Eating Disorders and Problematic Eating Behaviours Before and After Bariatric Surgery: Characterization, Assessment and Association with Treatment Outcomes

Disordered eating after bariatric surgery: clinical aspects, impact on outcomes, and intervention strategies

PURPOSE OF REVIEW

Disordered eating behaviors (DEBs) are associated with poor weight outcomes following bariatric surgery. We describe DEBs most relevant to this population, their associations with weight outcomes, and emerging data on interventions for DEBs.

RECENT FINDINGS

Loss of control eating episodes and grazing have been the most well studied DEBs in bariatric samples. Although DEBs often remit after surgery even without targeted intervention, a subgroup of patients have persistent or newly developed DEBs postoperatively. Preoperative DEBs have little effect on weight outcomes, whereas preoperative impulse control-related features commonly associated with DEBs (e.g., inhibitory control) may have stronger predictive value. Postoperatively, DEBs appear to exert robust effects on concurrently measured weight. Postoperative interventions hold promise for optimizing treatment outcomes.

SUMMARY

We recommend the following to improve clinical care and move research forward: a common language for DEB constructs is needed to improve cross-talk among researchers and care providers; diagnostic schemes and assessment tools may require tailoring for the bariatric population; mechanisms underlying improvements in DEBs following surgery should be clarified; ongoing monitoring of DEBs in the postoperative period is warranted; and a stepped-care approach may improve weight outcomes in a cost-effective manner.

Is weight regain after bariatric surgery associated with psychiatric comorbidity? A systematic review and meta-analysis

Bariatric surgery has been recognized as the gold standard treatment for severe obesity. Although postbariatric surgery patients usually achieve and maintain substantial weight loss, a group of individuals may exhibit weight regain. Several factors are proposed to weight regain, including psychiatric comorbidity. The objective of the study is to conduct a systematic review and meta-analysis of studies investigating the relationship between psychiatric comorbidity and weight regain. A systematic review through PubMed, Web of Science, Cochrane Library, Scopus, and PsycINFO was performed, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After a stepwise selection, 13 articles were included in the qualitative analysis and 5 were included for a meta-analysis. Women was majority in most of the studies (87.6%), and a bypass procedure was the bariatric intervention most evaluated (66.8%), followed by gastric banding (32.1%) and sleeve (1.1%). Higher rates of postbariatric surgery eating psychopathology were reported in patients with weight regain. However, the association between general psychopathology and weight regain was not consistent across the studies. In the meta-analysis, the odds of eating psychopathology in the weight regain group was higher compared with the nonweight regain group (OR = 2.2, 95% CI 1.54-3.15). Postbariatric surgery eating psychopathology seems to play an important role in weight regain.

Presurgical Psychological Evaluation: Risk Factor Identification and Mitigation

Presurgical psychological evaluations (PPEs) are becoming an established component of the surgical process, though methods of conducting PPEs are variable. There is a lack of clarity about the goals of PPEs, the types of information that should be included, and the process for integrating information and making recommendations to the referring physicians/surgeons. This review proposes an empirically supported model for PPEs that is systematic, but flexible enough to be utilized across the broad range of surgical evaluations. This five-step method is termed the Risk Identification and Mitigation (RIM) model and is discussed in detail. The RIM model presented in this review can both serve as a structure to be utilized in under-researched PPE areas and as a stimulus for future empirical investigations.

Effects of the Postoepartive Dietetic/Behavioral Counseling on the Weight Loss After Bariatric Surgery

OBJECTIVE

Weight outcomes after bariatric surgery are due to an adequate adjustment of eating behavior to the new gastrointestinal conditions created by operation. The efficacy of dietary/behavior counseling for promoting weight loss and maintenance in a growing number of bariatric patients was investigated.

MATERIAL AND METHODS

One hundred seventy-six non-diabetic obese patients undergoing Roux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG) were investigated. The first group (CO, 88 subjects, 16 male) attended a standard surgical follow-up, while in the second (DIET, 88 subjects, 15 male) the surgeon was supported by a dietitian, and patients received behavioral-dietary sessions on individual request. Data prior to the operation and at 2 years were considered, the weight outcome being regarded as successful when postoperative body mass index (BMI) value was lower than 30 kg/m².

