four years since their procedures, Ken has lost weight and not regained it, and he feels like the surgery was a success. Brenda, on the other hand, has struggled. After losing 120 pounds, she gradually began to put weight back on.

“I didn’t fix what was wrong with my mental health,” Brenda says. “I never fixed my relationship with food. There’s no way this was sustainable for me.”

Brenda’s experience isn’t rare. Because obesity can have mental and physical health risks, weight-loss surgery can feel like a lifesaver for some. But while this surgery leads many patients to lose weight and maintain that loss, making dramatic changes to your body and lifestyle can also have lasting psychological effects.

If you’re considering bariatric surgery, here’s how to protect your mental health before and after the procedure. You might even build a healthier relationship with food and your body along the way.

What is weight-loss surgery?

As obesity rates climb, surgical solutions to weight loss are becoming more popular, especially given the controversies around emerging drugs like Ozempic and Wegovy.1, 2 Between 2011 and 2021, more than a quarter-million people underwent bariatric surgery in the United States.3

Generally speaking, three types of weight-loss surgery are available in the US.4 Options include gastric bypass, a “stapling” of the stomach that can be reversed; gastric sleeve (the type Brenda and Ken chose), which is irreversible; and adjustable gastric band, which is performed the least of the three due to a higher rate of complications.5

Signs of progress—and lasting stigma

Mallory, a 36-year-old teacher, had bariatric surgery nine years ago. She chronicled her journey on social media and became a trusted leader in a community of people getting the same surgery. But not everyone was supportive: Mallory also received private messages and comments trivializing her medical decision. “People said some mean things, and some accused me of taking the easy way out,” she says.

Weight-loss surgery is frequently dismissed as an “easy way out.” But for many people, the weeks, months, and years after the procedure are full of challenges. First there’s the postoperative pain, which can be intense. Then patients have to monitor their food intake at every meal (including some restrictions, such as carbonated drinks, for safety reasons), take care not to overeat because it may cause nausea or vomiting, and balance nutritional supplements with any medications.6 Underlying it all is the major adjustment of learning to live in a very different body.

Fatema Jivanjee-Shakir, LMSW, specializes in eating disorders and works with patients before and after bariatric surgery. Often, she says, they find themselves feeling trapped between two strong sets of opinions.

“In diet spaces, there tends to be a lot of weight stigma and judgment about being in a larger body, as well as expectations of what people should look like or how they should be eating after surgery,” says Jivanjee-Shakir. “At the same time, they may face stigma and judgment about obtaining the surgery, due to how it can contradict Health at Every Size and body acceptance.7 Being sandwiched between these two stigmas can leave someone feeling extremely lonely, isolated, and ashamed.”

The truth is that bariatric surgery is often the last resort for patients after years of dieting. In a 2014 survey of people seeking weight-loss surgery, more than half reported fear of health issues and a shortened lifespan as their main motivation.8 The second most popular motivating factor was building a healthier life. Concerns about mobility and independence came in third.

Mental health risks of weight-loss surgery

As you consider the potential physical side effects and complications of bariatric surgery, keep these mental health risks in mind as well.

Self-harm and suicidality: Research demonstrates that weight-loss surgery increases the risk of mental health difficulties, including suicidality and self-harm,” says Jivanjee-Shakir.9 Brenda says she felt shame both before and after her surgery, leaving her depressed and in a state of mind where self-harm was possible.

If you’re in crisis and need immediate help, call or text the 988 Suicide & Crisis Lifeline at 988 anytime for free, confidential support.

Addiction transfer: Some patients, especially those who showed signs of food addiction pre-surgery, may wind up replacing one addiction with another. In one study, patients who’d undergone surgical weight loss had higher instances of substance abuse disorder.10

Bariatric binge eating disorder: Binge eating disorder (BED) is characterized by consuming large portions of food with little to no control. This behavior is often physically impossible after bariatric surgery because the stomach is so much smaller. However, research suggests that patients who had BED before surgery are at risk of continuing that behavior afterward, just with smaller quantities of food.11

All these risks are best managed with the support of a mental health professional. To find a therapist near you, browse our directory.  

Caring for yourself before and after surgery

The amount and type of mental health support available to you around your surgery is most often determined by your insurance company and/or surgical center. For additional help, consider the following.

Keep your mental health top of mind

Sometimes patients are so scared for their physical health, they zero in on getting the surgery no matter what. “I jumped through whatever hoops my surgeon gave me and told them what I thought they wanted to hear,” says Brenda. “But if someone had really sat me down and dug deeper into my relationship with food and my body, they probably would have found that I was not a good candidate for the surgery.”

Find a weight-inclusive mental health professional

Jivanjee-Shakir says that a mental health therapist who understands how and why people struggle with weight is a critical source of support. “The therapy typically prescribed around this surgery focuses on behavioral changes to restrict food intake and maintain postsurgical weight loss,” she explains. “This approach implies that body size can and should be controlled, and it often assumes that size is indicative of diet and exercise.”

In reality, body size is impacted by a range of factors, including genetics, stress, and sleep. Working with a therapist who understands these issues makes a big difference.

Explore your relationship with food before surgery

Brenda describes herself as a food addict. “A month after my surgery, I was in a Burger King parking lot eating in my car,” she says. “I was sabotaging my progress.” Jivanjee-Shakir advises that if you’re considering surgery, take the opportunity to examine how you engage with food and your body first. Again, the right therapist can be an excellent guide: “It’s an opportunity to gain more education about the surgery from an anti-diet, fat-positive perspective so you can make a more informed decision,” says Jivanjee-Shakir.

Include mental health care in your recovery process

Your insurance company or surgical staff will send you home with postoperative care instructions. Mental health care should be a significant part of that, though you may need to arrange for it yourself. Just like standard follow-up appointments with a medical doctor, regular meetings with a therapist will help you navigate dramatic changes in how you look, feel, and interact with the world.

What does success look like?

Whether or not bariatric surgery is “successful” is relative. According to the Cleveland Clinic, more than 90% of people retain much of their weight loss, which the medical community considers a success.12 For Mallory and Brenda, success looks different.

Bariatric surgery helped turn Mallory’s physical health around, and she believes it also helped her conceive a child after years of trying. For Brenda, keeping 50 pounds off after four years has made a positive impact on her mobility. Even so, both of them say that if they could start the surgical process over again, they’d take better care of their mental health along the way.

*Name has been changed.

About the author

Amye Archer, MFA, is the author of “Fat Girl, Skinny” and the coeditor of “If I Don’t Make It, I Love You: Survivors in the Aftermath of School Shootings,” and her work has appeared in Creative Nonfiction magazine, Longreads, Brevity, and more. Her podcast, “Gen X, This Is Why,” reexamines media from the ’70s and ’80s. She holds a Master of Fine Arts in creative nonfiction and lives with her husband, twin daughters, and various pets in Pennsylvania.