Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Eating Pathology After Bariatric Surgery: an Updated Review of the Recent Literature


Purpose of Review

The goal of this paper was to extend the prior literature on eating pathology following bariatric surgery by highlighting themes in data published over the past 3 years and identifying limitations and future directions for research.

Recent Findings

Changes in eating pathology after bariatric surgery remain consistent with previous research. Specifically, diagnostic prevalence rates and incidence of related behaviors generally decrease following surgery. However, some research supports that these factors increase and/or remit over time following surgery, and that they subsequently have a negative impact on weight loss outcomes.


While recent findings have extended knowledge on eating pathology following bariatric surgery, the overall body of literature is still relatively limited. Additional research is needed, including work focusing on the standardization of eating pathology definitions, development/validation of standardized eating pathology instruments for bariatric surgery patients, and predictors of risk for continued or new onset eating pathology following surgery.

This is a preview of subscription content, log in to check access.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    American Psychiatric Association. DSM 5. Am J Psychiatry. 2013, 2013. https://doi.org/10.1176/appi.books.9780890425596.744053.

  2. 2.

    Opozda M, Chur-Hansen A, Wittert G. Changes in problematic and disordered eating after gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy: a systematic review of pre-post studies. Obes Rev. 2016;17:770–92.

  3. 3.

    Conceição EM, Utzinger LM, Pisetsky EM. Eating disorders and problematic eating behaviours before and after bariatric surgery: characterization, assessment and association with treatment outcomes. Eur Eat Disord Rev. 2015;23:417–25.

  4. 4.

    Marino JM, Ertelt TW, Lancaster K, Steffen K, Peterson L, de Zwaan M, et al. The emergence of eating pathology after bariatric surgery: a rare outcome with important clinical implications. Int J Eat Disord. 2012;45:179–84.

  5. 5.

    •• Devlin MJ, King WC, Kalarchian MA, Hinerman A, Marcus MD, Yanovski SZ, et al. Eating pathology and associations with long-term changes in weight and quality of life in the longitudinal assessment of bariatric surgery study. Int J Eat Disord. 2018;51:1322–30. The longest follow-up study to date regarding changes in multiple aspects of eating pathology following bariatric surgery.

  6. 6.

    •• Kalarchian MA, King WC, Devlin MJ, Hinerman A, Marcus MD, Yanovski SZ, et al. Mental disorders and weight change in a prospective study of bariatric surgery patients: 7 years of follow-up. Surg Obes Relat Dis. 2019. https://doi.org/10.1016/j.soard.2019.01.008. The longest follow-up and most comprehensive study to date of mental health disorders among bariatric surgery candidates.

  7. 7.

    •• Smith KE, Orcutt M, Steffen KJ, Crosby RD, Cao L, Garcia L, et al. Loss of control eating and binge eating in the 7 years following bariatric surgery. Obes Surg. 2019:1–8. A study with the largest sample size to date examining relationships between key aspects of eating pathology and changes in weight following bariatric surgery.

  8. 8.

    Morseth MS, Hanvold SE, Rø Ø, Risstad H, Mala T, Benth JŠ, et al. Self-reported eating disorder symptoms before and after gastric bypass and duodenal switch for super obesity — a 5-year follow-up study. Obes Surg. 2016;26:588–94.

  9. 9.

    • Goldschmidt AB, Khoury J, Jenkins TM, Bond DS, Thomas JG, Utzinger LM, et al. Adolescent loss-of-control eating and weight loss maintenance after bariatric surgery. Pediatrics. 2018;141:e20171659. An important study among the Teen-LABS cohort examining changes in eating pathology and associations with weight loss following bariatric surgery for adolescents.

  10. 10.

    Devlin MJ, King WC, Kalarchian MA, White GE, Marcus MD, Garcia L, et al. Eating pathology and experience and weight loss in a prospective study of bariatric surgery patients: 3-year follow-up. Int J Eat Disord. 2016;49:1058–67.

  11. 11.

    Kalarchian MA, King WC, Devlin MJ, Marcus MD, Garcia L, Chen J-Y, et al. Psychiatric disorders and weight change in a prospective study of bariatric surgery patients: a 3-year follow-up. Psychosom Med. 2016;78:373–81.

  12. 12.