RESULTS

Weight results were better (p < 0.01) in the RYGBP than in the SG patients. In comparison to CO, in the DIET group a greater adherence to the bariatric program was observed (76% vs. 41%, < 0.01), while body weight data and prevalence of successful cases at 2 years (87 ± 23 vs. 83 ± 16 kg and 27% vs.33%, respectively) were similar.

CONCLUSIONS

After RYSG and SG, postoperative dietetic/behavioral sessions delivered on patient's request does not influence weight results. The dietetic intervention promotes the adherence to bariatric program and prevents postoperative follow-up loss. In a dietitian/behavioral strategy after RYGBP and SG, a cognitive reinforcement of the compliance to bariatric program and a strengthening of the motivation to changes could promote better weight results.

One-year follow-up of a dissonance-based intervention on quality of life, wellbeing, and physical activity after Roux-en-Y gastric bypass surgery: a randomized controlled trial

BACKGROUND

Health-related quality of life (HRQoL) peaks around 1 year after Roux-en-Y gastric bypass (RYGB) surgery, and thereafter, in many patients, slowly deteriorates.

OBJECTIVES

The aim of the present study was to test early effects (study endpoint 2 years) of a dissonance-based group intervention on HRQoL (primary outcome) and wellbeing among women who underwent RYGB: a 1-year follow-up of the WELL-GBP trial.

SETTING

Women were recruited from 5 different hospitals in Sweden pre-RYGB surgery. Participants were randomized to intervention or a control group (regular care).

METHODS

The intervention consisted of 4 group sessions, 2 to 3 months post-surgery, comprising the following 4 different topics: (1) physical activity, (2) eating behavior, (3) social relationships, and (4) intimate relationships. Participants answered questionnaires about HRQoL (SF-36, Short-Form Health Survey), social adjustment, body esteem, eating behavior, and wore an accelerometer for 7 days at pre- and 1 year post-RYGB.

RESULTS

Two hundred fifty-nine women were recruited and 203 (78%) completed 1-year follow-up measurements. Mean body mass index pre-surgery was 40.8 (standard deviation = 4.5), mean age 44.7 (standard deviation = 10.3) years, and 61 of 120 women in the intervention group received the intervention according to protocol (≥3 group sessions). We observed no difference between the intervention and the control group at 1-year post-RYGB surgery. All scales improved in both groups from pre- to 1 year post-surgery.

CONCLUSIONS

We did not observe any 1-year early effects on HRQoL from a dissonance-based group intervention among female RYGB patients. Future studies may investigate long-term effects of the intervention.

Eating Pathology After Bariatric Surgery: an Updated Review of the Recent Literature

PURPOSE OF REVIEW

The goal of this paper was to extend the prior literature on eating pathology following bariatric surgery by highlighting themes in data published over the past 3 years and identifying limitations and future directions for research.

RECENT FINDINGS

Changes in eating pathology after bariatric surgery remain consistent with previous research. Specifically, diagnostic prevalence rates and incidence of related behaviors generally decrease following surgery. However, some research supports that these factors increase and/or remit over time following surgery, and that they subsequently have a negative impact on weight loss outcomes. While recent findings have extended knowledge on eating pathology following bariatric surgery, the overall body of literature is still relatively limited. Additional research is needed, including work focusing on the standardization of eating pathology definitions, development/validation of standardized eating pathology instruments for bariatric surgery patients, and predictors of risk for continued or new onset eating pathology following surgery.

Psychometric properties of the eating loss of control scale among postbariatric patients

BACKGROUND

Assessing the complexities of eating behaviors in patients who undergo bariatric surgery is challenging. The Eating Loss of Control Scale (ELOCS), a measure of loss-of-control (LOC) eating, has not yet been evaluated psychometrically among bariatric surgery patients.

OBJECTIVE

This study presents a psychometric examination of the ELOCS in postoperative bariatric surgery patients.

