Have you or any of your loved ones been recommended bariatric surgery? Has your doctor recommended bariatric surgery as a long-term “tool” to help you recover from your eating disorder? Why is the long way the only way to recovery? In this podcast episode, Dr. Cristina Castagnini speaks about bariatric surgery with Dr. Marianne Miller.


Dr. Marianne has been in the mental health field for 26 years and has specialized in eating disorders for the last 11 years. She was a full-time academic for 12 years and had a part-time eating disorder practice for much of that time until she left the university and went into private practice full-time in 2018. Dr. Marianne loves working with eating disorders as a therapist and a coach, and she takes a non-diet, feminist approach that helps people of all genders live empowered authentic lives. She embraces the Health at Every Size model and is LGBTQIAA+ affirming. Dr. Marianne recently launched the self-paced Inevitable Binge Eating Recovery online program to help high-achieving professionals regain their mental and emotional energy by shifting their relationship with food to be fully present in their life.

Visit Dr. Marianne Miller's website and connect on Facebook, Instagram, and LinkedIn.


  • Bariatric surgery is not a long-term solution
  • Gastric sleeve surgery for children?
  • Be mindful of intentions

Bariatric surgery is not a long-term solution

It doesn’t teach you how to eat, right? It teaches you how to restrict. And again, restriction is the foundation of all eating disorders. (Dr. Miller)
Bariatric surgery can have a huge toll on the body, and not only that but in the recovery process from the surgery people often have to drastically restrict what they are eating. The surgery is not a long-term solution, because it also does not address the root causes of why a person might be suffering from an eating disorder.
[Cristina] and I know that if we don’t ask about restriction then we’re missing a huge component of the eating disorders … and so when you have a full medical team that is promoting that [surgery] and basically amputating a part of your stomach … that’s extreme. (Dr. Miller)

Gastric sleeve surgery for children?

For many medical professions, new medical guidelines that have recently been released are incredibly alarming.
The American Academy of Pediatrics has now said that gastric sleeve surgery is okay for children [that are age] 13 and up. I mean, that is appalling. (Dr. Miller)
A huge portion of the medical field is purely based on numbers, like BMI. The BMI doesn’t take outliers into consideration, and many children whose bodies are going through puberty that may be “bigger” than average may be encouraged to get these invasive and dangerous surgeries simply because they are considered bigger. Remember that size and healthy are not always correlated.

Be mindful of intentions

Sure, doctors want to help people, and most – almost all – doctors aspire to uplift and help the people that come into their offices seeking treatment. However, some people will sell anything, from medications to procedures, because it pays well, regardless of whether it is good for their clients. These types of people are unfortunately in almost every industry, and although they are rare, they are sometimes present.
[People] are being told that [these surgeries] are tools to get [them] there, that this is going to help [them], and I don’t think people are really thinking about what life is like after. (Dr. Castagnini)
Sometimes the intentions behind these medical suggestions are not completely well-meant. These surgeries can earn the medical industry lots of money, and they are not always in the truest best interests of the people that are considering them.
I used to call it the trifecta in the hospitals; they’d go to bariatrics, get the surgery and then come see me because they were super depressed [afterward] and having a lot of problems, or they’d see me first and despite me trying to persuade them against bariatric surgery someone else … gives them the rubber stamp to go ahead … and then they’d end up in chemical dependency because they would turn to alcohol. After all, they could [no longer] escape with food … and then you have another problem on your hands. (Dr. Castagnini)
Recovery from an eating disorder is fully possible, but it requires you to make the effort. There is no shortcut, no cheat code and no way around actually sitting down with yourself and figuring out how to truly care for your complete well-being. Don’t cheat yourself out of a happy, healthy, and wholesome life because it’s something that’s difficult to do. Love yourself and your body enough to commit to recovery because you know that you are worth the effort.



  I am a licensed Psychologist and Certified Eating Disorder Specialist. While I may have over 20 years of clinical experience, what I also have is the experience of having been a patient who had an eating disorder as well. One thing that I never had during all of my treatment was someone who could look me in the eye and honestly say to me "hey, I've been there. I understand". Going through treatment for an eating disorder is one of the hardest and scariest things to do. I remember being asked to do things that scared me. Things I now know ultimately helped me to get better. But, at the time, I had serious doubts and fears about it. If even one of my providers had been able to tell me "I know it's scary, but I had to go through that part too. Here's what will probably happen...." then perhaps I would not have gone in and out of treatment so many times. My own experience ultimately led me to specialize in treating eating disorders. I wanted to be the therapist I never had; the one who "got it". I will be giving you my perspective and information as an expert and clinician who has been treating patients for over 2 decades. But don't just take my word for it...keep listening to hear the truly informative insights and knowledge guest experts have to share. I am so happy you are here!


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