"Loss of control" eating after bariatric surgery tied to worse outcomes in teens

Last Updated: 2017-12-13

By Megan Brooks

NEW YORK (Reuters Health) - In obese adolescents, "loss of control" eating declines sharply right after bariatric surgery but then gradually increases thereafter, and may adversely affect long-term weight outcomes, a new study finds.

Therefore, "continued monitoring of eating patterns" is needed after bariatric surgery, the study team advises.

Loss-of-control (LOC) eating is characterized by a sense that one cannot control what or how much one eats, Dr. Andrea Goldschmidt from Brown University in Providence, Rhode Island, and colleagues explain in Pediatrics, online December 13.

LOC eating is reported by up to 30% of obese adolescents, including those seeking surgical treatment options. In adults, LOC eating after (but not before) bariatric surgery is associated with poorer weight-loss outcomes. The course and outcome of LOC eating in surgery-seeking adolescents are unclear, the authors note.

To investigate, they studied 234 morbidly obese adolescents (mean age, 17; 76% female) who had bariatric surgery and were assessed at baseline (within 30 days of surgery) and six months and one, two, three and four years after surgery.

At the baseline presurgical assessment, LOC binge eating was reported by 15% of adolescents, and continuous LOC eating by 28%. Both forms of LOC eating were significantly lower at all assessments after surgery, relative to before surgery, and ranged from 0.5% to 14.5%. However, both behaviors "gradually increased" between six months and four years.

Presurgical LOC eating had no discernible association with percent BMI change after surgery, suggesting, say the authors, that presurgical LOC eating does not appear to be a contraindication for surgery in adolescents. However, engaging in LOC eating at one, two or three years after surgery was associated with greater subsequent weight regain.

"Taken together, results reveal that assessing for the presence of LOC eating in the postsurgical period may be warranted because this phenotype is associated with poorer weight outcomes," the team writes.

In email to Reuters Health, Dr. Goldschmidt noted that "other research has documented that loss-of-control eating is related with a variety of psychological health concerns as well, like depression and anxiety. I believe the take-home message is that clinicians should be attuned to the presence of loss-of-control eating in their adolescent bariatric surgery patients, even when the behavior is absent prior to surgery, in order to promote optimal health and well-being in the years after surgery."

"Not only should health providers be aware that loss-of-control eating is a common behavior in adolescents seeking bariatric surgery, but they should also understand how to classify and assess this behavior," she said.

"Many providers believe that binge eating is only a problem if it is accompanied by really large amounts of food, or by other behaviors like self-induced vomiting. However, even in the context of smaller amounts of food, experiencing loss of control was associated with poorer weight outcomes. Clinicians should ask their patients if they ever experience a feeling of being unable to control what or how much they are eating, regardless of what or how much they were actually eating at the time, and they should closely monitor these symptoms at follow-up visits so they can have a sense of when it's time to refer their patients for more intensive psychological treatment," Dr. Goldschmidt advised.

The researchers say studies are needed to determine the impact of treating LOC eating on weight outcomes.

SOURCE: http://bit.ly/2AR2Z5P

Pediatrics 2017.