The utility of DSM-5 indicators of loss of control eating for the bariatric surgery population.

OBJECTIVES: This study investigated the utility of DSM-5 indicators of loss of control (LOC) eating in adult bariatric surgery patients who presented with binge-eating episodes. METHODS: Participants (all women) were 40 preoperative and 28 postoperative bariatric surgery patients reporting objective binge eating (OBE), 46 preoperative and 52 postoperative with subjective binge-eating (SBE), 53 bulimia nervosa (BN) controls, and 34 binge-eating disorder (BED) controls. Face-to-face Eating Disorder Examination interviews and questionnaires were administered. ANOVA, T-test, χ 2 , and regressions compared the groups in terms of LOC indicators endorsed and to explain disordered eating psychopathology. RESULTS: The indicator most commonly reported by bariatric patients with OBE was "feeling disgusted" (90% and 75% of pre- and postoperative groups), and the least endorsed was "eating alone" (40 and 28.6%). These indicators were reported by >84.9% of the BN and BED. Bariatric patients (pre- or post-surgery) with OBE only reported a higher number of indicators than patients with SBE only (t(150) = 2.34, p = .021). A higher number of indicators reported were associated with increased eating-related psychopathology (F(1,134) = 31.06, p < .001), but only for the post-surgery patients. CONCLUSIONS: The LOC indicators proposed by DSM-5 need to be refined or revised for the bariatric population. Highlights Bariatric patients endorse fewer LOC indicators than BN or BED during a binge-eating episode. Some of the DSM-5 LOC indicators may not be suited to assess episodes of loss of control eating among bariatric patients. The Higher the number of LOC indicators reported, the higher the eating-related psychopathology.

Validation of the Portuguese version of the Clinical Impairment Assessment (CIA) in eating disorders' patients.

PURPOSE: The purpose of the study was to assess the psychometric properties of the Portuguese version of the Clinical Impairment Assessment (CIA) in eating disorders (ED) patients. METHOD: The CIA is a 16-item brief self-reported instrument developed to assess psychosocial impairment secondary to EDs. The CIA was administered to a clinical sample of 237 women with EDs and a college sample of 196 women. The clinical sample completed the Eating Disorders Examination Questionnaire, the Beck Depression Inventory and the Outcome-45 Questionnaire. Reliability, confirmatory factor analysis, validity, and clinically significant change were calculated. RESULTS: Confirmatory factor analysis validated the original 3-factor structure showing an adequate model fit. CIA showed good psychometric properties with high internal consistency, good convergent validity with the EDE-Q, the OQ-45, and the BDI. For divergent validity, participants CIA scores in the clinical sample were significantly higher than in the non-clinical sample. ROC curve analysis provided a cutoff of 15. For known-groups validity participants' scoring above CIA cutoff reported significantly higher CIA scores. In addition, non-underweight participants and participants reporting the presence of dysfunctional ED behaviors had significantly higher CIA scores. Finally, for clinically significant change, a reliable change index of 5 points was obtained to consider a reliable change in the CIA global score. CONCLUSIONS: Our findings support the validity and clinical utility of the CIA as a good self-report measure to be used in both clinical and research settings. LEVEL OF EVIDENCE: Level V. Cross-sectional descriptive study.

Perceived social support before and after bariatric surgery: association with depression, problematic eating behaviors, and weight outcomes.

PURPOSE: Engaging in a healthy lifestyle after bariatric surgery is essential to optimize and sustain weight loss in the long term. There is promising evidence that social support of patients who undergo bariatric surgery plays an important role in promoting a better quality of life and adherence to the required behavioral changes and medical appointments. This study sought to investigate: (a) if post-operative patients experience different levels of perceived social support compared to pre-operative patients; (b) correlations between perceived social support, depression, disordered eating, and weight outcomes; (c) if social support is a moderator between psychological distress, and disordered eating behavior and weight outcomes. METHODS: A group of 65 patients assessed pre-surgery and another group of 65 patients assessed post-surgery (M = 26.12; SD 7.97 months since surgery) responded to a set of self-report measures assessing social support, eating disorder psychopathology, disordered eating, and depression. RESULTS: Greater social support was associated with lower depression, emotional eating, weight and shape concerns, and greater weight loss in pre- and post-surgery groups. Social support was found to be a moderator between different psychological/weight variables but only for the post-surgery group: the relation between depression and eating disorder psychopathology or weight loss was significant for patients scoring medium to high level is social support; the relation between grazing and weight regain was significant for patients scoring medium to low levels of social support. CONCLUSIONS: The associations found between perceived social support and depression, disordered eating and weight outcomes highlight the importance of considering and working with the social support network of patients undergoing bariatric surgery to optimize treatment outcomes. Level of Evidence  Level III: case-control study.

