Nurse-Researcher Finds Past Sexual Abuse Affects Bariatric Surgery Recovery

Nurse Leader Insider, September 27, 2018

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By Jennifer Thew, RN

Adults who experienced childhood abuse have different recovery needs after bariatric surgery than those who were not abused.

Children who experience physical, sexual, or verbal abuse sustain long-term consequences, studies have found. Abuse, neglect, witnessing crime, parental conflict, mental illness, or substance abuse can create dangerous levels of stress that can impact healthy brain development. These Adverse Childhood Experiences can increase the risk for smoking, alcoholism, heart disease, and many other illnesses and unhealthy behaviors throughout life.

For example, survivors of abuse are more likely to suffer from depression, eating disorders, and obesity, according to Polly Hulme, a nursing professor at South Dakota State University whose research focuses on how childhood sexual abuse affects victims as adults.

Of the 78 million Americans who are obese or morbidly obese, more than six million have likely suffered from physical, sexual or verbal abuse as children, found the CDC-Kaiser Permanente Adverse Childhood Experiences study, one of the largest studies focusing on how childhood abuse and neglect affects the victims’ adult lives.

Hulme's recent study of patients undergoing bariatric surgery may help healthcare professionals better understand the challenges those who have experienced physical or sexual abuse face during recovery. She and a team of researchers examined recovery of patients after a bariatric surgery known as biliopancreatic diversion with duodenal switch.

“The same mechanisms that link physical and sexual abuse to increased risk for obesity may also negatively affect bariatric surgery outcomes,” Hulme says of the findings.
Abuse Leads to Risk for Malnutrition

The study was conducted using data on all patients who underwent the procedure during 2009 and 2010 at a healthcare facility in Omaha, Nebraska.

As part of the screening process, bariatric surgery candidates are asked whether they have experienced abuse. Of the 189 patients in the study, 42 reported a history of physical or sexual abuse.

    Nearly 73% of those who were abused experienced abuse as children


    More than 6% experienced abuse both as children and as adults

The surgeon performing the procedures inserted a feeding tube in the small intestine to prevent malnutrition during recovery. This allowed the researchers to compare the length of time the feeding tube was needed for patients to maintain nutritional levels.

“Those patients who reported abuse had good outcomes in terms of weight loss, but their feeding tubes, on average, were in place 17 days longer than other patients,” Hulme says in a news release. "This finding increases our understanding of the role abuse plays in malnutrition risk and suggests these patients would benefit from the support of mental health and nutritional experts.”

The next phase will be to determine whether gastric bypass patients who do not receive feeding tubes face similar nutritional challenges during recovery if they have a history of sexual or physical abuse.

“Many bariatric surgeons have noticed that patients with a history of childhood sexual or physical abuse often seem like a different population,” Hulme explains.  “Now we know that their weight loss outcomes are similar to those who do not report sexual or physical abuse, but we can better help these patients deal with the nutritional and psychological aspects associated with the changes they experience after bariatric surgery.”

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