Grazing and Loss of Control Related to Eating: Two High-risk Factors Following Bariatric Surgery

Monash University, Centre for Obesity Research and Education (CORE), Alfred Hospital, Melbourne, Victoria, Australia.
Obesity (Impact Factor: 3.73). 03/2008; 16(3):615-22. DOI: 10.1038/oby.2007.101
Source: PubMed


Gastric restrictive surgery induces a marked change in eating behavior. However, the relationship between preoperative and postoperative eating behavior and weight loss outcome has received limited attention.
This study assessed a range of eating behaviors before and 1 year after laparoscopic adjustable gastric banding (LAGB) and explored the nature and extent of change in eating patterns, their clinical associates, and impact on weight loss.
A 12-month observational study assessed presurgical and postsurgical binge eating disorder (BED), uncontrolled eating, night eating syndrome (NES), grazing, nutrient intake and eating-related behaviors, and markers of psychological distress. A total of 129 subjects (26 male and 103 female, mean age 45.2 +/- 11.5 and BMI 44.3 +/- 6.8) participated in this study.
Presurgical BED, uncontrolled eating, and NES occurred in 14%, 31%, and 17.1% of subjects, which reduced after surgery to 3.1%, 22.5%, and 7.8%, respectively (P = 0.05 for all). Grazing was prevalent before (26.3%) and after surgery (38.0%). Preoperative BED most frequently became grazers (P = 0.029). The average percentage weight loss (%WL) was 20.8 +/- 8.5%; range -0.67 to 50.0% and percentage of excess weight loss (%EWL) 50.0 +/- 20.7%; range -1.44 to 106.9% (P < 0.001). Uncontrolled eating and grazing after surgery showed high overlap and were associated with poorer %WL (P = 0.008 and P < 0.001, respectively) and elevated psychological distress.
Consistent with recent studies, uncontrolled eating and grazing were identified as two high-risk eating patterns after surgery. Clearer characterization of favorable and unfavorable postsurgical eating behaviors, reliable methods to assess their presence, and empirically tested postsurgical intervention strategies are required to optimize weight loss outcomes and facilitate psychological well-being in at-risk groups.

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    • "Such results have led to a rapid proliferation of lifestyle interventions in which persons undergoing weight loss surgery are increasingly expected to engage. By focusing on the importance of changing habits in terms of diet and exercise, such interventions are regarded as paramount to prevent weight regain in the long run (Colles, Dixon, & O'Brien, 2008; Hofsø et al., 2011; Sjöström et al., 2010).1 "
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    ABSTRACT: Background To prevent weight regain, patients undergoing weight loss surgery are encouraged to change their exercise and dietary habits. Building on previous research, the aim of this study was to explore women's experiences of changing exercise habits – focusing on women participating in a group based rehabilitation program including surgical as well as non-surgical participants. Findings Based on interviews with the 11 women included in this study, as well as participant observation, two themes were identified; 1) Pushing ones tolerance limits, and 2) Rebutting the “quick fix” fallacy. Taken together, the findings showcase how being a part of this mixed group involved having to relate to social stigmas, as well as notions regarding successful and non-successful surgical outcomes. Although such notions may be useful in identifying potential challenges related to changing exercise habits, they do not illuminate the complexity of undergoing such changes following weight loss surgery. Conclusion The findings point to the need of acknowledging patients' own exceriences to determine how successful they are after surgery. Given the findings, I argue for the need to reconsider the notion of success in relation to group based interventions.
    International Journal of Qualitative Studies on Health and Well-Being 07/2014; 9(1):24378. DOI:10.3402/qhw.v9.24378 · 0.93 Impact Factor
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    • "The present results show that grazing behaviour is in fact associated with a perception of loss of control over eating. Further , this perception is not only present in extreme obese patients opting for bariatric surgery (Colles et al., 2008; Kofman et al., 2010; Saunders, 2004), but it can also be observed in a healthy young adult sample of university students. Nevertheless, a two-factor solution underlying participants' responses to the Grazing Questionnaire suggests that, at least in a young, normal-weight population, some individuals do "
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    ABSTRACT: Grazing, or the uncontrolled, repetitive eating of small amounts of food is being increasingly recognised as an important eating behaviour associated with obesity. In spite of the need for a better understanding of this eating behaviour for improved obesity treatment, currently there is no empirically validated self-report measure to assess grazing. Therefore, to contribute to a better understanding of this relatively understudied eating pattern, a new self-report questionnaire of grazing was developed in this study. Questionnaire items were designed to reflect previous empirical descriptions of grazing. A group of 248 university students completed the Grazing Questionnaire, other measures of eating-related behaviours and cognitions, and negative emotion. Sixty-two participants completed the Grazing Questionnaire a second time to calculate its temporal stability. Exploratory factor analysis revealed a clear two-factor solution for the questionnaire, reflecting repetitive eating behaviour and a perception of loss of control. Scores on the Grazing Questionnaire were positively associated with other measures of disordered eating, especially with binge eating. Initial psychometric properties of the new questionnaire are promising. Future research is now needed to examine the prevalence of this eating behaviour in more diverse populations, including those with binge eating disorder and obesity.
    Behaviour Change 06/2013; 30(2):57-73. DOI:10.1017/bec.2013.6 · 0.51 Impact Factor
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    • "Loss of control is fairly high in postoperative bariatric surgery patients (between 30 and 40 % in the first two postoperative years, and as much as 50 % eight years postsurgically) and has been associated with less favorable weight loss outcomes, as well as greater depressive symptomatology and poorer quality of life (Kruseman et al., 2010; White, Kalarchian, Masheb, Marcus, & Grilo, 2010). Postoperative grazing, although not consistently defined, includes ''consumption of smaller amounts of food continuously over an extended period of time'' (Colles et al., 2008a, p. 616) and has also been associated with poorer weight loss postoperatively (Colles et al., 2008a). "
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    ABSTRACT: Bariatric surgery is increasingly recognized as a highly effective treatment for individuals who are severely obese. Amount of weight loss and resolution of comorbidities surpass those of nonsurgical approaches; however, suboptimal weight loss and weight regain are not uncommon. These outcomes, though not fully understood, are likely at least partially explained by failure to make long-term behavioral and/or cognitive changes. We are unaware of any established clinical tools to guide providers in assessing postoperative behaviors and identifying those who may require specialized treatment. The goal of this paper is to introduce a brief screening tool, The WATCH, to help clinicians assess and identify patients who may be at risk for poor or untoward outcomes post bariatric surgery. We first review the literature on postoperative outcomes, including weight loss, resolution of comorbidities, suboptimal outcomes, and development of problematic eating behaviors. We then provide an easily-recalled, five-item tool that assesses outcomes, and discuss patient responses that may necessitate further intervention or referral.
    Journal of Clinical Psychology in Medical Settings 05/2013; 20(4). DOI:10.1007/s10880-012-9358-4 · 1.49 Impact Factor
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