Problematic eating behaviors and psychopathology in patients undergoing bariatric surgery: The mediating role of loss of control eating.

OBJECTIVE: This study compares different problematic eating behaviors (PEBs; objective [OBE]/subjective [SBE] binge-eating and compulsive [CG]/noncompulsive [NCG] grazing) in relation to the severity of loss of control (LOC) and psychopathology. We also investigate LOC as a mediator between PEBs and psychopathology. METHOD: This cross-sectional study assessed a group of patients before bariatric surgery (n = 163), and a group of bariatric patients 12 months or more after surgery (n = 131). Face-to-face assessment: Eating Disorders Examination for binge-eating episodes; Rep(eat) for grazing. LOC was measured by five questions answered in a 5-point Likert scale. Self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. RESULTS: OBEs were reported by 26(8.8%), SBE by 29(9.8%), CG by 35(11.9%), and NCG by 36(12.2%) of patients. The different PEBs differed significantly in the severity of LOC (F(3,120)= 25.81, p < .001). Patients reporting OBEs scored higher and patients with NCG scored lower in most measures than patients with other PEBs. Patients with any PEBs scored higher in all self-report measures than those not reporting any PEBs, with statistical significance reached for uncontrolled eating (F(4,288)= 20.21, p < .001), emotional eating (F(4,288)= 23.10, p < .001), repetitive eating F(4,288)= 18.34, p < .001), and compulsive grazing (F(4,288)= 27.14, p < .001). LOC was found to be a full mediator between PEBs and psychopathology. DISCUSSION: There is no evidence that the different PEBs differ in the psychopathology severity, independently of the experience of LOC eating during the eating episodes. We show evidence for the conceptualization of different PEB, including grazing, on a continuous scale of LOC and psychopathology.

Prevalence of eating disorders and picking/nibbling in elderly women.

OBJECTIVE: The aim of this study was to examine the point prevalence of eating disorders and picking/nibbling in elderly women. METHODS: This was a two-stage epidemiological study that assessed 342 women aged 65-94 years old. In Stage 1, the following screening measures were used to identify possible cases: the Mini-Mental State Examination, to screen and exclude patients with cognitive impairment; Weight Concerns Scale; SCOFF (Sick, Control, One, Fat, Food) Questionnaire; Eating Disorder Examination Questionnaire-dietary restraint subscale; and three questions to screen for picking/nibbling and night eating syndrome. Women selected for Stage 2 (n = 118) were interviewed using the diagnostic items of the Eating Disorder Examination. RESULTS: According to the DSM-5, the prevalence of all eating disorders was 3.25% (1.83-5.7, 95% C.I.). Prevalence of binge-eating disorder was 1.68% (0.82-3.82, 95% C.I.), of other specified feeding or eating disorders was 1.48% (0.63-3.42, 95% C.I.), and of bulimia nervosa 0.3% (.05-1.7, 95% C.I.)]. Binge-eating episodes were reported by 5.62% of women. No cases of anorexia nervosa or night eating syndrome were identified. The prevalence of picking/nibbling was 18.9%. Picking/nibbling was associated with increased body mass index (t(322) = -3.28, p < .001) and binge-eating episodes (χ2 (1) = 5.65, p < .017). DISCUSSION: Prevalence rates of eating disorders on elderly Portuguese women were comparable to those found on young women. Our data support the literature that suggests that binge-eating disorder is particularly prevalent in older adults. Picking/nibbling was the most prevalent eating behavior and we provide further evidence for its association with weight and disordered eating.

Repetitive eating questionnaire [Rep(eat)-Q]: Enlightening the concept of grazing and psychometric properties in a Portuguese sample.