SETTING

Academic medical center in the United States.

METHODS

One hundred seventy-one postbariatric treatment-seeking adults (82.5% female, 52.4% white) with LOC eating completed the ELOCS and measures assessing eating psychopathology and mood. Confirmatory factor analysis (CFA) was used to test fit for a 1-factor solution. Exploratory factor analysis (EFA) examined alternative factor structures.

RESULTS

CFA revealed poor fit for a 1-factor structure (χ² = 220.375, degrees of freedom = 135, P < .001, comparative fit index = .917, Tucker-Lewis index = .906, root mean square error of approximation = .067). EFA data suggested an alternative factor solution (χ² = 157.76, degrees of freedom = 118, P = .009, comparative fit index = .965, Tucker-Lewis index = .955, root mean square error of approximation = .047). Factor 1 (α = .88) reflected behavioral aspects and factor 2 (α = .92) reflected cognitive/emotional aspects of LOC eating. Bivariate correlations with measures of eating and other psychopathology suggested good construct validity for factors.

CONCLUSIONS

Findings suggest possible differences in the construct validity of the ELOCS among postbariatric patients. The 1-factor solution previously supported in clinical and nonclinical groups demonstrated poor fit. EFA revealed a possible alternative 2-factor solution that aligns with emerging literature, suggesting that LOC eating presents differently in postbariatric patients. Researchers interested in LOC eating among bariatric patients should consider use of the ELOCS and testing the proposed alternative factor structure.

Medical Complications of Binge Eating Disorder

Binge eating disorder (BED) is the most common eating disorder and is accompanied by multiple medical comorbidities, many of which are associated with obesity-related diseases. However, the BED itself is likely to confer additional risk factors. BED presents with medical symptoms in virtually every body system and can have devastating consequences on both quality and length of life. This review covers the major comorbidities of BED and highlights areas of ongoing research in this disorder.

Analysis of the Association between Eating Behaviors and Weight Loss after Laparoscopic Sleeve Gastrectomy

SETTING

In a private medical center, 300 patients who underwent a laparoscopic sleeve gastrectomy (LSG) were classified into 4 groups according to their eating behaviors (EB) preoperatively. During a 3-year postoperative follow-up, dietary changes in relation to weight loss were studied.

OBJECTIVES

To explore the influence of abnormal EB on the outcome of sleeve gastrectomy.

BACKGROUND

Patients with morbid obesity often suffer from abnormal EB. After LSG, the outcome depends largely on improvement of the feeding behaviors acquired.

METHODS

This prospective study includes 300 patients who underwent LSG from 2013 to 2014, divided into the following 4 groups: binge eaters, snack eaters, sweet eaters, and volume eaters.

RESULTS

The average age was 41.65 years, the ratio of male to females was 1 to 2. The average baseline body mass index (BMI) was 42.02. After 3 years, no significant change was found in the number of binge eaters (p = 0.396), but there was an 8.9% increase in snack eaters (p < 0.001), a 12.9% increase in sweet eaters (p < 0.001), and 17.2% increase in healthy eating habits (p < 0.001). Sixty-five (24.8%) patients did not experience changes in their eating patterns. However, after surgery, 24.6% of the patients continued with the same EB and 125 (49.5%) patients changed from one EB to another unhealthy EB. Weight loss, measure as ΔBMI, was similar in each group after 3 years, with a mean BMI of 29.8. When eating habits were related to different features such as gender, sports practice, type of work, smoking, marital status, comorbidities, no influence on the operative results were found.

CONCLUSION

LSG promotes the reduction of overeaters; however, it promotes a switch between other unhealthy EB. The significant increase in snack eaters and sweet eaters is outstanding, although it did not affect weight loss in the midterm follow-up. Worsening of eating habits after LSG is a common fact.

Food-related behaviours among individuals with overweight/obesity and normal body weight

BACKGROUND

Emotional eating is a factor associated with a negative body image and other problematic eating behaviours. In this context little is known about differences between individuals with overweight and obesity and those with normal body weight. The main aim of the study was to evaluate the role of emotional eating in the relationship between the desire to consume chocolate and the wish to avoid social situations related to food and body exposures. For this purpose, we tested the direct, indirect and buffer effects. In addition, we used moderated mediation by introducing snacking into the model.

