Obesity Surgery

, 17:445 | Cite as

Eating Behavior as a Prognostic Factor for Weight Loss after Gastric Bypass

  • Paulo C. SalletEmail author
  • José A. Sallet
  • John B. Dixon
  • Eliane Collis
  • Carlos E. Pisani
  • Andréa Levy
  • Fábio L. Bonaldi
  • Taki A. Cordás


Binge-eating disorder (BED) may be associated with unsatisfactory weight loss in obese patients submitted to bariatric procedures.This study aims to investigate whether the presence of binge eating before Roux-en-Y gastric bypass (RYGBP) influences weight outcomes.


In a prospective design, 216 obese patients (37 males, 178 females, BMI––5.9 ±–.0 kg/m2) were assessed for the lifetime prevalence of BED and classified at structured interview into 3 subgroups: no binge eating (NBE––3), sub-threshold binge eating (SBE––29), and binge-eating disorder (BED––4). All patients were encouraged to take part in a multidisciplinary program following surgery, and weight loss at follow-up was used as the outcome variable.


At 1-year follow-up, NBE patients (n––1) showed percent excess BMI loss (%EBL) significantly higher than SBE patients (n––12) (P––.027), although this effect was not significantly different between NBE and BED patients (n––4). At 2-year follow-up, NBE patients (n––3) showed %EBL higher than SBE (n––4) (P––.003) and BED patients (n––4) (P–lt;–.001). Nevertheless, we found no significant weight loss differences between SBE (subclinical) and BED (full criteria) patients at any period of followup. Preliminary results at 3-year follow-up suggest that such an effect may be enduring.


The presence of a history of binge eating prior to treatment is associated with poorer weight loss in obese patients submitted to RYGBP. Because BED is highly prevalent in obese patients seeking bariatric surgery, its early recognition and treatment may be of important clinical value.

Key words

Binge-eating disorder eating behavior morbid obesity bariatric surgery weight loss Roux-en-Y gastric bypass 