BACKGROUND/OBJECTIVE: Grazing has been associated with poor weight loss or weight regain in obese patients undergoing bariatric surgery, but research remains scarce and complicated by the use of different non-validated measures. The aim of this paper is to describe the validation of the Rep(eat)-Q, a self-report measure developed to assess grazing, and investigates its relationship with BMI and psychopathology. SUBJECTS/METHODS: 1223 university students and community participants (non-clinical; Study A) and 154 pre-bariatric and 84 post-bariatric patients (Study B) completed a set of self-report measures, including the Rep(eat)-Q (worded in Portuguese), to assess disordered eating, depression, anxiety, stress and impulsivity. Exploratory and confirmatory factor analyses tested the factor structure; internal consistency construct, convergent and divergent validity were also tested. RESULTS: The Rep(eat)-Q scales showed good internal consistency (α ≥ 0.849) and temporal stability (rsp = 0.824, p < 0.000). Factor analyses generated two subscales: compulsive grazing and repetitive eating. Significant correlations (p < 0.05) were found between the Rep(eat)-Q and BMI in the non-clinical population and weight loss and weight regain in the bariatric sample. Generally, the correlations with psychological distress were weak (rsp < 0.4). Strong and significant (rsp≥0.4; p's < 0.05) correlations were found between compulsive grazing and eating disorder psychopathology. Repetitive eating subscale was inversely correlated with cognitive restraint (rsp -0.321, p < 0.05) and directly correlated with uncontrolled eating and emotional eating (rsp = 0.754; rsp = 0.691; p < 0.05). DISCUSSION/CONCLUSION: The Rep(eat)-Q is a valid measure to assess grazing in non-clinical and in bariatric surgery populations. Grazing can be conceptualized on the spectrum of disordered eating behavior, and appears associated with loss of control over eating. Considering the link between grazing and weight outcomes, the Rep(eat)-Q represents a necessary strategy for the systematic screening of grazing.

Metabolic profile and psychological variables after bariatric surgery: association with weight outcomes.

PURPOSE: This study aims to examine associations between metabolic profile and psychological variables in post-bariatric patients and to investigate if metabolic and psychological variables, namely high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), glycated hemoglobin (HbA 1c), impulsivity, psychological distress, depressive and eating disorder symptoms are independently associated with percentage of excess weight loss (%EWL) after bariatric surgery. METHODS: One hundred and fifty bariatric patients (BMI = 33.04 ± 5.8 kg/m(2)) who underwent to bariatric surgery for more than 28.63 ± 4.9 months were assessed through a clinical interview, a set of self-report measures and venous blood samples. Pearson's correlations were used to assess correlations between %EWL, metabolic and psychological variables. Multiple linear regression was conducted to investigate which metabolic and psychological variables were independently associated with %EWL, while controlling for type of surgery. RESULTS: Higher TG blood levels were associated with higher disordered eating, psychological distress and depression scores. HDL-C was associated with higher depression scores. Both metabolic and psychological variables were associated with %EWL. Regression analyses showed that, controlling for type of surgery, higher % EWL is significantly and independently associated with less disordered eating symptoms and lower TG and HbA_1c blood concentrations (R (2) aj = 0.383, F (4, 82) = 14.34, p < 0.000). CONCLUSION: An association between metabolic and psychological variables, particularly concerning TG blood levels, disordered eating and psychological distress/depression was found. Only higher levels of disordered eating, TG and HbA_1c showed and independent correlation with less weight loss. Targeting maladaptive eating behaviors may be a reasonable strategy to avoid weight regain and optimize health status post-operatively.

Corrigendum: Severe and enduring' stage in anorexia nervosa: comparing eating attitudes, impairment and associated psychopathology.

[This corrects the article DOI: 10.3389/fnut.2022.867401.].

Eating disorders during lockdown: the transcultural influence on eating and mood disturbances in Ibero-Brazilian population.

