In March 2015, 34-year-old Kelly Burndred believed she was finally on the verge of finding happiness. She had recently lost an extraordinary 20 stones — two-thirds of her body weight — thanks to weight-loss surgery. For the first time in her life, a child’s mother doesn’t have to fixate on her size.
But far from bringing relief, the surgery marked the beginning of a dark episode of depression. Three years after the procedure, her husband, Gareth, woke up one morning to find Kelly on the floor, having committed suicide.
The Stoke-on-Trent council worker had suffered from mental health problems for years, Gareth told local newspapers after her death. But surgery had made everything worse.
All her life, Kelly had blamed her problems on her weight, he said, reaching more than 30 stone at her heaviest. But once she slimmed down to 10.5 stone, the problems were still there.
The story is undeniably tragic and not a one-off. A wealth of research shows that the risk of suicide quadruples in the decade following weight-loss surgery – known medically as bariatric surgery – with those aged 18 to 34 at highest risk.
Kelly Burndred, 34, from Stoke-on-Trent, went from 30 stone (pictured) to 10.5 stone after weight loss surgery
Other studies have found a significant decline in some patients’ mental health in the two years following surgery.
It is estimated that about one in four teenage patients who undergo bariatric surgery suffer from depression in the five years following surgery.
Meanwhile, some patients have taken to online forums to express their psychological distress. On the Facebook group Obesity UK Bariatric And Metabolic Surgery Support Group, which has nearly 7,000 members, a woman writes that her surgery has ‘played with my head’.
“I’m depressed when I should be happy,” she says. “Stupidly pining for the old ways – and (have) days when I just feel a little lost and depressed.”
Another, who had surgery in October, says, “I don’t know how to deal with it anymore… my depression is really on the rise.”
With health chiefs offering the procedure to even more Britons, experts are calling for better protection of patients’ mental health.
Last month NHS watchdog, the National Institute for Health and Care Excellence (NICE), ruled that weight loss surgery should no longer be the last resort – doctors can now refer patients who have not tried to lose weight in any other way.
The updated guideline also scraps the previous rule that stated that those referred for surgery must have a certain level of fitness.
NICE says the change will increase the number of surgeries performed, including inclusion in “previously overlooked” groups. But specialists have raised concerns about the mental health risks, which they say support is lacking.
‘There needs to be a better system in place to ensure that warning signs (of mental health problems) are picked up early, when they can be managed,’ says Prof Carel Le Roux, a consultant in metabolic medicine at Imperial College London. “Doctors are not doing enough to manage patients’ expectations before surgery. They should be told not to expect any cosmetic transformation.
“Every time (suicide) happens, it’s catastrophic, so it’s very important to recognize it as a known complication.”
Kelly (pictured after surgery) committed suicide because she felt worse because she was thin
So what is the connection between weight loss surgery and the increased risk of suicide?
There were around 4,000 slimming procedures performed in the UK last year – before Covid that was around 6,000 a year.
The surgeries are offered to people with a body mass index (BMI) of 40 or more, or between 35 and 40 with a serious weight-related health problem, such as high blood pressure or type 2 diabetes.
There are different types of procedures, but in the end they all work the same way: shrinking the stomach to reduce hunger. The most common is a sleeve gastrectomy, in which a large portion of the stomach is removed. But also common is the gastric bypass, in which surgeons reduce the size of the stomach using staples and a gastric band – an implant placed around the stomach that limits the size and amount that can be eaten.
Studies show that patients lose an average of 20 to 30 percent of their body weight, and three-quarters of them manage to keep it off in the long term.
This reduces the risk of heart attacks and strokes by about 50 percent and reduces the risk of cancer by 20 percent in women.
Overall, the procedures reduce the risk of dying within five years by 89 percent, according to a 2004 Canadian study of 1,000 patients.
‘Surgery is the only approved treatment we have for obesity that has been proven to maintain adequate weight over the long term,’ says Dr Alex Miras, a consultant in endocrinology and a researcher in digestion and metabolism at Imperial College London.
The new breed of weight-loss drugs, including liraglutide and semaglutide, have been proven to be effective, he adds, but still nowhere near as effective as surgery.
