Binge-Eating and Outcomes in Gastric Bypass Surgery

Psychological and psychiatric assessment prior to bariatric surgery is an essential part of our current management model and is recommended by all current obesity guidelines. Indeed, there is little doubt that psychiatric diagnoses are relatively common in weight loss-seeking obese individuals. Specifically, the prevalence of binge eating disorder (BED) has been reported to be in the range of 25-40% of all individuals seeking bariatric surgery.

The general notion is that patients with significant BED should undergo cognitive behavioural intervention prior to surgery and that severe BED may be a contraindication to proceeding with any form of weight-loss.

However, contrary to this widely held notion, hard data confirming that the presence of BED is indeed a predictor of poor surgical outcomes is sparse. In fact, most published studies, suggest that weight loss results in BED patients may be as good (or in some cases even better) than in patients without BED!

Nevertheless, there appear to be some important caveats. Thus, in a new study by Sharon Alger-Mayer and colleagues from Albany Medical College, NY, published in this months edition of Obesity Surgery, weight loss outcomes in patients with severe BED (37 out of 157 patients), who managed to lose 10% of body weight prior to surgery and attended all follow-up consultations during the first 12 months following surgery, were similar to the outcomes in patients without BED over 6 years of follow-up.

Note: the two caveats are:

1) losing 10% of their weight prior to surgery and

2) attending all follow-up appointments.

The study of course did not include patients with BED, who did not lose 10% body weight prior to surgery or who failed to attend their follow-up appointments.

Incidentally, depression (Beck’s Depression Inventory) and poor quality of life (SF-36) likewise did not predict weight loss outcomes.

Overall, this study is consistent with previous shorter-term studies that did not find BED to be a negative predictor of surgical outcomes. Nevertheless, the authors still regard psychological and psychiatric assessment an essential part of patient work-up prior to surgery.

Thus, BED should not generally be seen as a contraindication to proceeding with gastric bypass surgery. Does the same apply to other types of surgery such as the gastric sleeve or gastric banding? We’ll have to wait for the appropriate studies.

In the meantime, at our centre, we continue to insist on regular attendance and demonstration of significant lifestyle changes that include diligent food journaling, regular planned exercise, strict attendance of all clinic appointments, and a minimum of 5-10% weight loss in all pateints prior to consideration for surgery (in addition, we insist on smoking cessation, elimination of all pop, juices and carbonated beverages, elimination of all junk foods and high-caloric snacks, and a sound understanding of the risks and benefits of the planned procedure) .

I guess it may be time for a randomized trial to determine if assessment and treatment for BED will help improve surgical outcomes or prove a waste of resources and an unwarranted barrier to sugery.

Till then, I believe it is advisable to err on the side of caution.

Edmonton, Alberta