METHODS

The study included 123 outpatients with excessive body weight and 123 individuals with normal weight. The mean of body mass index (BMI) in the first group was 30.19 kg/m2 (SD = 4.37) and, in the second, it was 23.02 kg/m2 (SD = 1.20). The Three-Factor Eating Questionnaire, the Attitudes to Chocolate Questionnaire and the Body Image Avoidance Questionnaire were used.

RESULTS

Results show that in all individuals, the greater emotional eating is, the greater the desire for chocolate consumption and avoidance of social situations related to food and body exposures are. In addition, the desire for chocolate consumption are positively associated with avoidance of social situations related to food and body exposures in both group. Among individuals with excessive and normal body weight, emotional eating is a significant mediator in the relationship between desire for chocolate consumption and avoidance of social situations related to food and body exposures. However, it does not moderate the relationship between these variables. Outcomes show that there is a significant model of moderated mediation of the link between social situation-avoidance related to food and body exposure and the desire to consume chocolate through emotional eating, moderated by snacking among individuals with normal body weight. A similar effect has not been discovered in the group with excessive body weight.

CONCLUSION

The presented results show that among people with varied BMI categories, emotional eating is connected to craving chocolate and avoidance of social situations related to food and body exposure that plays only the role of mediation. In addition, snacking is crucial for this relationship among the group with normal body weight.

Transdiagnostic Approach to Food Avoidance After Bariatric Surgery: A Case Study

This study describes treatment of an adult woman, referred to as “Carla,” who was referred for psychological intervention following bariatric surgery due to recurrent nausea and vomiting along with food avoidance. Carla evinced symptoms including dietary range restriction, failure to progress to recommended caloric intake, fear of vomiting, and body dissatisfaction. She was diagnosed with generalized anxiety disorder, along with comorbidities including dysthymia, body dysmorphia, and subsyndromal specific phobia of vomiting (SPOV). Treatment included 20 weekly sessions utilizing a transdiagnostic approach to treatment, which has been shown to be efficacious in management of multiple comorbidities. The limited body of research and results of this case suggest expansion of the criteria for avoidant restrictive food intake disorder (ARFID) to allow for inclusion of this constellation of symptoms within bariatric patients.

Problematic eating behaviors and psychopathology in patients undergoing bariatric surgery: The mediating role of loss of control eating

OBJECTIVE

This study compares different problematic eating behaviors (PEBs; objective [OBE]/subjective [SBE] binge-eating and compulsive [CG]/noncompulsive [NCG] grazing) in relation to the severity of loss of control (LOC) and psychopathology. We also investigate LOC as a mediator between PEBs and psychopathology.

METHOD

This cross-sectional study assessed a group of patients before bariatric surgery (n = 163), and a group of bariatric patients 12 months or more after surgery (n = 131). Face-to-face assessment: Eating Disorders Examination for binge-eating episodes; Rep(eat) for grazing. LOC was measured by five questions answered in a 5-point Likert scale. Self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress.

RESULTS

OBEs were reported by 26(8.8%), SBE by 29(9.8%), CG by 35(11.9%), and NCG by 36(12.2%) of patients. The different PEBs differed significantly in the severity of LOC (F(3,120)= 25.81, p < .001). Patients reporting OBEs scored higher and patients with NCG scored lower in most measures than patients with other PEBs. Patients with any PEBs scored higher in all self-report measures than those not reporting any PEBs, with statistical significance reached for uncontrolled eating (F(4,288)= 20.21, p < .001), emotional eating (F(4,288)= 23.10, p < .001), repetitive eating F(4,288)= 18.34, p < .001), and compulsive grazing (F(4,288)= 27.14, p < .001). LOC was found to be a full mediator between PEBs and psychopathology.

DISCUSSION

There is no evidence that the different PEBs differ in the psychopathology severity, independently of the experience of LOC eating during the eating episodes. We show evidence for the conceptualization of different PEB, including grazing, on a continuous scale of LOC and psychopathology.

