Disordered eating, meal patterns, and weight outcomes following bariatric surgery

Abstract

Bariatric surgery is the most effective treatment for morbid obesity; however, evidence suggests that maladaptive eating behaviors such as binge eating, grazing, and out-of-control eating might be contributors to reduced or reversed success, further contributing to long-term medical and psychological morbidity. Additionally, little is known about the meal and snack consumption patterns following surgery and how this may affect postsurgical outcomes. The current study sought to characterize the weight outcomes, eating patterns, and perceived quality of life (HRQL) of patients 3 to 10 years following gastric bypass (GBP) surgery and to assess the relationships between eating behaviors, weight outcomes, and quality of life. There were 497 eligible subjects (mean age 43.2 years, 96.5% female) who completed an Internet survey of their eating behaviors, HRQL, and surgery-related weight history. Subjects initially lost a mean of 81% of their excess weight and maintained a mean excess weight loss of 70%, 3-10 years following surgery (mean 4.2 years). Eighty-seven percent reported weight regain ranging from 1 to 124 lbs (mean 22.6 lbs). Frequency of binge eating, out-of-control eating and grazing were all significantly correlated with greater weight regain, lesser excess weight loss, and poorer HRQL. Subjects reported eating an average of 5.7 times a day (SD 1.6) including 2.7 +/- .5 meals per day and 2-10 snacks. No relationships were seen between frequencies of meals each week and weight outcomes. Nor did frequency of any particular meal predict weight outcomes. Number of snacks per day and number of afternoon and evening snacks were correlated with lesser excess weight loss and greater weight regain. Number of eating episodes (meals + snacks) per day was also correlated with lesser excess weight loss and greater weight regain. The findings of the study suggest that eating disturbances and a pattern of out-of-control eating are significant following GBP and are a risk factor for poor weight outcomes. Patients should be appraised of these risks and given education and support around these issues both before and after surgery. Additionally there is a need for greater research and guidelines on normative eating patterns in the longer-term following GBP.