BACKGROUND: COVID-19 pandemic has implied exceptional restrictive measures to contain its widespread, with adverse consequences on mental health, especially for those people with a background of mental illness, such as eating disorders (EDs). In this population, the influence of socio-cultural aspects on mental health has been still underexplored. Then, the main aim of this study was to assess changes in eating and general psychopathology in people with EDs during lockdown regarding the ED subtype, age, and provenance, and considering socio-cultural aspects (e.g., socioeconomical factors such as work and financial losses, social support, restrictive measures, or health accessibility, among others). METHODS: The clinical sample was composed of 264 female participants with EDs (74 anorexia nervosa (AN), 44 bulimia nervosa (BN), 81 binge eating disorder (BED), and 65 other specified feeding and eating disorder (OSFED)), with a mean age of 33.49 years old (SD = 12.54), from specialized ED units in Brazil, Portugal, and Spain. The participants were evaluated using the COVID-19 Isolation Eating Scale (CIES). RESULTS: A global impairment in mood symptoms and emotion regulation was reported in all the ED subtypes, groups of age, and countries. Spanish and Portuguese individuals seemed more resilient than Brazilian ones (p < .05), who reported a more adverse socio-cultural context (i.e., physical health, socio-familial, occupational, and economic status) (p < .001). A global trend to eating symptoms worsening during lockdown was observed, regardless of the ED subtype, group of age, and country, but without reaching statistical significance. However, the AN and BED groups described the highest worsening of the eating habits during lockdown. Moreover, individuals with BED significantly increased their weight and body mass index, similarly to BN, and in contrast to the AN and OSFED groups. Finally, we failed to find significant differences between groups of age although the younger group described a significant worsening of the eating symptoms during lockdown. CONCLUSIONS: This study reports a psychopathological impairment in patients with EDs during lockdown, being socio-cultural aspects potential modulatory factors. Individualized approaches to detect special vulnerable groups and long-term follow-ups are still needed.

Problematic eating behaviors in patients undergoing bariatric surgery: Studying their relationship with psychopathology.

This study explored the associations between individuals presenting different problematic eating behaviors (Objective/Subjective binge-eating-OBE/SBE-and Compulsive/Non-compulsive grazing-C_Grazing/NC_Grazing) and eating disorder related symptoms. About 163 pre- and 131 post-bariatric patients were assessed. Assessment included: Face-to-face clinical interview to assess binge-eating and grazing episodes, and self-report measures to assess eating disorder symptomatology, psychological distress, and negative urgency. OBE and NC_Grazing were the problematic eating behaviors most and least associated with psychopathology, respectively. OBE and C_Grazing uniquely accounted for the significant variance in the most disordered eating variables. Our findings emphasize the need for the conceptualization of grazing behavior in the spectrum of disordered eating.

Severe and Enduring' Stage in Anorexia Nervosa: Comparing Eating Attitudes, Impairment and Associated Psychopathology.

This study aimed to assess differences in eating attitudes, impairment, and related psychopathology at treatment presentation for patients with "Non-severe and enduring Anorexia Nervosa" (illness duration of <7 years) and patients with "severe and enduring Anorexia Nervosa" (illness duration of 7 years or more). One hundred and thirty-nine patients diagnosed with Anorexia Nervosa participated in this study. Participants were interviewed with the Eating Disorder Examination (EDE) and asked to complete several questionnaires at the end of the first treatment appointment. We also explored differences at treatment presentation by considering alternative criteria to define groups, namely a composite of illness duration and clinical impairment (≥16 CIA total score). No differences were found when comparing participants based on illness duration. However, when participants were classified into a different classification scheme: "Non-severe and enduring Anorexia Nervosa" (illness duration <7 years and a CIA total score <16) vs. "severe and enduring Anorexia Nervosa" (illness duration ≥7 years and CIA total score ≥16), significant differences were found in terms of eating pathology, depressive symptomatology, psychological distress, and emotion dysregulation. Further research is needed to better understand the role of illness duration and clinical impairment in informing the course of AN.

Eating behaviors and weight outcomes in bariatric surgery patients amidst COVID-19.

