Binge Eating Disorder and the Outcome of Bariatric Surgery at One Year: A Prospective, Observational Study

Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Obesity (Impact Factor: 3.73). 01/2011; 19(6):1220-8. DOI: 10.1038/oby.2010.336
Source: PubMed


Previous studies have suggested that binge eating disorder (BED) impairs weight loss following bariatric surgery, leading some investigators to recommend that patients receive behavioral treatment for this condition before surgery. However, many of these investigations had significant methodological limitations. The present observational study used a modified intention-to-treat (ITT) population to compare 1-year changes in weight in 59 surgically treated participants, determined preoperatively to be free of a current eating disorder, with changes in 36 individuals judged to have BED. Changes in weight and binge eating in the latter group were compared with those in 49 obese individuals with BED who sought lifestyle modification for weight loss. BED was assessed using criteria proposed for the Diagnostic and Statistical Manual (DSM) 5. At 1 year, surgically treated participants without BED lost 24.2% of initial weight, compared with 22.1% for those with BED (P > 0.309). Both groups achieved clinically significant improvements in several cardiovascular disease (CVD) risk factors. Participants with BED who received lifestyle modification lost 10.3% at 1 year, significantly (P < 0.001) less than surgically treated BED participants. The mean number of binge eating days (in the prior 28 days) fell sharply in both BED groups at 1 year. These two groups did not differ significantly in BED remission rates or in improvements in CVD risk factors. The present results, obtained in carefully studied participants, indicate that the preoperative presence of BED does not attenuate weight loss or improvements in CVD risk factors at 1 year in surgically treated patients. Longer follow-up of participants is required.

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Available from: David B Sarwer, Oct 07, 2015
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    • "Weight loss at one time point predicted depression score at next time point, but depression score did not predict subsequent weight loss. Longitudinal study Wadden et al., 2011 4 [82] 144 surgically treated (59 no ED, 36 BED), 49 BWL intervention for obese with BED 12 surgical follow-up vs. 12 BWL treatment 41.2-17.6% to follow-up At follow-up, surgically-treated participants without BED lost 24.2% of initial weight, compared with 22.1% for those with BED. "
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    ABSTRACT: Binge Eating Disorders is a clinical syndrome recently coded as an autonomous diagnosis in DSM-5. Individuals affected by Binge Eating Disorder (BED) show significantly lower quality of life and perceived health and higher psychological distress compared to the non-BED obese population. BED treatment is complex due to clinical and psychological reasons but also to high drop-out and poor stability of achieved goals. The purpose of this review is to explore the available data on this topic, outlining the state-of-the-art on both diagnostic issues and most effective treatment strategies. We identified studies published in the last 6 years searching the MeSH Term “binge eating disorder”, with specific regard to classification, diagnosis and treatment, in major computerized literature databases including: Medline, PubMed, PsychINFO and Science Direct. A total of 233 studies were found and, among them, 71 were selected and included in the review. Although Binge Eating Disorder diagnostic criteria showed empirical consistency, core psychopathology traits should be taken into account to address treatment strategies. The available body of evidence shows psychological treatments as first line interventions, even if their efficacy on weight loss needs further exploration. Behavioral and self-help interventions evidenced some efficacy in patients with lower psychopathological features. Pharmacological treatment plays an important role, but data are still limited by small samples and short follow-up times. The role of bariatric surgery, a recommended treatment for obesity that is often required also by patients with Binge Eating Disorder, deserves more specific studies. Combining different interventions at the same time does not add significant advantages, planning sequential treatments, with more specific interventions for non-responders, seems to be a more promising strategy. Despite its recent inclusion in DSM-5 as an autonomous disease, BED diagnosis and treatment strategies deserve further deepening. A multidisciplinary and stepped-care treatment appears as a promising management strategy. Longer and more structured follow-up studies are required, in order to enlighten long term outcomes and to overcome the high dropout rates affecting current studies.
    BMC Psychiatry 04/2015; 15(1). DOI:10.1186/s12888-015-0445-6 · 2.21 Impact Factor
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    • "Following the DSM 5 criteria the 48.3% of our obese patients seeking surgical treatment were diagnosed with BED. This percentage is not radically different from those reported by authors following less restrictive criteria for BED diagnosis (Wadden et al., 2011), (at least one binge episode per week on average over 3 months). Kalarchian & coll (Kalarchian, Wilson, Brolin, & Bradley, 1998) reported a prevalence of 39% of BED in a sample of 64 patients and Hsu (Hsu et al., 2002) reported a rate of 25%. "
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    ABSTRACT: Unlabelled: We evaluate whether there are any significant differences in psychopathology between severe obese patients affected by Binge Eating Disorder diagnosed following both the DSM IV TR and the DSM5 criteria, and severe obese patients not having an eating disorder. Method: 118 severe obese patients seeking treatment at a center for bariatric surgery in northern Italy were asked to take part in the current study for a period of six months. Average participant age was 44.27 years, SD 12.42. Age ranged from 18 to 67 years. Average patient BMI was 45.03, SD 7.11, ranging from 32.14 to 66.16 kg/m(2). Seventy seven of the patients (65.3%) were females and 41 (34.7%) were males. BED diagnosis was determined following the diagnostic criteria of both the DSM IV TR and the DSM 5. The presence of other eating disorders was excluded through a clinical screening using the Eating Disorder Inventory (EDI). Patient eating habits and the presence of emotional eating were appraised using the Three-Factor Eating Questionnaire. Levels of depression and anxiety were evaluated using the Beck Depression Inventory and the State Trait Anxiety Inventory. Results: 57 out of 118 patients were found to be affected by BED following the DSM 5 criteria; among them 24 followed those of the DSM IV TR. BED patients scored higher on four subscales of the Eating Disorders Inventory: Drive for thinness (DT), Bulimia (B), Body dissatisfaction (BD) and Interoceptive awareness (IA) on the STAI and on the Disinhibition and Hunger subscales of the TFEQ. Discussion: The results confirm the presence of high levels of psychopathology among patients diagnosed with BED, even if they have been diagnosed following the criteria of the DSM 5. There is a great overlap in psychopathology between BED patients diagnosed following the DSM IV TR and the DSM 5 criteria.
    Eating Behaviors 11/2014; 16. DOI:10.1016/j.eatbeh.2014.10.004 · 1.58 Impact Factor
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    • "Binge eating status has been found to predict weight loss in some studies [57] [88], whereas others [54] [55] [58] have reported that binge eating assessed before surgery does not predict weight loss. It may be speculated that the inconsistent results are related to differences in study design, including differences in assessment and diagnosis of binge eating. "
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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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