Emotional eating behavior hinders body weight loss in women after Roux-en-Y gastric bypass surgery

OBJECTIVE

Successful weight loss and maintenance after Roux-en-Y gastric bypass (RYGB) may be related to eating behavior. The aim of this study was to assess the eating behavior domains that prevail in women during the RYGB postoperative period and their associations with surgery outcome.

METHODS

This cross-sectional study investigated eating behavior in 95 women (47.3 ± 9.8 y old)  ≥ 2 y after Roux-en-Y gastric bypass. Patients were grouped according to surgery outcome: successful group (SG; n = 67), defined as having lost ≥ 50% of the preoperative excess weight loss (EWL), and an unsuccessful group (UG; n = 28). Mean postoperative time was 59.5 ± 21.2 mo (55.7 ± 19.9 in the SG and 68.6 ± 21.9 in the UG). The short version of the Three-Factor Eating Questionnaire was used to assess cognitive restraint, emotional eating, and uncontrolled eating behaviors. Multivariate analysis was used to investigate associations between eating behavior scores and EWL.

RESULTS

The highest score in both groups was for the cognitive restraint domain, followed by emotional and uncontrolled eating. Emotional eating was negatively associated with percentage of EWL (β = -0.286; P = 0.033), regardless of age, educational attainment, and postoperative time.

CONCLUSION

The cognitive restraint domain was the main type of eating behavior observed, and patients with higher emotional eating score were at a higher risk for having insufficient weight loss after RYGB. These results indicate the relevance of monitoring emotional components during the long-term nutritional follow-up of bariatric patients to achieve better surgery outcomes.

Effect of Grazing Behavior on Weight Regain Post-Bariatric Surgery: A Systematic Review

Grazing, a type of maladaptive eating behavior, has been associated with poor weight outcomes in bariatric patients. The purpose of this study was to conduct a systematic review of the association between grazing behavior and weight regain post-bariatric surgery. Literature searches, study selection, design of the method, and quality appraisal were carried out by two independent authors. The search strategy was performed until October 2017 in Medline, Embase, Cochrane, Lilacs, Scopus, Web of Science, Google Scholar, ProQuest Dissertation &amp; Theses, and Open Grey. Of a total of 3764 articles, five papers met the inclusion criteria (four original articles and one thesis), comprising 994 subjects, mostly women. The prevalence of grazing behavior ranged from 16.6 to 46.6%, and the highest prevalence of significant weight regain was 47%. The association between grazing and weight regain was observed in four of the five evaluated studies. Our findings support an association between grazing behavior and weight regain after bariatric surgery, regardless of surgery type and contextual concept of grazing. Further studies are needed to confirm the clarity of the real prevalence and interfering factors related to grazing behavior and weight outcomes.

Morbidity persistence and comorbidity of mood, anxiety, and eating disorders among preoperative bariatric patients

The current study investigates the patterns of disease persistence and comorbidity of psychiatric disorders among patients with class III obesity in pre-operative period. For 393 treatment-seeking patients with severe obesity recruited from a bariatric center, we ascertained their psychiatric diagnosis through Structured Clinical Interview for DSM-IV (SCID-I). Following, the frequency, persistence and comorbidity pattern of psychiatric disorders in this sample were determined. Current psychiatric disorders were observed in over half of patients during preoperative period, being anxiety disorders the most frequent diagnosis. For lifetime disorders, mood disorders were the most frequent diagnosis. Most of the sample presented 2 or more concurrent lifetime psychiatric disorders. While mood and eating disorders were frequent conditions, anxiety disorders were the most persistent conditions (the highest one month-to-lifetime prevalence ratio) and were significantly correlated with bipolar, depressive and eating disorders. Psychiatric disorders are frequent and enduring conditions among patients looking for bariatric surgery. Comorbid anxiety, mood, and eating disorders are remarkable features in treatment-seeking patients with obesity. Prognostic implications of preoperative psychiatric disorders on surgery outcome should be demonstrated prospectively in intervention studies.

