Binge eating and exercise behavior after surgery for severe obesity: A structural equation model

Department of Clinical Psychology, Radboud University Nijmegen, Nymegen, Gelderland, Netherlands
International Journal of Eating Disorders (Impact Factor: 3.13). 07/2006; 39(5):369-75. DOI: 10.1002/eat.20249
Source: PubMed


The current study sought to find indications for the appropriateness of a model in which eating patterns and exercise beliefs influence binge eating and physical exercise, respectively, that, in turn, influence outcome after gastric banding for severe obesity.
Participants were 157 patients (144 females, 13 males) who completed questionnaires approximately 34 months (range = 8-68 months) after laparoscopic adjustable gastric banding (LAGB).
Our data showed a well-fitting model in which external and emotional eating were associated with outcome through binge eating. Several exercise beliefs were associated with physical exercise, but physical exercise was not associated with weight loss or physical health.
Binge eating was related more strongly to the outcome after gastric banding than physical exercise. Future research should examine whether a strong focus on the management of binge eating and external and emotional eating could improve the outcome of morbidly obese patients with unsuccessful weight outcome after obesity surgery.

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    • "EE has been implicated in postoperative graze eating [21, 27–29] uncontrolled overeating [19, 30–32], and snack eating [19, 25]. "
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    ABSTRACT: Empirical investigations implicate emotional eating (EE) in dysfunctional eating behavior such as uncontrolled overeating and insufficient weight loss following bariatric surgery. They demonstrate that EE may be a conscious or reflexive behavior motivated by multiple negative emotions and/or feelings of distress about loss-of-control eating. EE, however, has not been targeted in pre- or postoperative interventions or examined as an explanatory construct for failed treatment of dysfunctional eating. Three cases suggest that cognitive behavioral treatment (CBT) might alleviate EE. One describes treatment for distress provoked by loss-of-control eating. The first of two others, associated with negative emotions/life situations, link treatment of a super-super-preoperative obese individual's reflexive EE with 52% excess BMI (body mass index) loss maintained for the past year, 64 months after surgery. The second relates treatment of conscious/reflexive EE with 84.52% excess BMI loss 53 months after surgery. Implications for research and treatment are discussed.
    Full-text · Article · Apr 2012 · The Scientific World Journal
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    • "The 5-point Likert-rating format ranges from 1 (strongly disagree) to 5 (strongly agree). The psychometric characteristics of the PEBQ have been found to be satisfactory [21]. Cronbach’s α values indicate the reliability or internal consistency of an instrument. "
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    ABSTRACT: Physical activity after bariatric surgery is associated with sustained weight loss and improved quality of life. Some bariatric patients engage insufficiently in physical activity. This may be due to exercise cognitions, i.e., specific beliefs about benefits of and barriers to physical exercise. The aim of this study was to examine whether and to what extent both physical activity and exercise cognitions changed at 1 and 2 years post-surgery and whether exercise cognitions predict physical activity. Forty-two bariatric patients (38 women, 4 men; mean age 38 ± 8 years, mean body mass index prior to surgery 47 ± 6 kg/m(2)) filled out self-report instruments to examine physical activity and exercise cognitions pre- and post-surgery. A large increase in physical activity and favorable changes in exercise cognitions were observed after surgery, viz. a decrease of fear of injury and embarrassment and an increase of the perception of exercise benefits and confidence in exercising. Perceiving less exercise benefits and having less confidence in exercising before surgery predicted less physical activity 2 years after surgery. High fear of injury 1 year after surgery predicted less physical activity 2 years after surgery. After bariatric surgery, favorable changes in physical activity and beliefs about the benefits and barriers of exercising are observed. Our results suggest that targeting exercise cognitions before and after surgery might be relevant to improve physical activity.
    Full-text · Article · Dec 2011 · Obesity Surgery
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    • "Some individuals are more susceptible to stress-induced eating than others and may adopt a self-regulation strategy for coping with aversive states in which attention is shifted away from negative selfappraisal or affect and towards the immediate stimulus environment, such as food [48] [49]. Individuals who are identified as " emotional eaters " are more vulnerable to weight gain compared to nonemotional eaters, [43] [50] and they may regain more weight after successful weight loss through either diet and exercise [51] or bariatric surgery [52]. Most behavioral weight loss interventions do not aim to reduce psychological stress as a primary goal, if at all, and stress may be one factor contributing to the modest success of long-term weight loss maintenance [51] [53]. "
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    ABSTRACT: Psychological distress and elevated cortisol secretion promote abdominal fat, a feature of the Metabolic Syndrome. Effects of stress reduction interventions on abdominal fat are unknown. Forty-seven overweight/obese women (mean BMI = 31.2) were randomly assigned to a 4-month intervention or waitlist group to explore effects of a mindfulness program for stress eating. We assessed mindfulness, psychological distress, eating behavior, weight, cortisol awakening response (CAR), and abdominal fat (by dual-energy X-ray absorptiometry) pre- and posttreatment. Treatment participants improved in mindfulness, anxiety, and external-based eating compared to control participants. Groups did not differ on average CAR, weight, or abdominal fat over time. However, obese treatment participants showed significant reductions in CAR and maintained body weight, while obese control participants had stable CAR and gained weight. Improvements in mindfulness, chronic stress, and CAR were associated with reductions in abdominal fat. This proof of concept study suggests that mindfulness training shows promise for improving eating patterns and the CAR, which may reduce abdominal fat over time.
    Full-text · Article · Oct 2011 · Journal of obesity
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