BACKGROUND: Recent studies suggest that eating habits are an area particularly affected by the lockdown imposed by many countries to curb the COVID-19 epidemic. Individuals that received bariatric surgery may represent a particularly susceptible population to the adverse effects of lockdown for its potential impact on eating, psychological, and weight loss outcomes. OBJECTIVES: This study seeks to investigate the incremental impact of COVID-19 lockdown on treatment outcomes of postbariatric patients in the risk period for weight regain. SETTING: Main hospital center. METHODS: This work uses data from an ongoing longitudinal study of bariatric patients assessed before surgery (T0), 1.5 years after sugery (T1), and 3 years after surgery (T2). Two independent groups were compared: the COVID-19_Group (n = 35) where T0 and T1 assessments were conducted before the pandemic started and T2 assessment was conducted at the end of the mandatory COVID-19 lockdown; and the NonCOVID-19_Group (n = 66), covering patients who completed T0, T1, and T2 assessments before the epidemic began. Assessment included self-report measures for disordered eating, negative urgency, depression, anxiety, stress, and weight outcomes. RESULTS: General linear models for repeated measures showed that the COVID-19_Group presented significantly higher weight concern (F = 8.403, P = .005, ƞ2p = .094), grazing behavior (F = 7.166, P = .009, ƞ2p = .076), and negative urgency (F = 4.522, P = .036, ƞ2p = .05) than the NonCOVID-19_Group. The COVID-19_Group also showed less total weight loss (F = 4.029, P = .05, ƞ2p = .04) and larger weight regain at T2, with more COVID-19_Group participants experiencing excessive weight regain (20% versus 4.5%). CONCLUSION: These results show evidence for the impact of the coronavirus outbreak on eating-related psychopathology and weight outcomes in postbariatric surgery patients.

Understanding Uncontrolled Eating after Bariatric Surgery: The Role of Excessive Skin and Body Image Shame.

Excess skin and disordered eating behaviors are referred to as some of the major negative consequences of bariatric surgery as well as body image shame. This study sought to explore how discomfort with excessive skin, body image shame, psychological distress, eating-related psychopathology, and negative urgency interact to understand uncontrolled eating among woman submitted to bariatric surgery. A cross-sectional sample of 137 women was evaluated postoperatively through self-report questionnaires assessing discomfort with excess skin, body image shame, eating-related psychopathology, negative urgency, and uncontrolled eating in a hospital center in the north of Portugal. Pearson correlations and Structural Equation Modeling (SEM) were performed. Body image shame mediated the relationship between discomfort with excess skin and eating-related psychopathology. In turn, the relationship between eating-related psychopathology and uncontrolled eating was mediated by negative urgency. This study highlights the impact of excess skin and body image shame on eating behavior post-bariatric-surgery. Considering the proven impact of uncontrolled eating on weight-loss results post-surgery, understanding the mechanisms underlying this problem is highly important. Our findings provide helpful insight for multidisciplinary teams committed to providing care to bariatric patients struggling with body image and eating difficulties.

Weight loss expectations and weight loss after surgery: the mediating role of body image and weight concerns.

BACKGROUND: Preliminary evidence suggests bariatric patients' unrealistic expectations regarding weight loss after bariatric surgery are related to worse weight outcomes. OBJECTIVES: This study aimed to examine preoperative weight loss expectations and their association with weight loss, body image, eating behavior, and depressive symptoms. SETTING: Hospital Centers, Portugal. METHODS: This longitudinal study assessed 64 bariatric patients. Participants were asked about their desired postoperative weight and responded to the following set of self-report measures before and 2 years after surgery: Eating Disorder Examination Questionnaire, Beck Depression Inventory, and Body Shape Questionnaire. RESULTS: The majority of participants (81.1%) did not reach the desired weight, 10 (13.5%) lost more weight than initially expected, and only 4 (5.4%) obtained the desired weight. More discrepant expectations were associated with more dissatisfaction with the body image and higher scores concerning eating psychopathology after surgery but not presurgery. Postsurgery body dissatisfaction and weight concerns were significant mediators in the relationship between discrepant expectations and poorer weight loss. CONCLUSIONS: This study shows bariatric patients hold preoperative unrealistic expectations about their weight loss, and that they sustain those expectations in the postoperative time. Our findings bring evidence for an interplay between preoperative and postoperative factors to explain weight loss. Educating about flexible weight loss goals before surgery may be a simple strategy to optimize psychological functioning and weight loss after surgery.

Impact of COVID-19 lockdown measures on a cohort of eating disorders patients.