Semaglutide is also only available on the NHS for overweight or obese patients with type 2 diabetes. “Newer, more effective versions of these drugs will come onto the market in the coming years, but the ones available at the moment are not as effective as surgery,” says Dr. Miras.
However, surgery already carries some serious risks. The most common procedures — gastric bypass and sleeve gastrectomy — have a one in 500 chance of death and a three in 1,000 chance of surgical complications, such as serious infection.
About five percent of patients will develop severe nutritional deficiencies, adds Dr. Miras. “It’s also not uncommon for people to have bone fractures after surgery and hair and nail loss.”
But the psychological risks, says Dr. Miras, are less likely to be discussed with patients. This is often because they are indirect, meaning they are not directly caused by the physical surgery.
An intriguing phenomenon is the increased risk of alcohol dependence, which has been documented in numerous studies.
On the Facebook group Obesity UK Bariatric And Metabolic Surgery Support Group, which has nearly 7,000 members, a woman writes that her surgery has ‘played with my head’
“Some people struggle with losing the comforting effect food has had on their lives,” says Dr Miras. “They’ve learned to rely on food to relieve stress and ameliorate difficult emotions, and when suddenly they can’t, because they can’t eat as much, they sometimes look for other ways to get that comfort.”
“That could include gambling, recreational drugs, and alcohol. A small percentage find no substitute for this comfort and instead live in immense need. This can lead to severe depression and, in extreme cases, suicide.’
Studies show that after about a year or two, some patients gain a little weight, which can cause feelings of failure.
Of course, psychological problems that a patient had before surgery may still be present afterwards.
Major life changes are also common after surgery.
A recent study of weight loss patients found that they were twice as likely to get a divorce in the years following their surgery than people who didn’t have the surgery. “About 80 percent of those who have the surgery are women, and we often see male partners become jealous and uncomfortable because their wives are attractive to other men,” says Dr Miras.
The experts also say that long-term psychological support is lacking in many obesity services in the UK.
One patient who says bariatric surgery worsened her mental health is 50-year-old Angela Chesworth from Liverpool. She had been overweight since the age of eight. Over the years, she tried different ways to lose weight – and even managed to shed eight stone at Slimming World.
“But each time the weight started creeping back,” she says, “even though I didn’t do anything else.” I exercised for two hours three times a week and ate healthy, low-calorie meals. It was like my body couldn’t hold it off.’
In 2012, at the age of 40 and weighing 24 stone, Angela began to struggle with sleep apnea – an obesity-related condition in which breathing is interrupted during sleep – as well as pain in her back and knees. Her GP referred her for weight loss surgery and she underwent a gastric bypass.
The weight began to fall off almost immediately. Angela lost 12 stones in 12 months and went from dress size 26 to size 12-14. But as her body shrank, her mental health deteriorated.
“I still saw myself as a bigger woman. And the feelings that came with it, like being a failure, didn’t go away,” she says. “Besides, you feel like you have no idea who you are anymore. I remember crying in clothing stores thinking, what does Angela want to wear? Who is she?’
To make matters worse, surgery was a catalyst for ending her 15-year marriage.
“We hadn’t been physical for five years and I thought the problem was my weight,” she says. “But things didn’t improve after the surgery, which made me realize we’d lost a spark.”
In 2015, Angela hit rock bottom: “I started binge eating to punish myself. I felt ungrateful, like I’d wasted NHS money because I still wasn’t happy.
“I remember going to Asda, buying a big box of donuts and then sitting in front of the mirror and eating them all.”
She went to her GP for help and was referred for 18 months of cognitive behavioral therapy.
“It took a long time to deal with the demons in my head,” she says. “I had medical treatment for my body, but I still had to recover my brain.”
Angela has since remarried, but she still struggles with binge eating. She says she takes antidepressants to “stay sober,” adding, “Bariatric surgery changed my life, but I believe it was the therapy that really saved me.”
Despite the negatives, the majority of patients feel their quality of life improves after weight loss surgery, says Prof. Le Roux.
“If you look at studies of thousands of people who have had bariatric surgery, you see that people who have had this procedure tend to live longer.
Weight loss surgery is often treated like any other acute surgery, such as removing your appendix. But that is not the case. Obesity is a chronic condition. Patients should not be forgotten.’