Bariatric Surgery and Binge Eating Disorder

What is Bariatric Surgery?

The purpose of bariatric surgery is to alter the stomach and/or intestines to create a dramatic decrease in body weight. The resulting rapid reduction in body weight has made it a popular option for addressing a host of medical conditions, but in addition, it frequently addresses a host of medical conditions such as type 2 diabetes mellitus, cardiovascular disease, dyslipidemia, hypertension, gall stones, gastroesophageal reflux disease, obstructive sleep apnea, and degenerative joint disease. Weight loss surgeries can be life-changing—and lifesaving—to many individuals who undergo them.

Bariatric surgeries are increasing each year in the United States. In 2016, there were an estimated 216,000 bariatric surgeries, about 10% more than the year before (1). The most commonly performed surgery is vertical sleeve gastrectomy, making up nearly 60% of all bariatric surgeries (2). In this procedure, the stomach is surgically altered so that approximately 20-25% of the stomach remains in use. Typically patients see a reduction of up to 95% of excess weight in the first year and up to 75% after five years (3). This procedure is permanent and cannot be reversed. Complications can arise in an estimated 13% of the procedures (4). These include nausea, vomiting, gallstone formation, reflux, nutritional deficiencies, dumping syndrome, and substance abuse.

Bariatric surgery and disordered eating 

There is a high prevalence of disordered eating and eating disorders among individuals seeking bariatric surgery. Studies show that 10-23% of people seeking bariatric surgery have active binge eating disorder (BED) and lifetime BED prevalence rates ranged from 13.1 to 50% (5). This compares with only a 4.5% lifetime prevalence in the general population (5).

It is a myth that everyone struggling with binge eating disorder lives in a larger body. Individuals who struggle with BED present across the body size and age spectrum. However, BED in higher-weight individuals is often undiagnosed or under-diagnosed due to medical professionals focusing on weight and related conditions. Because of this, there are a substantial number of individuals seeking bariatric surgery who have undetected disordered eating.

Because of the high prevalence of eating disorders in this population, it is critical that evaluations be done prior to surgery to avoid disordered eating patterns that could occur or persist post-surgery, complicating or compromising the desired outcomes. Some surgeons are very conscious of this risk and require patients to undergo thorough mental health examinations prior to surgery. However, not all do so, leaving the possibility that an underlying eating disorder may be present. Several commonly used screening and diagnostic tools include the Structured Clinical Interview for DSM-IV (SCID), The Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV), Eating Disorder Diagnostic Scale, and the Questionnaire on Eating and Weight Patterns-5. Should indications of disordered eating appear, it is important that those individuals meet with an experienced eating disorder therapist for further evaluation and treatment to help ensure the most successful long-term outcomes from both a physical and mental health viewpoint.

If eating disorder symptoms appear following surgery, effective psychological treatments exist that can help address underlying cognitive/emotional causes. Cognitive Behavioral Therapy (CBT) is an evidence-based approach proven effective in the treatment of eating disorders. Studies show that CBT combined with mindfulness techniques and CBT along with Dialectical Behavior Therapy (DBT) produces reductions in disordered eating and improvement in post-surgical outcomes. (6,7)

References

1) English, W.J., DeMaria, E.J., Brethauer S.A., Mattar, S.G., Rosenthal, R.J., Morton, J.M., American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016, Surgery For Obesity and Related Diseases. March 2018, Vol 14, Issue 3, 259-263

2) American Society for Metabolic and Bariatric Surgery, 2016

3) Hoyuela, C., Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study, World J Gastrointest Surg. 2017; Apr 27; 9(4), 109-117

4) Chang S.H., Stoll C.R., Song J., Varela J.E., Eagon C.J., Colditz G.A. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–287.

5) Devlin, M.J., King, W.C., Kalarchian, M.A., White, G.E., Marcus, M.D., Garcia, L., Yanovski, S.Z., & Mitchell, J.E. (2016). Eating pathology and experience and weight loss in a prospective study of bariatric surgery patients: 3 year-follow up. International Journal of Eating Disorders, 49(12), 1058-1067.

6) Leahey, T.M. Crowther, J.H. & Irwin, S.R. (2008). A cognitive-behavioral mindfulness group therapy intervention for the treatment of binge eating in bariatric survey patients. Cognitive and Behavioral Practice. 15(4): 364-375.

7) Himes, S.M. Stop Regain: A Pilot Psychological Intervention for Bariatric Patients Experiencing Weight Regain (2015). Obesity Surgery, 25(3): 922-927.