Binge Eating in Gastric Bypass Patients Before Surgery

Background: Binge eating in the obese, specifically those undergoing bariatric surgery, has only recently been investigated. This study is a continuation of a long-term effort to determine the impact of eating disorders on the outcome of bariatric surgery. Methods: Self-report questionnaires (Binge Eating Scale, Beck Depression Inventory, Questionnaire on Weight and Eating Patterns) were completed by 125 patients preparing to undergo gastric bypass surgery. Results: Binge eating was clearly a problem in this population, with 33.3% showing severe binge eating problems on the Binge Eating Scale. Over half of patients engaged in bingeing or grazing, most reporting a frequency of two or more times per week. A high level of depression was associated with binge eating. Conclusions: Because postsurgical long-term weight loss maintenance is contingent on modifying eating behavior, the identification and treatment of such disorders may be critical to successful long-term outcome in these patients.     

Preoperative Binge Eating Status and Gastric Bypass Surgery: A Long-Term Outcome Study

Background  The primary purpose of the study was to evaluate the effect of preoperative binge status on long-term weight loss outcomes. Methods  IRB approval was obtained. This prospective study was initiated in 1997 at a large teaching hospital. Adult patients who participated in the study and attended post-surgery clinic visits for at least 12 months were included. Patients completed the gormally binge eating scale (BES), the beck depression inventory (BDI), and the SF-36 at baseline prior to surgery. All data are expressed as mean ± SD. Data were analyzed using a Student’s t test, pairwise correlation and regression analysis as appropriate. Results  A total of 157 patients (135 women) aged 45 ± 10  years were recruited. Their preoperative BMI was 50.7 ± 8.0  kg/m². Thirty-seven patients were classified as severe binge eaters (BES ≥ 27) prior to surgery. There was no significant difference in their weight loss compared to the rest of the group at any time point up to 6 years after surgery. Patients with significant depressive symptoms (BDI >13) had no significant difference in their weight loss outcomes compared to the rest of the group. Pre-surgery SF-36 scores did not predict differences in weight loss outcome. Conclusion  Pre-surgical binge status, incidence of depressive symptoms and health related quality of life were not predictive of poor weight loss outcomes in patients up to 6 years after gastric bypass surgery, who were able to make lifestyle changes in preparation for surgery and who adhered to scheduled post surgery clinic visits.     

Psychosocial Status in Adolescents Undergoing Bariatric Surgery

Background Little is known about the psychosocial status of adolescents who undergo bariatric surgery. Our objective was to describe the psychological and behavioral characteristics of patients in this age group who underwent bariatric surgery at our institution. Methods A review of clinical charts of patients aged 14–21 years who had bariatric surgery at our institution between 2000 and 2005 was conducted. Abstracted data included clinical information and the results of a psychosocial evaluation consisting of a clinical interview with a psychologist and self-reported data from the Weight and Lifestyle Inventory and the Beck Depression Inventory-II. Results Twenty-five patient records were reviewed. Nineteen patients (76%) were female. The mean (±SD) age was 18.7 ± 1.6 years, and mean body mass index was 50.6 ± 7.9 kg/m². Depression was the most common psychiatric comorbidity (68%). Abnormal eating behaviors were frequent and included binge eating (48%), rapid eating (44%), having guilt associated with eating (36%), eating until uncomfortably full (36%), loss of control (24%), eating without hunger (24%), and eating alone (20%). Sixteen patients were judged to be appropriate for surgery by the bariatric surgery team; surgery was delayed for nine patients primarily because of concerns about ability to adhere to the postoperative diet. These patients were recommended for additional dietary counseling and/or psychotherapeutic treatment prior to surgery. Conclusions Among adolescent bariatric surgery candidates, depression and aberrant eating behaviors were very common. Early identification and management of these conditions may enable most of these patients to undergo bariatric surgery and optimize the likelihood for a successful outcome.     

The role of body appreciation,weight bias internalization,and disordered eating behaviors among presurgical bariatric patients

BackgroundBody appreciation and internalized weight bias have consistently been associated with eating behaviors. However, research has yet to examine the role of these variables among presurgical bariatric patients.ObjectivesThe present study sought to assess the relationships between body appreciation and weight bias internalization, binge eating, disinhibited eating, and symptoms of depression and anxiety among a sample of presurgical bariatric patients. The study also sought to examine the extent to which body appreciation and weight bias internalization account for unique variance in disordered eating even when controlling for depression and anxiety.SettingAcademic medical center in the United States.MethodsData were collected on body appreciation, weight bias internalization, eating behaviors, depression, and anxiety as part of a standard presurgical psychological evaluation for bariatric surgery (n = 319). Pearson correlations were used to assess relationships between all study variables. Multiple regressions were conducted to assess the roles of body appreciation and weight bias internalization on disordered eating.ResultsSignificant associations were found between low levels of body appreciation and high levels of weight bias internalization, disordered eating, and symptoms of depression and anxiety. Results indicated that body appreciation and weight bias internalization each significantly accounted for unique variance in symptoms of binge eating and disinhibited eating. Depressive symptoms were also statistically significant in all analyses.ConclusionFindings indicate the importance of conducting future positive body image research, as well as continuing to examine weight-related constructs, such as internalized weight bias, among bariatric surgery patients.     