BACKGROUND: Lockdown implemented to prevent the COVID-19 spread resulted in marked changes in the lifestyle. The objective of the current study was to assess the impact of lockdown measures on a cohort of eating disorder (ED) patients being followed as part of an ongoing naturalistic treatment study. METHODS: Ninety-nine patients aged 18 or older, currently or previously, in treatment at a Portuguese specialized hospital unit were contacted by phone and invited to participate in the current survey. Fifty-nine agreed to be interviewed by phone, and 43 agreed to respond to a set of self-report measures of ED symptoms, emotion regulation difficulties, clinical impairment, negative urgency, and COVID-19 impact, during the week after the end of the lockdown period. RESULTS: Data showed that of the 26 patients currently in treatment: 8 remained unchanged (31%), 7 deteriorated (27%), and 11 reliably improved (42%). Of the 17 participants not currently in treatment: 3 deteriorated (18%), 9 remained unchanged (53%), and 5 (29%) improved after the lockdown period. The Coronavirus Impact Scale showed that most patients considered their routines moderately or extremely impacted, experienced stress related to coronavirus, and showed difficulty in maintaining physical exercise and feeding routines. Results suggest that higher impact of COVID-19 lockdown was significantly correlated with eating disorder symptoms and associated psychopathology, impulsivity, difficulties in emotion regulation and clinical impairment measured at post-lockdown. In addition, the impact of COVID-19 and lockdown measures on clinical impairment was mediated by difficulties in emotion regulation. CONCLUSIONS: Findings suggest that some ED patients may experience worsening of their condition, especially if associated with difficulties in emotion regulation, and these difficulties might be exacerbated in the context of a stressful crisis and lockdown measures, highlighting the need for intervention strategies to mitigate its negative impact.

Weight loss trajectories and psychobehavioral predictors of outcome of primary and reoperative bariatric surgery: a 2-year longitudinal study.

BACKGROUND: Long-term behavioral and psychological aspects associated with weight outcomes after reoperative bariatric surgery have rarely been investigated. OBJECTIVES: This study sought (1) to identify differences in weight loss trajectories during the first 24 months in reoperative bariatric surgery (R group) and primary bariatric surgery (P group) and (2) to investigate pre- and postsurgery psychobehavioral predictors of weight loss and weight regain for both groups. SETTING: Hospital center and university, Portugal. METHODS: This longitudinal study compared an R group (n = 157) and a P group (n = 216). Patients were assessed at presurgery and at 6, 12, 18, and 24 months postsurgery. Assessment included the Eating Disorder Examination-Questionnaire and Repetitive Eating Questionnaire diagnostic interviews and a set of self-report measures assessing eating disorder symptomatology, grazing, depression, anxiety, and impulsive behavior. RESULTS: The P and R groups presented a similar trajectory for the percentage of total weight loss (%TWL) (ß = 1.46, standard error = 1.96; Wald χ2 = .55, P = .457) and weight regain (ß = 1.66, standard error = 2.72; Wald χ2 = .24, P = .622). No significant presurgery predictors of weight loss and weight regain were found for the P and R groups. Regarding postsurgery predictors, higher Eating Disorder Examination-Questionnaire scores (Wald χ2(1) = 6.88, P = .009) and grazing behavior (Wald χ2(1) = 8.30, P = .004) were associated with less %TWL for both groups. Belonging to the P group emerged as a significant predictor of more weight loss (Wald χ2(1) = 7.25, P = .007). Postsurgery anxiety predicted less %TWL in R group (Wald χ2(1) = 3.89, P = .043). Considering weight regain, higher postoperative disordered eating (global Eating Disorder Examination-Questionnaire; Wald χ2(1) = 4.66, P = .031) was associated with increased weight regain for the P and R groups. CONCLUSIONS: Problematic eating behaviors and psychological distress are significant predictors of poor weight outcomes for both groups.

Psychological, behavioral, and weight-related aspects of patients undergoing reoperative bariatric surgery after gastric band: comparison with primary surgery patients.

