Binge Eating Disorder and the Outcome of Bariatric Surgery at One Year: A Prospective, Observational Study

Abstract

Previous studies have suggested that binge eating disorder (BED) impairs weight loss following bariatric surgery, leading some investigators to recommend that patients receive behavioral treatment for this condition before surgery. However, many of these investigations had significant methodological limitations. The present observational study used a modified intention‐to‐treat (ITT) population to compare 1‐year changes in weight in 59 surgically treated participants, determined preoperatively to be free of a current eating disorder, with changes in 36 individuals judged to have BED. Changes in weight and binge eating in the latter group were compared with those in 49 obese individuals with BED who sought lifestyle modification for weight loss. BED was assessed using criteria proposed for the Diagnostic and Statistical Manual (DSM) 5. At 1 year, surgically treated participants without BED lost 24.2% of initial weight, compared with 22.1% for those with BED (P > 0.309). Both groups achieved clinically significant improvements in several cardiovascular disease (CVD) risk factors. Participants with BED who received lifestyle modification lost 10.3% at 1 year, significantly (P < 0.001) less than surgically treated BED participants. The mean number of binge eating days (in the prior 28 days) fell sharply in both BED groups at 1 year. These two groups did not differ significantly in BED remission rates or in improvements in CVD risk factors. The present results, obtained in carefully studied participants, indicate that the preoperative presence of BED does not attenuate weight loss or improvements in CVD risk factors at 1 year in surgically treated patients. Longer follow‐up of participants is required.

Invited Commentary: Childhood and Adolescent Obesity: Psychological and Behavioral Issues in Weight Loss Treatment

“…This may be caused by stretching of the gastric pouch, allowing for increased food intake over time. A recent study, however, suggested no differences in weight loss at 1 year after surgery in persons with and without BED (Wadden et al 2011). …”

Deep brain stimulation for obesity: rationale and approach to trial design

“…Interestingly, bariatric surgery has been repeatedly shown to improve binge-eating postoperatively. 53,87 However, at 2 years after surgery, Sallet et al noted that the association between presurgery binge eating status and higher postsurgery weight regain are most clear. 66 The question remains whether ongoing maladaptive eating behaviors such as binge eating are critical factors in patients who fail bariatric surgery.…”

A psychiatric perspective view of bariatric surgery patients

“…Despite the inconsistencies, the majority of studies report a decrease in binge eating and an improvement in eating behavior after bariatric surgery 4,26,27 . Moreover, most patients report a smaller amount of food eaten, a decrease in hunger, an earlier satiety, less inadequate eating behaviors and more control over their food intake 22,27 .…”