Psychopathology,disordered eating,and impulsivity in patients seeking bariatric surgery

BackgroundMost patients who undergo bariatric surgery experience significant weight loss and improvements in obesity-related co-morbidities in the first 6–18 months after surgery. However, 20%–30% of patients experience suboptimal weight loss or significant weight regain within the first few postoperative years. Psychosocial functioning may contribute to suboptimal weight loss and/or postoperative psychosocial distress.ObjectiveAssess psychosocial functioning, eating behavior, and impulsivity in patients seeking bariatric surgery.SettingTwo university hospitals.MethodsValidated interviews and questionnaires. Impulsivity assessed via computer program.ResultsThe present study included a larger (n = 300) and more racially diverse (70% non-White) sample than previous studies of these relationships. Forty-eight percent of participants had a current psychiatric diagnosis and 78% had at least 1 lifetime diagnosis. Anxiety disorders were the most common current diagnosis (25%); major depressive disorder was the most common lifetime diagnosis (44%). Approximately 6% of participants had a current alcohol or substance use disorder; 7% had a positive drug screen before surgery. A current psychiatric diagnosis was associated with greater symptoms of food addiction and night eating. Current diagnosis of alcohol use disorder or a lifetime diagnosis of anxiety disorders was associated with higher delay discounting.ConclusionThe study identified high rates of psychopathology and related symptoms among a large, diverse sample of bariatric surgery candidates. Psychopathology was associated with symptoms of disordered eating and higher rates of delay discounting, suggesting impulse control issues.     

Eating patterns and unhealthy weight control behaviors are associated with loss-of-control eating following bariatric surgery

BackgroundLoss-of-control (LOC) eating is associated with poor weight-loss outcomes following bariatric surgery. It is not clear whether eating patterns (e.g., total number of daily meals/snacks, eating after suppertime, eating when not hungry) and unhealthy weight control behaviors (e.g., smoking, using laxatives) are associated with or predictive of LOC eating.ObjectivesTo examine whether eating patterns and unhealthy weight-control behaviors are associated with LOC eating and, if so, whether they predict LOC eating in bariatric patients.SettingMulticenter study, United States.MethodsThis is a secondary analysis of the Longitudinal Assessment of Bariatric Surgery–2 study. Assessments were conducted before surgery and at 12, 24, 36, 48, 60, and 84 months after surgery. Logistic mixed models were used to examine the longitudinal associations between eating patterns, unhealthy weight-control behaviors, and LOC eating. Time-lag techniques were applied to examine whether the associated patterns and behaviors predict LOC eating.ResultsThe participants (n = 1477) were mostly women (80%), white (86.9%), and married (62.5%). At the time of surgery, the mean age was 45.4 ± 11.0 years and the mean body mass index was 47.8 ± 7.5 kg/m². The total number of daily meals/snacks, food intake after suppertime, eating when not hungry, eating when feeling full, and use of any unhealthy weight-control behaviors were positively associated with LOC eating (P < .05). Food intake after suppertime, eating when not hungry, and eating when feeling full predicted LOC eating (P < .05).ConclusionMeal patterns and unhealthy weight control behaviors may be important intervention targets for addressing LOC eating after bariatric surgery.     

Obesity and co-morbid psychiatric disorders as contraindications for bariatric surgery?—A case study

INTRODUCTION

Many patients undergoing bariatric surgery report current or past psychiatric disorders and controversy exists regarding their outcome after bariatric surgery.

PRESENTATION OF CASE

We present a case of an obese patient with a borderline personality disorder, a recurrent depressive disorder, post-traumatic stress symptoms and binge eating episodes who underwent bariatric surgery.

DISCUSSION

Although the psychiatric disorders remained, the procedure contributed to an improvement of the health status and well-being of the patient. Adequate psychological care after the surgical procedure is necessary to enable a long-term stabilization of patients with mental co-morbidities.

CONCLUSION

Patients with psychiatric co-morbidities should not be excluded from the procedure if adequate post-operative support is provided.     

