Elsevier

Surgery for Obesity and Related Diseases

Volume 6, Issue 1, January–February 2010, Pages 79-85
Surgery for Obesity and Related Diseases

Allied health article
Comprehensive interview assessment of eating behavior 18–35 months after gastric bypass surgery for morbid obesity

https://doi.org/10.1016/j.soard.2009.08.011Get rights and content

Abstract

Background

Weight loss surgery induces a marked change in eating behavior. However, not much work has been done characterizing the eating behavior after weight loss surgery. We conducted a detailed analysis of patients' eating behavior 18–35 months after Roux-en-Y gastric bypass surgery, determined whether preoperative eating disorders might be associated with non-normative postoperative eating, and examined the association of such eating behaviors with weight loss and psychopathology.

Methods

A sample of 59 patients who had undergone Roux-en-Y gastric bypass was interviewed in person after surgery about a range of eating behaviors, including binge eating, chewing and spitting out food, picking at and nibbling food, and nocturnal eating and compensatory behaviors such as vomiting and laxative and diuretic misuse. An established semistructured interview was used. The prevalence of preoperative eating disorders was assessed retrospectively. The eating-related and general psychopathology and quality of life were assessed using self-report questionnaires before and after surgery.

Results

Subjective bulimic episodes were reported by 25% and vomiting for weight and shape reasons by 12% of the participants, on average, 2 years after surgery. Subjective bulimic episodes were significantly associated with a preoperative binge eating disorder, with more eating-related and general psychopathology after surgery, and with less weight loss.

Conclusion

A substantial subgroup of patients with a preoperative eating disorder will develop binge eating after surgery that might be associated with less weight loss. A subsample will start vomiting for weight and shape reasons after bariatric surgery. Clinicians must probe carefully for these behaviors postoperatively to identify patients in need of treatment of pathological eating behaviors.

Section snippets

Participants

The study participants were 59 severely obese patients (50 women and 9 men) who had undergone RYGB at the Department of Surgery, MeritCare Health Systems (Fargo, ND). A total of 119 bariatric surgery candidates had agreed to participate in the present study. All patients gave written informed consent before their preoperative evaluation and agreed that they could be contacted for additional follow-up after surgery. The study was approved by the Human Subjects Committees of the Neuropsychiatric

Preoperative eating disorders

A diagnosis of BED was assessed prospectively using the QEWP [21] and retrospectively at follow-up using the EDE-BSV interview. Using the QEWP, 14 patients (23.7%) met the full diagnostic criteria for BED. Using the EDE-BSV interview, 17 patients (28.8%) met the full eating disorder criteria before surgery (BN in 2 and BED in 15). With both methods, all patients with an eating disorder preoperatively were women. The agreement between QEWP and EDE-BSV was satisfactory, with 84.7% agreement and

Discussion

This is the first study to apply a standardized face-to-face interview rather than self-report measures or telephone interviews to provide a fine-grained description of postoperative eating behaviors. Overall, non-normative eating behaviors were common. Preoperatively, the prevalence of BED or BN was 28.8% in our sample, which is within the wide range of 2–49% found in the published data [13], [28]. Postoperatively, no OBEs were detected in our sample, likely owing to the small size of the

Conclusion

The present study has provided a detailed assessment of a range of eating behaviors on average 2 years after gastric bypass. Our results showed that a subgroup of patients after weight loss surgery will develop or redevelop subjective binge or “loss of control” eating and self-induced vomiting for weight and shape reasons. A preoperative eating disorder seemed to be a clear predictor; however, not all of those with preoperative binge eating (<50%) will develop SBE or “loss of control” eating or

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