Identifying prebariatric subtypes based on temperament traits, emotion dysregulation, and disinhibited eating: A latent profile analysis

OBJECTIVE

The efficacy of bariatric surgery has been proven; however, a subset of patients fails to achieve expected long-term weight loss postoperatively. As differences in surgery outcome may be influenced by heterogeneous psychological profiles in prebariatric patients, previous subtyping models differentiated patients based on temperament traits. The objective of this study was to expand these models by additionally considering emotion dysregulation and disinhibited eating behaviors for subtyping, as these factors were associated with maladaptive eating behaviors and poor postbariatric weight loss outcome.

METHOD

Within a prospective multicenter registry, N = 370 prebariatric patients were examined using interview and self-report questionnaires. A latent profile analysis was performed to identify subtypes based on temperament traits, emotion dysregulation, and disinhibited eating behaviors.

RESULTS

Five prebariatric subtypes were identified with specific profiles regarding self-control, emotion dysregulation, and disinhibited eating behaviors. Subtypes were associated with different levels of eating disorder psychopathology, depression, and quality of life. The expanded model increased variance explanation compared to temperament-based models.

CONCLUSION

By adding emotion dysregulation and disinhibited eating behaviors to previous subtyping models, specific prebariatric subtypes emerged with distinct psychological deficit patterns. Future investigations should test the predictive value of these subtypes for postbariatric weight loss and health-related outcomes.

The first case report of failed single-anastomosis-duodeno-ileal bypass converted to One anastomosis gastric bypass/Mini-gastric bypass

•

Revisional bariatric surgery will rise in the future.

•

The established single-anastomosis-duodeno-ileal bypass with sleeve gastrectomy (SADI-S) as the restrictive part of the procedure. Due to preserved pylorus, SG has the disadvantage of a high-pressure system with de-novo or worsening of existing gastroesophageal reflux disease in the long-term.

•

One anastomosis gastric bypass/Mini-gastric bypass (OAGB/MGB) reduces the high-pressure system of SG in a low-pressure system of OAGB/MGB.

•

OAGB/MGB might be a simple method to rescue failed SADI-S patients.

Introduction

The established single-anastomosis-duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is based on a sleeve gastrectomy (SG) as the restrictive part of the procedure. Due to preserved pylorus, SG has the disadvantage of a high-pressure system with de novo or worsening of existing gastroesophageal reflux disease (GERD).

Case presentation

A female patient presented herself due to protracted GERD and weight regain after multiple bariatric surgeries. At an initial weight of 158 kg (BMI 62.5 kg/m²) the patient underwent adjustable gastric banding in 2009. After band removal in slippage, the patient underwent SG at a weight of 135 kg in 2012. Nine months after SG, SADI-S was performed as a malabsorptive second step procedure. After 32 months the patient suffered from severe GERD under proton pump inhibitor therapy. Actual weight was 107.9 kg (BMI 42.7 kg/m²). Upper endoscopy showed a hiatal hernia and esophagitis B and dorsal hiatoplasty was performed. After 6 months in still existing severe GERD and weight regain indication for laparoscopic conversion to One anastomosis gastric bypass/Mini-gastric bypass (OAGB/MGB) was given, aiming to reduce the high-pressure system of SG in a low-pressure system of OAGB/MGB. One year after revisional surgery reflux was reported to be only occasionally. Further weight loss was seen (91 kg, BMI 36 kg/m², EWL 67.7%).

Conclusion

SG as the restrictive part of SADI-S may lead to GERD and consequently to pathologic eating of “soft” calories, that defeats the operation and results in weight regain. OAGB/MGB might be a simple method to rescue such failed SADI-S patients.