Associations of Weight-Based Teasing History and Current Eating Disorder Features and Psychological Functioning in Bariatric Surgery Patients

Background The study investigated associations between childhood history of being negatively teased (i.e., being made fun of) about weight with psychiatric history, weight and eating concerns, and psychological functioning in 174 bariatric surgery candidates. Methods Bariatric surgery candidates participating in a comprehensive psychiatric evaluation completed a structured diagnostic interview, a psychosocial history interview, and a battery of established self-report measures assessing broad aspects of functioning. Patients who reported a history of being teased during childhood about weight were compared with those who denied having been teased in demographic features, obesity history, dietary and eating patterns and psychological functioning. Results Of the study group, 88 participants (50.6%) reported a weight-based childhood teasing history and 86 (49.4%) denied such a history.Teasing was not significantly associated with demographic features or current obesity level. As expected, analyses revealed that teasing was associated with younger age of onset of both obesity and dieting.Teasing was significantly associated neither with the frequency of lifetime psychiatric disorders, including eating disorder diagnoses, nor with binge eating. Analyses of covariance controlling for childhood onset of obesity, however, revealed that teasing history was associated with significantly higher current levels of weight and shape concerns, depression, body dissatisfaction, and shame, and with lower levels of self-esteem. Conclusion Health-care providers should recognize the importance of a history of having been teased or made fun of about weight in bariatric surgery candidates. Although the prognostic significance of a history of such negative teasing for bariatric surgery outcomes is unknown, our findings suggest that such experiences are prevalent in this patient group and are associated with negative sequelae. Funding for this research came from the VA Office of Research and Development, Rehabilitation Research and Development Program, National Institutes of Health grant K24 DK070052, and Rudd Center for Food Policy and Obesity     

Successful Weight Loss Surgery Improves Eating Control and Energy Metabolism: A Review of the Evidence

Eating behavior is determined by a balance of memories in terms of reward and punishment to satisfy the urge to consume food. Refilling empty energy stores and hedonistic motivation are rewarding aspects of eating. Overfeeding, associated adverse GI effects, and obesity implicate punishment. In the current review, evidence is given for the hypothesis that bariatric surgery affects control over eating behavior.Moreover, any caloric overload will reduce the feeling of satiety. Durable weight loss after bariatric surgery is probably the result of a new equilibrium between reward and punishment, together with a better signaling of satiation due to beneficial metabolic changes.We propose to introduce three main treatment goals for bariatric surgery: 1) acceptable weight loss, 2) improvement of eating control, and 3) metabolic benefit. To achieve this goal, loss of 50% to 70% of excess weight will be appropriate (i.e. 30% to 40% loss of initial weight), depending on the degree of obesity prior to operation.     

Psychological,behavioral, and weight-related aspects of patients undergoing reoperative bariatric surgery after gastric band: comparison with primary surgery patients

Background

Patients experiencing insufficient weight loss or weight regain in their first bariatric surgery may represent a high-risk group with greater problematic eating and general psychopathology levels, which may compromise the success of a reoperative procedure.

What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year?

BackgroundPrior evidence indicates that predictors of weight loss outcomes after gastric bypass surgery fall within 5 domains: 1) presurgical factors, 2) postsurgical psychosocial variables (e.g., support group attendance), 3) postsurgical eating patterns, 4) postsurgical physical activity, and 5) follow-up at postsurgical clinic. However, little data exist on which specific behavioral predictors are most associated with successful outcomes (e.g.,≥50% excess weight loss) when considering the 5 domains simultaneously. The objective of this study was to specify the behavioral variables, and their respective cutoff points, most associated with successful weight loss outcomes.MethodsSignal detection analysis evaluated associations between 84 pre- and postsurgical behavioral variables (within the 5 domains) and successful weight loss at≥1 year in 274 postgastric bypass surgery patients.ResultsSuccessful weight loss was highest (92.6%) among those reporting dietary adherence of>3 on a 9-point scale (median = 5) who grazed no more than once-per-day. Among participants reporting dietary adherence<3 and grazing daily or less, success rates more than doubled when highest lifetime body mass index was<53.7 kg/m². Success rates also doubled for participants with dietary adherence = 3 if attending support groups. No variables from the physical activity or postsurgical follow-up domains were significant, nor were years since surgery. The overall model’s sensitivity = .62, specificity = .92.ConclusionsTo our knowledge, this is the first study to simultaneously consider the relative contribution of behavioral variables within 5 domains and offer clinicians an assessment algorithm identifying cut-off points for behaviors most associated with successful postsurgical weight loss. Such data may inform prospective study designs and postsurgical interventions.