BACKGROUND: Patients experiencing insufficient weight loss or weight regain in their first bariatric surgery may represent a high-risk group with greater problematic eating and general psychopathology levels, which may compromise the success of a reoperative procedure. OBJECTIVES: This study seeks to describe and compare disordered eating-related psychological and behavioral features of primary and reoperative surgery candidates after gastric band. SETTING: Hospital center and university in Portugal. METHODS: The baseline (preoperative) data from a longitudinal observational study are presented. Patients were interviewed by trained psychologists to identify binge-eating episodes and grazing and responded to a set of self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. RESULTS: Two hundred twenty-five patients were undergoing primary surgery, and 166 were undergoing reoperative (REOP group) surgery. The groups did not differ in body mass index preoperatively, but the REOP group had greater weight suppression (t387 = -5.35, P = .001), higher highest (t387 = -3.40, P = .001) and lower lowest body mass index (t381 = 2.22, P = .03). The main reasons for reoperative surgery were weight regain/poor weight loss (42.8%) or medical complications (32.5%). REOP patients with objective binge eating reported a higher frequency of these episodes (t47 = 2.15, P = .04). No significant difference was found for the self-report measures assessed (only shape concern was higher for REOP group, F1,216 = 8.30, P<.001). CONCLUSIONS: Despite the preoperative similarities between patients undergoing reoperative or primary surgeries, the differences in binge eating and weight-related variables may associate with postoperative difficulties. The link between binge eating, weight suppression, and weight gain found in other samples suggests that patients undergoing reoperative surgery may be at increased risk for poor weight outcomes.

Psychological and Behavioral Aspects of Primary and Reoperative Surgery: a 6-Month Longitudinal Study.

BACKGROUND: Problematic eating behaviors and general psychopathology have been associated with poor weight loss after bariatric surgery. However, little is known about how these aspects impact weight loss outcomes for the increasing number of patients undergoing reoperative surgeries. This study compares disordered eating and weight-related outcomes before and 6 months after surgery in patients undergoing primary (P-Group) and reoperative bariatric surgery (R-Group). METHODS: This longitudinal study assessed 122 P-Group and 116 R-Group patients before and 6 months after surgery. The assessment included the eating disorder examination diagnostic items, and a set of self-report measures assessing eating disorder symptomatology, grazing, depression, anxiety, and negative urgency. RESULTS: Preoperatively, no differences were found between the R- and P-Groups in terms of disordered eating-related variables (except for shape concern, which was higher for the R-Group). At 6 months after surgery, the R-Group revealed significantly higher values for restraint (F(1,219) = 5.84, p = 0.016), shape (F(1,219) = 5.59, p = 0.019), weight concerns (F(1,219) = 13.36, p = 0.000), depression (F(1,219) = 7.17, p = 0.008), anxiety (F(1,219) = 6.94, p = - 0.009), and compulsive grazing (F(1,219) = 6.13, p = 0.014). No significant pre- or post-surgery predictors of weight loss were found for the P-Group (χ2 = 0.70, p = 0.872). In the R-Group, post-surgery anxiety (Waldχ2(1) = 6.19, p = 0.01) and the post-surgery number of days with grazing in the previous month (Waldχ2(1) = 3.90, p = 0.04) were significant predictors of weight loss. CONCLUSION: At 6 months after surgery, the R-Group presented more problematic eating and general psychological distress, which may put these patients at greater risk of poorer long-term weight outcomes.

Reoperative Bariatric Surgery: a Systematic Review of the Reasons for Surgery, Medical and Weight Loss Outcomes, Relevant Behavioral Factors.

Reoperative surgery following the failure of primary bariatric surgery is increasing due to the significant rates of patients experiencing poor weight loss or medical complications. This literature review was conducted to organize the emerging, but scattered, literature regarding the reasons for undergoing surgery, the best available options, the predictors of success, and the psychological characteristics of patients submitted to reoperative surgeries. Reoperative procedures are technically challenging, but the possible benefits of reoperation supplant the increased risks associated with these procedures. The etiology of reasons for undergoing a second surgery includes medical (e.g., fistula, ulcer disease) and behavioral aspects. Factors that may compromise outcomes have not been much studied. Particular attention should be paid to candidates with a history of difficulties in engaging in healthy eating patterns.

Correction to: Reoperative Bariatric Surgery: a Systematic Review of the Reasons for Surgery, Medical and Weight Loss Outcomes, and Relevant Behavioral Factors.

Eating and lifestyle behaviors, difficulty in embracing the required lifestyle changes, and reappearance of depressive and anxious symptoms have been associated with failure of weight loss or weight regain after primary surgeries. These aspects are further developed in the original manuscript.