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.
    No preview · Article · Dec 2014 · Journal of Clinical Psychology in Medical Settings
    • "Although the descriptive efforts have been quite beneficial in clarifying the cognitive, behavioral, social, and emotional characteristics of bariatric surgery patients, the predictive efforts have proved much more challenging. One of the most common psychological assessment instruments that has been used within the bariatric surgery population for both descriptive and predictive purposes is the Minnesota Multiphasic Personality Inventory (MMPI, MMPI-2, MMPI-2-RF)123456. In fact, Bauchowitz et al.[7]found that nearly 30% of bariatric surgery programs that included standardized psychological testing preoperatively included a personality inventory, the most common of which was the MMPI. "
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    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.☆☆
    No preview · Article · Oct 2014 · Surgery for Obesity and Related Diseases
    • "such as loss of control (LOC) eating, binge eating disorder (BED), or night eating syndrome (NES) have been the focus of attention in the study of behavioral predictors of successful weight loss after bariatric surgery345. Grazing behavior is one of the eating problems that has been associated with less weight loss and eventually weight regain following bariatric surgery. "
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    ABSTRACT: Background Grazing, characterized by a repetitive eating pattern, has received increased attention among bariatric surgery patients. However, different definitions and terminology have been used, preventing the accurate measurement of this phenomenon and comparison of data across studies. Objective To review existing definitions and associated clinical features of grazing among different samples and to propose a standardized definition that will allow for consistency in future work. Setting University and Clinical Research Institute. Methods Of the 39 studies found, 9 provided an original definition and 12 provided data of its association with weight outcomes. Six were studies of non-bariatric surgery populations. Based on this literature review, the most common criteria used in previous studies to define grazing were included in a survey that was sent to 24 individuals who have published work in the field. These experts were asked to provide their opinion on what should constitute grazing. Results Grazing is a frequent behavior in the bariatric surgery population as well as in eating disordered and community samples. Its association with psychopathology is not clear, but its negative impact on weight outcomes after bariatric surgery generally has been supported. Survey data provided a consensus regarding the definition of grazing as an eating behavior characterized by the repetitive eating (more than twice) of small/modest amounts of food in an unplanned manner, with what we characterize as compulsive and non-compulsive subtypes. Conclusions Given the clinical relevance of grazing among bariatric surgery patients, a unique definition is crucial to better study its associated features and impact on different populations.
    No preview · Article · May 2014 · Surgery for Obesity and Related Diseases
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