Early post-operative psychosocial and weight predictors of later outcome in bariatric surgery: a systematic literature review

This is the first systematic review to synthesize the evidence concerning early post-operative variables predictive of later weight and psychosocial outcomes in bariatric surgery. Eight electronic databases for empirical studies were searched (1954 to 2016). Most of the 39 included studies reported solely on weight outcomes; eating and psychosocial outcomes were less common. A better early weight loss trajectory was the most consistent predictor of more successful medium-term weight outcome (≤24 months); however, its relationship to longer term weight loss maintenance is less certain. Early eating adaptation may be associated with later weight loss, but further research is needed. Evidence is lacking for associations between early adherence or early psychosocial variables and later outcome. In particular, the relationship between early post-operative depression and later weight remains unclear. Little research has considered early prediction of later eating or psychosocial outcomes. Consideration of mediating or moderating relationships is lacking. The body of evidence is limited, and synthesis is hampered by heterogeneity in the type and time at which predictors and outcomes are measured and quality of statistical reporting. Further research on prospective prediction of bariatric surgery outcome is needed to guide early post-operative intervention for those at greatest risk of poor outcomes.

Maladaptive Eating Behaviors and Metabolic Profile in Patients Submitted to Bariatric Surgery: a Longitudinal Study

PURPOSE

This study aims to investigate relations between maladaptive eating behaviors (MEB) and metabolic profile in patients submitted to bariatric surgery.

METHODS

Longitudinal study including 70 patients before (T0), in the first year after surgery assessment (T1), and the second year after surgery assessment (T2). A face-to-face clinical interview assessed MEB at T0 and T2. Blood samples were collected at T0, T1, and T2 to assess fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), insulin, insulin resistance (IR), and triglycerides (TG). Mixed model analyses with growth curves tested the differences between patients with MEB (M group) and non-MEB patients (NM group) on the course of metabolic parameters, while controlling for total weight loss and type of surgery.

RESULTS

No differences between both groups were reached for levels of FPG (F(1, 140) = 2.936, p = 0.089), HbA1c (F(1, 96) = 0.099, p = 0.754), insulin (F(1, 121) = 0.146, p = 0.703), IR (F(1, 60) = 0.976, p = 0.327), and TG (F(1, 128) = 0.725, p = 0.396). All parameters improved from T0 to T1 for both groups. A distinct trend on the course of metabolic markers in the M group but not the NM group is observed, presenting an increase in HbA1c levels, insulin, and TG levels.

CONCLUSIONS

Both groups progressed favorably in the first 12 months of surgery. MEB may be associated with a trend for deterioration of metabolic profile after 12 months of surgery. The study should be replicated with longer-term assessments and a larger sample size.

Cirurgia bariátrica e transtornos alimentares: uma revisão integrativa

RESUMO Objetivo Realizar revisão sobre transtornos alimentares e comportamentos alimentares transtornados relacionados à cirurgia bariátrica. Métodos Revisão integrativa da literatura nas bases de dados PubMed, Lilacs, Bireme, portal SciELO com descritores indexados com critérios de inclusão: oferecer dado sobre a presença ou frequência de transtorno alimentar e/ou comportamentos alimentares disfuncionais previamente e/ou após a cirurgia. Resultados Foram selecionados 150 estudos (14 nacionais e 136 internacionais): 80,6% eram com avaliação de pacientes pré-/pós-cirúrgicos; 12% eram estudos de caso e 7,3% eram estudos de revisão. Diferentes instrumentos foram usados para avaliação, principalmente o Questionnaire on Eating and Weight Patterns, a Binge Eating Scale e Eating Disorders Examination Questionnaire. A compulsão alimentar foi o comportamento mais avaliado, com frequências/prevalências variando de 2% a 94%; no caso do transtorno da compulsão alimentar as frequências/prevalências variaram de 3% a 61%. Houve também a descrição de anorexia e bulimia nervosa, síndrome da alimentação noturna e comportamento beliscador. Alguns estudos apontam melhora dos sintomas no pós-cirúrgico e/ou seguimento enquanto outros apontam surgimento ou piora dos problemas. Conclusão Apesar da variabilidade entre métodos e achados, comportamentos alimentares disfuncionais são muito frequentes em candidatos à cirurgia bariátrica e podem ainda surgir ou piorar após a intervenção cirúrgica. Profissionais de saúde devem considerar de maneira mais cuidadosa tais problemas neste público, dadas às consequências para o resultado cirúrgico e qualidade de vida.

