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<p>According to the medical examiner&rsquo;s report, the 54-year-old singer-songwriter, who was found unresponsive at her Calabasas, Calif., home on Jan. 12, died from a small bowel obstruction caused by adhesions that had formed after she underwent bariatric surgery several years ago. &ldquo;Lisa Marie&rsquo;s family and friends were shocked to learn that she&rsquo;d gotten the weight loss procedure,&rdquo; a source tells <em>Life &amp; Style</em>. &ldquo;She guarded her privacy so much that even they didn&rsquo;t know the things she was going through.&rdquo; While the mother of four had long struggled with body image issues, shares the source, the older she got, the more it bothered her.</p>
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<p>&ldquo;She had all the money in the world for high-tech home gyms, personal trainers, chefs, and dietitians, but she still wasn&rsquo;t happy with her appearance,&rdquo; the source says of Lisa Marie&rsquo;s decision to go under the knife. &ldquo;She didn&rsquo;t want anyone to know [about the surgery] because she never wanted to look weak. That&rsquo;s why she didn&rsquo;t tell anyone.&rdquo; Lisa Marie&rsquo;s loved ones, however, wish she had opened up to them. &ldquo;She was surrounded by people who cared about her, but always found it difficult to trust,&rdquo; frets the source. &ldquo;It&rsquo;s very sad.&rdquo;</p>
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