Loss of Control Over Eating Predicts Outcomes in Bariatric Surgery Patients: A Prospective, 24-Month Follow-Up Study

Department of Psychiatry, Yale University School of Medicine, PO Box 208098, New Haven, CT 06520, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 10/2009; 71(2):175-84. DOI: 10.4088/JCP.08m04328blu
Source: PubMed


This study examined the clinical significance of loss of control (LOC) over eating in bariatric surgery patients over 24 months of prospective, multiwave follow-ups.
Three hundred sixty-one gastric bypass surgery patients completed a battery of assessments before surgery and at 6, 12, and 24 months following surgery. In addition to weight loss and LOC over eating, the assessments targeted eating disorder psychopathology, depression levels, and quality of life. The study was conducted between January 2002 and February 2008.
Prior to surgery, 61% of patients reported general LOC; postsurgery, 31% reported LOC at 6-month follow-up, 36% reported LOC at 12-month follow-up, and 39% reported LOC at 24-month follow-up. Preoperative LOC did not predict postoperative outcomes. In contrast, mixed models analyses revealed that postsurgery LOC was predictive of weight loss outcomes: patients with LOC postsurgery lost significantly less weight at 12-month (34.6% vs 37.2% BMI loss) and 24-month (35.8% vs 39.1% BMI loss) postsurgery follow-ups. Postsurgery LOC also significantly predicted eating disorder psychopathology, depression, and quality of life at 12- and 24-month postsurgery follow-ups.
Preoperative LOC does not appear to be a negative prognostic indicator for postsurgical outcomes. Postoperative LOC, however, significantly predicts poorer postsurgical weight loss and psychosocial outcomes at 12 and 24 months following surgery. Since LOC following bariatric surgery significantly predicts attenuated postsurgical improvements, it may signal a need for clinical attention.

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Available from: Marney A White,
    • "Another limitation is that data was only collected prior to bariatric surgery and, as such, the change in LOC E and related variables could not be examined over time. Indeed, recent literature has focused on post-bariatric surgery variables (e.g., post LOC E ) as predictors of relevant outcomes (e.g., White et al., 2010). Given that many individuals with pre-surgical LOC E continue to experience uncontrolled eating following bariatric surgery, we believe it is also useful to study pre-surgical variables. "
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    ABSTRACT: The goal was to examine the relationship between loss of control over eating (LOCE) and other variables, including eating pathology, in bariatric candidates. Two hundred and twenty-six participants completed measures of depressive symptoms, eating pathology, health-related quality of life (HRQOL), and alcohol use. Participants were divided into those who did (n = 123) and did not (n = 103) report subjective LOCE. Participants with LOCE had significantly higher levels of night eating, depressive symptoms, and eating disorder psychopathology and lower mental HRQOL. There were no observed differences in alcohol use, dietary restraint, or physical HRQOL. This study highlights eating and mental health-related correlates of LOCE, providing evidence that it is associated with increased psychological burden in bariatric candidates. This is one of the first studies to report the relationship between LOCE and night eating in this group and future research could elaborate on these variables to determine their importance in long-term weight loss.
    Journal of Clinical Psychology in Medical Settings 12/2014; 22(1). DOI:10.1007/s10880-014-9411-6 · 1.49 Impact Factor
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    • "Although weight loss was greater for older, heavier patients, neither binge eating nor depressive symptoms was associated with preoperative weight loss. However, post-surgery follow-up is essential because these factors have been associated with poorer postoperative weight control (12, 13). "
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    ABSTRACT: To document preoperative outcomes of a behavioral lifestyle intervention delivered to patients prior to bariatric surgery in comparison to treatment as usual (insurance-mandated physician supervised diet). After completing a baseline assessment, candidates for surgery were randomized to a 6-month, evidence-informed, manualized lifestyle intervention (LIFESTYLE, n = 121) or to preoperative care as usual (USUAL CARE, n = 119). At 6 months, 187 participants remained candidates for bariatric surgery and were included in the analyses. LIFESTYLE participants lost significantly more weight than those receiving USUAL CARE [8.3 ± 7.8 kg vs. 3.3 ± 5.5 kg, F(1,183) = 23.6, P < 0.0001], with an effect size of 0.72. Additionally, logistic regression modeling indicated that LIFESTYLE patients were significantly more likely to lose at least 5% of initial body weight than those in USUAL CARE [OR (95% CI) = 2.94 (1.253, 6.903)], as were participants who were heavier [OR (95% CI) = 1.07 (1.001-1.14) for each unit increase in BMI] or with larger improvements in eating behaviors [OR (95% CI) = 1.1 (1.049, 1.145) for each unit increase on the Eating Behavior Inventory). A behavioral lifestyle intervention for severely overweight individuals leads to clinically significant weight loss prior to bariatric surgery. Post-surgery follow-up will allow us to examine the impact of the preoperative intervention on postoperative outcomes.
    Obesity 02/2013; 21(2). DOI:10.1002/oby.20069 · 3.73 Impact Factor
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    • "In line with prior research [26], recent studies have suggested that postoperative eating behaviour may be a more important determinant of surgical weight loss than preoperative eating factors. More specifically, uncontrolled eating and grazing have consistently been identified as high-risk eating behaviours after surgery, often associated with weight regain and mental distress [21] [56] [59]. Therefore, continuous monitoring and identification of high risk eating patterns after surgery and the development of supportive postoperative interventions are important to optimise surgical outcome for bariatric patients. "
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    ABSTRACT: Background Morbid obesity is the fastest growing BMI group in the U.S. and the prevalence of morbid obesity worldwide has never been higher. Bariatric surgery is the most effective treatment for severe forms of obesity especially with regard to a sustained long-term weight loss. Psychological factors are thought to play an important role for maintaining the surgical weight loss. However, results from prior research examining preoperative psychological predictors of weight loss outcome are inconsistent. The aim of this article was to review more recent literature on psychological predictors of surgical weight loss. Methods We searched PubMed, PsycInfo and Web of Science, for original prospective studies with a sample size >30 and at least one year follow-up, using a combination of search terms such as ‘bariatric surgery’, ‘morbid obesity’, ‘psychological predictors’, and ‘weight loss’. Only studies published after 2003 were included. Results 19 eligible studies were identified. Psychological predictors of surgical weight loss investigated in the reviewed studies include cognitive function, personality, psychiatric disorder, and eating behaviour. Conclusion In general, recent research remains inconsistent, but the findings suggest that pre-surgical cognitive function, personality, mental health, composite psychological variables and binge eating may predict post-surgical weight loss to the extent that these factors influence post-operative eating behaviour.
    Obesity Research & Clinical Practice 01/2013; 8(4). DOI:10.1016/j.orcp.2013.09.003 · 1.18 Impact Factor
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