Disordered eating following bariatric surgery: a review of measurement and conceptual considerations

Ivezaj, Valentina; Carr, Meagan M.; Brode, Cassie; Devlin, Michael J.; Heinberg, Leslie J.; Kalarchian, Melissa A.; Sysko, Robyn; Williams-Kerver, Gail A.; Mitchell, James E.

doi:10.1016/j.soard.2021.03.008

Cited by 23 publications

(14 citation statements)

References 96 publications

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“…However, although bariatric surgery seems to be the most effective treatment for obesity, some individuals do not respond adequately, especially in the long-term evaluation [ 7 ]. Furthermore, specific subgroups of patients with obesity may report persistent or de novo pathological eating behaviors even after bariatric surgery [ 8 ]. On the other hand, obesity is bi-directionally associated with both physical and psychiatric diseases [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Development, validation and clinical use of the Eating Behaviors Assessment for Obesity (EBA-O)

et al. 2022

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Introduction Obesity is a major health problem with an increasing risk of mortality, associated with comorbidities and high rates of dropout. Research demonstrated that pathological eating behaviors could help to phenotype obese patients thus tailoring clinical interventions. Therefore, our aim was to develop (study 1), validate (study 2), and test in a clinical setting (study 3) the Eating Behaviors Assessment for Obesity (EBA-O). Method Study 1 included the exploratory factor analysis (EFA) and McDonald's ω in a general population sample (N = 471). Study 2 foresaw the confirmatory factor analysis (CFA) and convergent validity in 169 participants with obesity. Study 3 tested the capability of the EBA-O to characterize eating behaviors in a clinical sample of 74 patients with obesity. Results Study 1. EFA identified five factors (i.e., food addiction, night eating, binge eating, sweet eating, and prandial hyperphagia), explaining 68.3% of the variance. The final EBA-O consisted of 18 items. McDonald's ω ranged between 0.80 (hyperphagia) and 0.92 (binge eating), indicating very good reliability. Study 2. A second-order five-factor model, through CFA, showed adequate fit: relative chi-square (χ 2 /df) = 1.95, CFI = 0.93, TLI = 0.92, RMSEA = 0.075, and SRMR = 0.06, thus suggesting the appropriateness of the EBA-O model. Significant correlations with psychopathological questionnaires demonstrated the convergent validity. Study 3. Significant associations between EBA-O factors and emotional-related eating behaviors emerged. ConclusionThe EBA-O demonstrated to be a reliable and easy-to-use clinical tool to identify pathological eating behaviors in obesity, particularly useful for non-experts in eating disorders. Level of evidence Level V, descriptive research.

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Section: Introductionmentioning

confidence: 99%

Development, validation and clinical use of the Eating Behaviors Assessment for Obesity (EBA-O)

et al. 2022

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“…Beyond clarification of ED diagnostic criteria in OS, future research is warranted to improve definition and assessment of NEBs. 15,[67][68][69] Because of possible differences in the course and prospective value of NEBs and EDs by surgical procedure, 7,15,17,70 separate analyses should be conducted for SG at a larger sample size. In addition, factors associated with postsurgical NEBs and EDs deserve clarification beyond their presurgical presentation.…”

Section: Discussionmentioning

confidence: 99%

“…Beyond clarification of ED diagnostic criteria in OS, future research is warranted to improve definition and assessment of NEBs . Because of possible differences in the course and prospective value of NEBs and EDs by surgical procedure, separate analyses should be conducted for SG at a larger sample size.…”

Section: Discussionmentioning

confidence: 99%

Nonnormative Eating Behaviors and Eating Disorders and Their Associations With Weight Loss and Quality of Life During 6 Years Following Obesity Surgery

