Long-Term Results of Gastroplasty for Morbid Obesity: Binge-Eating as a Predictor of Poor Outcome

Abstract

We investigated the long-term results after vertical banded gastroplasty (VBG) for morbid obesity and evaluated some predictors of poor outcome. Twenty-seven morbidly obese patients (mean BMI 50 kg/m(2)) who underwent VBG a mean of 5.4 years earlier were studied. The mean weight loss was 31 kg or 40.5% of excess weight. Ten patients (37%) were within 50% of their ideal weight. The patients were classified as bingers (n = 10) and non-bingers (n = 17) according to the modified Binge Eating Scale. One-year postoperative weight losses were 55% and 57% respectively of excess weight, but at the time of the study weight losses were 24% and 50% of excess weight (p = 0.04) in the bingers and non-bingers, respectively. The mean weight regain was 23 kg in the bingers vs 8 kg in the non-bingers, p = 0.01. Two bingers had excellent weight loss results, but otherwise an unsuccessful outcome. Weight reduction did not correlate with age, sex or age of onset of obesity. These results show that binge-eating strongly predicts poor weight loss maintenance after gastroplasty in the long-term, though initial weight reduction is good. We suggest that binge-eating should be evaluated before gastroplasty and taken into consideration in the design of treatment.

Does obesity surgery improve psychosocial functioning? A systematic review

“…Powers et al 66,80 published two studies both corresponding to EC IIb indicating a decrease in binge eating behavior during follow-up but an increase in vomiting. Higher rates of postsurgery vomiting were also reported by three other studies (one EC IIb, 78 two EC III 35,81 …”

“…Social functioning in general was assessed by 10 studies, one study corresponding to level IIa, 55 four corresponding to EC IIb, 62,64,67,88 and six to EC III, 35,59,81,85,95,96 respectively. Obesity-related psychosocial problems were assessed in every day life of morbidly obese subjects undergoing bariatric surgery or conventionally treated subjects in the SOS study.…”

“…Satisfaction with obesity surgery A total of 11 studies, five corresponding to EC IIb 62,66,70,79,88 and six to EC III, 35,75,81,83,89,95 asked patients about their satisfaction with the operation. Within the EC IIb studies, 72 70 to 86% 79 were very satisfied with the operation; within the EC III studies, the rate even went up to 90%.…”

“…30 Substantial psychopathology is reported in morbidly obese individuals requesting obesity surgery with a lifetime history of 84% of major mental disorders (according to the DSM-IV 31 ) and 39.5-72% of personality disorders. 32,33 However, evidence is accumulating that severe obesity cannot in general be ascribed to psychopathological determinants, at most to certain subgroups of obese patients, for example, with a binge eating disorder (BED), 34,35 or subtypes of affective disorders. 36 In recent years, consensus has been reached on the importance of quality of life (QoL) besides weight loss and comorbidity as an outcome measure after obesity surgery.…”

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

“…Nesse sentido, fatores como autoimagem corporal, traços de personalidade e presença de compulsão alimentar prévios à intervenção, entre outros, têm sido implicados na evolução e prognóstico desses pacientes, embora as evidências sejam ainda controversas. A presença de compulsão alimentar antes da intervenção cirúrgica, por exemplo, tem sido vista como fator de pior prognóstico, seja com relação à menor redução de peso [6][7][8] , seja com relação à reaquisição dele após a fase de estabilização, em geral devido ao equivalente "beliscar" compulsivo 3,[9][10][11][12][13] . Por outro lado, alguns estudos não encontraram associação consistente entre transtorno da compulsão alimentar periódica no pré-operatório e redução de peso após a cirurgia [14][15][16][17][18][19] .…”