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Objective The objectives of the study were (1) to determine the prevalence of eating pathology in patients before bariatric surgery and at follow‐up; (2) to assess the relationship of presurgical eating pathology to various measures of psychopathology; and (3) to assess the relationship between presurgical eating pathology and outcome. Method One hundred sixteen patients were evaluated prior to surgery and at follow‐up an average of 5.5 years after surgery. Results Preoperative binge eating occurred in 52% of patients, 16% met criteria for binge eating disorder, and 10% had the night eating syndrome. All three forms of presurgical eating pathology were statistically associated with cognitive distortions. At follow‐up, 33% of patients were vomiting at least weekly. There was no relationship between presurgical eating pathology and weight outcome or presence of vomiting at follow‐up. Discussion Although postoperative vomiting usually does not represent purge behavior, it may represent failed attempts to binge. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 25: 293–300, 1999.

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Mean weight losses were less than have been previously reported with gastric restriction procedures but the follow-up was longer than usually reported and many patients had 'super obesity' prior to surgery. The implications of 'super obesity' for weight loss are discussed.

Patients who manifest both binge eating and purging behaviour are at higher risk of substance use which may have important treatment implications.

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This guideline watch reviews new evidence and highlights salient developments since the 2006 publication of APA's Practice Guideline for the Treatment of Patients With Eating Disorders, 3rd Edition. The authors of this watch constituted the work group that developed the 2006 guideline. We find the guideline to remain substantially correct and current in its recommendations. The sole exception is a recommendation (with moderate-level confidence) for sibutramine for binge-eating disorder. In 2010, the U.S. Food and Drug Administration (FDA) withdrew approval for sibutramine because clinical trials showed increased risk of heart attack and stroke, and the manufacturer, Abbott Laboratories, subsequently withdrew this medication from the U.S. market. Noteworthy recent publications about the treatment of eating disorders include systematic reviews by the Agency for Healthcare Research and Quality (Berkman et al. 2006; Bulik et al. 2007); practice guidelines from international groups, including the Catalan Agency for Health Information, Assessment and Quality (Working Group of the Clinical Practice Guideline for Eating Disorders 2009), the World Federation of Societies of Biological Psychiatry (Aigner et al. 2011), and the German Society of Psychosomatic Medicine and Psychotherapy and the German College for Psychosomatic Medicine (Herpertz et al. 2011); and a 2011 guidance statement by the Academy for Eating Disorders, which was written by some of the authors of this From December 2011 to July 2012 (the time period during which this watch was developed), Drs. Yager, Devlin, Halmi, Herzog, Mitchell, Powers, and Zerbe report no competing interests. The American Psychiatric Association's (APA's) practice guidelines are developed by expert work groups using an explicit methodology that includes rigorous review of available evidence, broad peer review of iterative drafts, and formal approval by the APA Assembly and Board of Trustees. APA practice guidelines are intended to assist psychiatrists in clinical decision making. They are not intended to be a standard of care. The ultimate judgment regarding a particular clinical procedure or treatment plan must be made by the psychiatrist in light of the clinical data presented by the patient and the diagnostic and treatment options available. Guideline watches summarize significant developments in practice that have occurred since publication of an APA practice guideline. Watches may be authored and reviewed by experts associated with the original guideline development effort and are approved for publication by APA's Executive Committee on Practice Guidelines. Thus, watches represent the opinion of the authors and approval of the Executive Committee but not APA policy.