et al. 2022

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ImportanceIndividuals with severe obesity presenting for obesity surgery (OS) frequently show nonnormative eating behaviors (NEBs) and eating disorders (EDs), but the long-term course and prospective associations with weight loss and health-related quality of life (HRQOL) remain unclear.ObjectiveTo examine the prevalence and prospective relevance of presurgical and postsurgical NEBs and EDs according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosed through clinical interview, for weight loss and HRQOL up to 6 years following OS.Design, Setting, and ParticipantsIn the prospective, multicenter Psychosocial Registry for Obesity Surgery cohort study, patients seeking OS were recruited at 6 OS centers in Germany and assessed at baseline before surgery and at 6 months and 1 to 6 years after surgery. From a consecutive sample of 1040 volunteers with planned OS from March 1, 2012, to December 31, 2020, a total of 748 (71.92%) were included in this study. Across follow-up, 93 of the 748 patients (12.43%) dropped out. Data were analyzed from April to November 2021.InterventionsLaparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy.Main Outcomes and MeasuresBoth NEBs and EDs were identified using the Eating Disorder Examination interview. Main outcomes were the percentage of total body weight loss (%TBWL) and HRQOL (Impact of Weight on Quality of Life-Lite; range, 0-100, with 0 indicating worst and 100 indicating best).ResultsIn 748 patients undergoing OS (mean [SD] age, 46.26 [11.44] years; mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 48.38 [8.09]; 513 [68.58%] female), the mean (SD) %TBWL was 26.70% (9.61%), and the mean (SD) HRQOL improvement was 35.41 (20.63) percentage points across follow-up. Both NEBs and EDs were common before surgery, with postsurgical improvements of varying degrees. Whereas NEBs and EDs did not reveal significant prospective associations with %TBWL, loss-of-control eating at follow-up was concurrently associated with lower %TBWL (estimate, −0.09; 95% CI, −0.14 to −0.04). Loss-of-control eating (estimate, −0.10; 95% CI, −0.17 to −0.03 percentage points) and binge-eating disorder of low frequency and/or limited duration (estimate, −6.51; 95% CI, −12.69 to −0.34 percentage points) at follow-up showed significant prospective associations with lower HRQOL.Conclusions and RelevanceThis cohort study found prospective relevance of loss-of-control eating and binge-eating disorder of low frequency and/or limited duration for reduced long-term HRQOL following OS. These findings underline the importance of monitoring both NEBs, especially loss-of-control eating, and EDs in the long term postsurgically to identify patients in need of targeted prevention or psychotherapy.

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“…Results showed that all the indicators held predictive value in discriminating participants with vs without binge-eating, and eating large amounts of food when not feeling hungry performed the best in predicting the presence and feeling disgusted, guilty, or depressed after eating performed the best in predicting the absence of binge-eating (White & Grilo, 2011). On the contrary, in (Ivezaj et al, 2021). However, this method does not entirely tease out the "food amount" component because in objective binge-eating, the quantity of food is considered objectively large and in subjective binge-eating, eating episodes are perceived to be excessive by the person eating.…”

Section: Various Interventions With Different Therapeutic Componentsmentioning

confidence: 98%

Experiences of loss of control eating in women after bariatric surgery: A qualitative study

Yeh

Kalarchian

et al. 2023

Intl J Eating Disorders

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Objective Loss of control (LOC) eating following bariatric surgery remains insufficiently understood, reflected in a lack of clear conceptualization, valid measurements, and effective treatments. This study explored patients' perspectives on LOC eating post‐bariatric surgery, focusing on the relevance of the Diagnostic and Statistical Manual of Mental Disorders‐5 (DSM‐5) indicators of impaired control, and patients' experiences before (precipitating factors), during (eating patterns, perpetuating factors), and after the episodes (strategies used to stop eating). Methods This was a qualitative study using descriptive phenomenology. Participants were adults who have undergone gastric bypass or sleeve gastrectomy and self‐reported recent LOC eating. Data were collected by semi‐structured interviews and analyzed using a combined inductive and deductive approach. Results Participants were all women (N = 15; age: 34.5 ± 9.2 years). Results suggested that (1) except for feeling disgusted, guilty, or depressed after eating, other DSM‐5 indicators did not seem to be highly relevant to this bariatric cohort; (2) LOC eating could occur across contexts, with food access, boredom, and food craving being consistent triggers; (3) the food amount consumed during a LOC episode was not necessarily considered excessive; (4) “mindlessness” and “satisfying hedonic, physiological, and mental needs” were the main perpetuating factors of LOC eating; and (5) self‐talk and distracting attention were the most adopted strategies to stop eating. Discussion Study findings have implications concerning the conceptualization, measurement, and intervention of LOC eating among bariatric patients. For example, results suggested the need for more data to determine the appropriate indicators of LOC eating and the inclusion of boredom as an intervention target in bariatric patients. Public Significance Loss of control (LOC) eating is characterized by a sense of being unable to stop while eating. LOC eating is prevalent in patients who have undergone weight loss surgery and is associated with worse surgical outcomes. This qualitative study that explored post‐bariatric surgery patients' experiences of LOC eating will inform efforts to better assess and intervene in this disordered eating behavior, thus ultimately optimizing patients' health following weight loss surgery.

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Disordered eating following bariatric surgery: a review of measurement and conceptual considerations

Cited by 23 publications

References 96 publications

Development, validation and clinical use of the Eating Behaviors Assessment for Obesity (EBA-O)

Development, validation and clinical use of the Eating Behaviors Assessment for Obesity (EBA-O)

Nonnormative Eating Behaviors and Eating Disorders and Their Associations With Weight Loss and Quality of Life During 6 Years Following Obesity Surgery

Experiences of loss of control eating in women after bariatric surgery: A qualitative study

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