Changes in problematic and disordered eating after gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy: a systematic review of pre-post studies

Despite differences in their mechanisms and outcomes, little is known about whether postsurgical changes in eating behaviours also differ by bariatric procedure. Following a systematic search, 23 studies on changes in binge eating disorder (BED) and related behaviours, bulimia nervosa and related behaviours, night eating syndrome, grazing and emotional eating after Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB) and vertical sleeve gastrectomy (VSG) were reviewed. Significant methodological problems and a dearth of literature regarding many behaviours and VSG were seen. Regarding BED and related behaviours, although later re-increases were noted, short to medium-term reductions after RYGB were common, and reported changes after AGB were inconsistent. Short to medium-term reductions in emotional eating, and from a few studies, short to long-term reductions in bulimic symptoms, were reported after RYGB. Reoccurrences and new occurrences of problem and disordered eating, especially BED and binge episodes, were apparent after RYGB and AGB. Further conclusions and comparisons could not be made because of limited or low-quality evidence. Long-term comparison studies of changes to problematic and disordered eating in RYGB, AGB and VSG patients are needed. It is currently unclear whether any bariatric procedure leads to long-term improvement of any problematic or disordered eating behaviours.

APOLO-Bari, an internet-based program for longitudinal support of bariatric surgery patients: study protocol for a randomized controlled trial

Background

Despite evidence of successful weight loss for bariatric surgery patients, some patients experience considerable weight regain over the long term. Given the strong association between post-surgery health behaviors and outcomes, aftercare intervention to address key behaviors appears to be a reasonable relapse-prevention strategy. As the burden of obesity rates increases in healthcare centers, an internet-based program appears to be a reasonable strategy for supporting bariatric surgery patients in the long term. The primary purpose of the current project is to develop and test the efficacy and perceived utility of APOLO-Bari.

Methods/design

This study is a randomized control trial, which will be conducted in two hospital centers in the North of Portugal; it includes a control group receiving treatment as usual and an intervention group receiving the APOLO-Bari program for one year in addition to treatment as usual. A total of 180 male and female participants who underwent bariatric surgery (gastric sleeve or gastric bypass surgery) for 12 to 20 months will be recruited. Both groups will complete a similar set of questionnaires at baseline, every 4 months until the end of the intervention, and at 6 and 12 months follow-up. Assessment includes anthropometric variables and psychological self-report measures. The primary outcome measure will be weight regain measured at the end of treatment, and at 6 and 12 months follow-up. The secondary aims are to test the cost-effectiveness of the intervention and to investigate psychological predictors and trajectories of weight regain. APOLO-Bari was developed to address the weight regain problem in the bariatric population by offering additional guidance to bariatric patients during the postoperative period. The program includes: (a) a psychoeducational cognitive-behavioral-based self-help manual, (b) a weekly feedback messaging system that sends a feedback statement related to information reported by the participant, and (c) interactive chat sessions scheduled with a trained psychologist in the field.

Discussion

APOLO-Bari may play an important role in broadening therapeutic reach to bariatric patients who would not otherwise have continuous support, with important implications for public health treatment.

Trial registration

Current Controlled Trials: ISRCTN37668662.

Eating Disorders and Problematic Eating Behaviours Before and After Bariatric Surgery: Characterization, Assessment and Association with Treatment Outcomes

Accumulating evidence suggests that bariatric surgery candidates are likely to present with eating disorders (EDs) and/or problematic eating behaviours (EBs), and research suggests that these problems may persist or develop after bariatric surgery. While there is growing evidence indicating that EDs and EBs may impact bariatric surgery outcomes, the definitions and assessment methods used lack consensus, and findings have been mixed. The aims of this paper were (1) to summarize the existing literature on pre‐operative and post‐operative EDs and problematic EBs; (2) to discuss the terms, definitions and assessment measures used across studies; and (3) to consider the extent to which the presence of these problems impact surgery outcomes. We highlight the importance of investigators utilizing consistent definitions and assessment methodologies across studies. © 2015 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.