  1. 1.
    Stunkard AJ. Eating patterns and obesity. Psych Quarterly 1959; 33: 284–5.CrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington 1994: 729–1.Google Scholar
  3. 3.
    Dymek-Valentine M, Rienecke-Hoste R, Alverdy J. Assessment of binge eating disorder in morbidly obese patients evaluated for gastric bypass: SCID versus QEWP-R. Eat Weight Disord 2004; 9: 211–.PubMedGoogle Scholar
  4. 4.
    Adami GF, Gandolfo P, Bauer B et al. Binge eating in massively obese patients undergoing bariatric surgery. Int J Eat Disord 1995; 17: 45–0.CrossRefPubMedGoogle Scholar
  5. 5.
    Powers PS, Perez A, Boyd F et al. Eating pathology before and after bariatric surgery: a prospective study. Int J Eat Disord 1999; 25: 293–00.CrossRefPubMedGoogle Scholar
  6. 6.
    Saunders R. Binge eating in gastric bypass patients before surgery. Obes Surg 1999; 9: 72–.CrossRefPubMedGoogle Scholar
  7. 7.
    Lang T, Hauser R, Buddeberg C et al. Impact of gastric banding on eating behavior and weight. Obes Surg 2002; 12: 100–.CrossRefPubMedGoogle Scholar
  8. 8.
    Striegel-Moore RH, Franko DL. Epidemiology of binge eating disorder. Int J Eat Disord 2003; 34: S19–S29.CrossRefPubMedGoogle Scholar
  9. 9.
    Hsu LKG, Benotti PN, Dwyer J et al. Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med 1998; 60: 338–6.PubMedGoogle Scholar
  10. 10.
    Saunders R. “Grazing– a high-risk behavior. Obes Surg 2004; 14: 98–02.CrossRefPubMedGoogle Scholar
  11. 11.
    van Hout GCM, Verschure SKM, van Heck GL. Psychosocial predictors of success following bariatric surgery. Obes Surg 2005; 15: 552–0.CrossRefPubMedGoogle Scholar
  12. 12.
    Guisado Macias JA, Vaz Leal FJ. Psychopathological differences between morbidly obese binge eaters and non-binge eaters after bariatric surgery. Eat Weight Disord 2003; 8: 315–.PubMedGoogle Scholar
  13. 13.
    Green AE, Dymek-Valentine M, Pytluk S et al. Psychosocial outcome of gastric bypass surgery for patients with and without binge eating. Obes Surg 2004; 14: 975–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Pekkarinen T, Koskela K, Huikuri K et al. Long-term results of gastroplasty for morbid obesity: Binge-eating as a predictor of poor outcome. Obes Surg 1994; 4: 248–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Kalarchian MA, Marcus MD, Wilson GT et al. Binge eating among gastric bypass patients at long-term follow-up. Obes Surg 2002; 12: 270–.CrossRefPubMedGoogle Scholar
  16. 16.
    Larsen JK, van Ramshorst B, Geenen R et al. Binge eating and its relationship to outcome after laparoscopic adjustable gastric banding. Obes Surg 2004; 14: 1111–.CrossRefPubMedGoogle Scholar
  17. 17.
    Busetto L, Segato G, De Marchi F et al. Outcome predictors in morbidly obese recipients of an adjustable gastric band. Obes Surg 2002; 12: 83–2.CrossRefPubMedGoogle Scholar
  18. 18.
    Burgmer R, Grigutsch K, Zipfel S et al. The influence of eating behavior and eating pathology on weight loss after gastric restriction operations. Obes Surg 2005; 15: 684–1.CrossRefPubMedGoogle Scholar
  19. 19.
    Bocchieri-Ricciardi LE, Chen EY, Munoz D et al. Pre-surgery binge eating status: effect on eating behavior and weight outcome after gastric bypass. Obes Surg 2006; 16: 1198–04.CrossRefPubMedGoogle Scholar
  20. 20.
    Cooper PJ, Taylor M, Cooper Z et al. The development and validation of the body shape questionnaire. Int J Eat Dis 1987; 6: 485–4.CrossRefGoogle Scholar
  21. 21.
    Beck AT, Ward CH, Mendelson M et al. Inventory for measuring depression. Arch Gen Psychiatr 1961; 4: 53–3.Google Scholar
  22. 22.
    Hamilton, M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32: 50–.PubMedGoogle Scholar
  23. 23.
    First MB, Spitzer RL, Gibbon M et al. Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition (SCID-P), version 2. New York State Psychiatric Institute, Biometric Research 1996.Google Scholar
  24. 24.
    Deitel M, Greenstein RJ. Recommendations for reporting weight loss. Obes Surg 2003; 13: 159–0.CrossRefPubMedGoogle Scholar
  25. 25.
    Yanovski SZ, Nelson JE, Dubbert BK et al. Association of binge eating disorder and psychiatric comorbidity in obese subjects. Am J Psychiatry 1993; 150: 1472–.PubMedGoogle Scholar
  26. 26.
    Bulik CM, Sullivan PF, Kendler KS. Medical and psychiatric morbidity in obese women with and without binge eating. Int J Eat Disord 2002; 32: 72–.CrossRefPubMedGoogle Scholar
  27. 27.
    Stunkard AJ, Allison KC. Binge eating disorder: disorder or marker? Int J Eat Disord 2003; 34: S107–S116.CrossRefPubMedGoogle Scholar
  28. 28.
    Greenberg I, Perna F, Kaplan M et al. Behavioral and psychological factors in the assessment and treatment of obesity surgery patients. Obes Res 2005; 13: 244–.CrossRefPubMedGoogle Scholar
  29. 29.
    Dixon JB, Dixon ME, O’Brien PE. Depression in association with severe obesity: Changes with weight loss. Arch Intern Med 2003; 163: 2058–5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Paulo C. Sallet
    • 1
    • 2
    • 4
    Email author
  • José A. Sallet
    • 2
  • John B. Dixon
    • 3
  • Eliane Collis
    • 2
  • Carlos E. Pisani
    • 2
  • Andréa Levy
    • 2
  • Fábio L. Bonaldi
    • 2
  • Taki A. Cordás
    • 1
  1. 1.Department and Institute of Psychiatry, Faculty of MedicineUniversity of São PauloSão PauloBrazil
  2. 2.Sallet ClinicSão PauloBrazil
  3. 3.Centre for Obesity Research and EducationMonash UniversityMelbourneAustralia
  4. 4.Institute of Psychiatry, Faculty of MedicineUniversity of São PauloSão PauloBrazil

Personalised recommendations