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: 4.39). 03/2008; 16(3):615-22. DOI: 10.1038/oby.2007.101
Source: PubMed

ABSTRACT 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.

  • Source
    [Show abstract] [Hide abstract]
    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; 9:24378. · 0.61 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective. To examine whether cognitive behavioral therapy (CBT) alleviates dysfunctional eating (DE) patterns and symptoms of anxiety and depression in morbidly obese patients planned for bariatric surgery. Design and Methods. A total of 98 (68 females) patients with a mean (SD) age of 43 (10) years and BMI 43.5 (4.9) kg/m2 were randomly assigned to a CBT-group or a Control group receiving usual care (i.e., nutritional support and education).The CBT-group received ten weekly intervention sessions. DE, anxiety, and depressionwere assessed by the TFEQ R-21 andHADS, respectively. Results. Compared with controls, the CBT-patients showed significantly less DE, affective symptoms, and a larger weight loss at follow-up. The effect sizes were large (DE-cognitive restraint, 𝑔 = −.92, 𝑃 ≤ .001; DE-uncontrolled eating, 𝑔 = −.90, 𝑃 ≤ .001), moderate (HADS-depression, 𝑔 = −.73, 𝑃 ≤ .001; DE-emotional eating,𝑔 = −.67, 𝑃 ≤ .001; HADS-anxiety,𝑔 = −.62, 𝑃 = .003), and low (BMI,𝑔 = −.24, 𝑃 = .004). Conclusion. This study supports the use of CBT in helping patients preparing for bariatric surgery to reduce DE and to improve mental health.This clinical trial is registered with NCT01403558.
    Journal of obesity 07/2014; 2014(127936).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Presurgical Psychological Screening (PPS) is used to identify factors that may impact postoperative adherence and surgical outcomes in bariatric surgery candidates. Minnesota Multiphasic Personality Inventory – 2 Restructured Form (MMPI-2-RF) findings have demonstrated utility for this task. Objectives To explore whether there are clinically meaningful gender, ethnicity, or age differences in pre-surgical MMPI-2-RF scores and the validity of these scores in bariatric surgery candidates. Setting Cleveland Clinic Bariatric and Metabolic Institute, United States Methods The sample was composed of 872 men and 2337 women. Ethnicity/race groups included 2,204 Caucasian, 744 African American, and 96 Hispanic individuals. Ages groups included 18-35 year olds (n= 454), 36-49 year olds (n = 1154), 50-64 year olds, (n = 1246), 65 years old or older (n = 355). Validity data, obtained via a retrospective chart review, were available for a subset patients (n=1,268) who were similarly distributed. Step-down hierarchical regression analyses were conducted to assess for differential validity. Results Bariatric surgery candidates produced comparable MMPI-2-RF scores in all subsamples, indicating that the test norms generalize across demographic groups. Validity findings were also generally comparable, indicating that MMPI-2-RF scores have the same interpretive implications in demographically diverse subgroups of bariatric surgery candidates. Conclusions The MMPI-2-RF can assist in presurgical psychological screening of demographically diverse bariatric surgery candidates.☆☆
    Surgery for Obesity and Related Diseases 10/2014; · 4.94 Impact Factor

Full-text (2 Sources)

Available from
May 29, 2014