The effects of bariatric surgery on psychological aspects of eating behaviour and food intake in humans.

Bariatric surgery has emerged as an increasingly popular weight loss intervention, with larger and more endurable weight loss compared to pharmacological and behavioural interventions. The degree of weight loss patients experience varies, between individuals, surgeries and over time. An explanation as to why differing weight loss trajectories exist post-surgery could be due to the complex interplay of individual differences in relation to eating behaviours and appetite. Thus the aim of this narrative review is to explore literature between 2008 and 2018, to assess the impact of impact of bariatric surgery on food selection and nutrient status, on eating behaviour traits and on disturbed and disordered eating behaviour, to determine their impact of weight loss success and weight loss trajectories. Immediately post-surgery, up until 1-2 years post-surgery, there is a reliance upon the surgery's alteration of the gastrointestinal tract to control food intake and subsequently lose weight. Energy intake is reduced, dietary adherence is higher, supplement intake is higher, appetite ratings are lower, there is a reduction in psychopathology, and an increase in wellbeing. After this point, patients become more susceptible to weight regain, as this is the point where passive observation of the weight reducing action of surgery, moves into more cognitive effort, on the part of the individual, to control energy intake. There are various factors which influence an individual's ability to successfully regulate their energy intake post-surgery, such as their level of Disinhibition, Restraint, Hunger, Emotional Eating, Uncontrolled Eating, psychopathology and wellbeing. The need for continued psychological and nutritional support post-surgery is necessary to reduce weight regain susceptibility.

Psycho-markers of weight loss. The roles of TFEQ Disinhibition and Restraint in exercise-induced weight management.

Eating behaviour traits, namely Disinhibition and Restraint, have the potential to exert an effect on food intake and energy balance. The effectiveness of exercise as a method of weight management could be influenced by these traits. Fifty eight overweight and obese participants completed 12-weeks of supervised exercise. Each participant was prescribed supervised exercise based on an expenditure of 500 kcal/session, 5d/week for 12-weeks. Following 12-weeks of exercise there was a significant reduction in mean body weight (-3.26±3.63 kg), fat mass (FM: -3.26±2.64 kg), BMI (-1.16±1.17 kg/m(2)) and waist circumference (WC: -5.0±3.23 cm). Regression analyses revealed a higher baseline Disinhibition score was associated with a greater reduction in BMI and WC, while Internal Disinhibition was associated with a larger decrease in weight, %FM and WC. Neither baseline Restraint or Hunger were associated with any of the anthropometric markers at baseline or after 12-weeks. Furthermore, after 12-weeks of exercise, a decrease in Disinhibition and increase in Restraint were associated with a greater reduction in WC, whereas only Restraint was associated with a decrease in weight. Post-hoc analysis of the sub-factors revealed a decrease in External Disinhibition and increase in Flexible Restraint were associated with weight loss. However, an increase in Rigid Restraint was associated with a reduction in %FM and WC. These findings suggest that exercise-induced weight loss is more marked in individuals with a high level of Disinhibition. These data demonstrate the important roles that Disinhibition and Restraint play in the relationship between exercise and energy balance.

Interaction between disinhibition and restraint: Implications for body weight and eating disturbance.

An increase in obesity is usually accompanied by an increase in eating disturbances. Susceptibility to these states may arise from different combinations of underlying traits: Three Factor Eating Questionnaire (TFEQ) Restraint and Disinhibition. Two studies were conducted to examine the interaction between these traits; one on-line study (n=351) and one laboratory-based study (n=120). Participants completed a battery of questionnaires and provided self-report measures of body weight and physical activity. A combination of high Disinhibition and high Restraint was associated with a problematic eating behaviour profile (EAT-26), and a higher rate of smoking and alcohol consumption. A combination of high Disinhibition and low Restraint was associated with a higher susceptibility to weight gain and a higher sedentary behaviour. These data show that different combinations of Disinhibition and Restraint are associated with distinct weight and behaviour outcomes.

Disinhibition: its effects on appetite and weight regulation.

Over the past 30 years, the understanding of eating behaviour has been dominated by the concept of dietary restraint. However, the development of the Three Factor Eating Questionnaire introduced two other factors, Disinhibition and Hunger, which have not received as much recognition in the literature. The objective of this review was to explore the relationship of the Disinhibition factor with weight regulation, food choice and eating disorders, and to consider its aetiology. The review indicates that Disinhibition is an important eating behaviour trait. It is associated not only with a higher body mass index and obesity, but also with mediating variables, such as less healthful food choices, which contribute to overweight/obesity and poorer health. Disinhibition is also implicated in eating disorders and contributes to eating disorder severity. It has been demonstrated that Disinhibition is predictive of poorer success at weight loss, and of weight regain after weight loss regimes and is associated with lower self-esteem, low physical activity and poor psychological health. Disinhibition therefore emerges as an important and dynamic trait, with influences that go beyond eating behaviour and incorporate other behaviours which contribute to weight regulation and obesity. The characteristics of Disinhibition itself therefore reflect many components representative of a thrifty type of physiology. We propose that the trait of Disinhibition be more appropriately renamed as 'opportunistic eating' or 'thrifty behaviour'.