    Schäfer L, Hübner C, Carus T, Herbig B, Seyfried F, Kaiser S, et al. Pre- and postbariatric subtypes and their predictive value for health-related outcomes measured 3 years after surgery. Obes Surg. 2019;29:230–8.

  13. 13.

    • Nasirzadeh Y, Kantarovich K, Wnuk S, Okrainec A, Cassin SE, Hawa R, et al. Binge eating, loss of control over eating, emotional eating, and night eating after bariatric surgery: results from the Toronto Bari-PSYCH cohort study. Obes Surg. 2018;28:2032–9. A large non-U.S. cohort study demonstrating changes in various aspects of eating pathology after bariatric surgery.

  14. 14.

    Pinto TF, Carvalhedo de Bruin PF, Sales de Bruin VM, Ney Lemos F, Azevedo Lopes FH, Marcos Lopes P. Effects of bariatric surgery on night eating and depressive symptoms: a prospective study. Surg Obes Relat Dis. 2017;13:1057–62.

  15. 15.

    Conceição EM, Mitchell JE, Pinto-Bastos A, Arrojado F, Brandão I, Machado PPP. Stability of problematic eating behaviors and weight loss trajectories after bariatric surgery: a longitudinal observational study. Surg Obes Relat Dis. 2017;13:1063–70.

  16. 16.

    Ruffault A, Vaugeois F, Barsamian C, Lurbe i Puerto K, le Quentrec-Creven G, Flahault C, et al. Associations of lifetime traumatic experience with dysfunctional eating patterns and postsurgery weight loss in adults with obesity: a retrospective study. Stress Health. 2018;34:446–56.

  17. 17.

    • Figura A, Rose M, Ordemann J, Klapp BF, Ahnis A. Changes in self-reported eating patterns after laparoscopic sleeve gastrectomy: a pre-post analysis and comparison with conservatively treated patients with obesity. Surg Obes Relat Dis. 2017;13:129–37. The only study included in the current review which examined changes in aspects of eating pathology among an entire sample of patients receiving VSG surgery.

  18. 18.

    Luiz LB, Brito CL de S, Debon LM, Brandalise LN, de AJT, Monbach KD, et al. Variation of binge eating one year after Roux-en-Y gastric bypass and its relationship with excess weight loss. PLoS One. 2016;11:e0167577.

  19. 19.

    Sarwer DB, Dilks RJ, Spitzer JC, et al. Changes in dietary intake and eating behavior in adolescents after bariatric surgery: an ancillary study to the Teen-LABS consortium. Obes Surg. 2017;27:3082–91.

  20. 20.

    Peterhänsel C, Linde K, Wagner B, Dietrich A, Kersting A. Subtypes of personality and ‘locus of control’ in bariatric patients and their effect on weight loss, eating disorder and depressive symptoms, and quality of life. Eur Eat Disord Rev. 2017;25:397–405.

  21. 21.

    Pinto-Bastos A, Conceição E, de Lourdes M, Arrojado F, Brandão I, Machado PPP. Psychological and behavioral aspects of primary and reoperative surgery: a 6-month longitudinal study. Obes Surg. 2018;28:3984–91.

  22. 22.

    Stone AA, Shiffman S. Ecological momentary assessment (EMA) in behavioral medicine. Ann Behav Med. 1994;16:199–202.

  23. 23.

    Engel SG, Crosby RD, Thomas G, Bond D, Lavender JM, Mason T, et al. Ecological momentary assessment in eating disorder and obesity research: a review of the recent literature. Curr Psychiatry Rep. 2016;18:37.

  24. 24.

    Meany G, Conceição EM, Mitchell JE. Binge eating, binge eating disorder and loss of control eating: effects on weight outcomes after bariatric surgery. Eur Eat Disord Rev. 2014;22:87–91.

  25. 25.

    Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22:70–89.

  26. 26.

    Kinzl J, Schrattenecker M, Traweger C, Mattesich M, Fiala M, Biebl W. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;16:1609–14.

  27. 27.

    van Hout GCM, Verschure SKM, Van Heck GL. Psychosocial predictors of success following bariatric surgery. Obes Surg. 2005;15:552–60.

  28. 28.

    Sarwer DB, Dilks RJ, West-Smith L. Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success. Surg Obes Relat Dis. 2011;7:644–51.

  29. 29.

    Mechanick J, Youdim A, Jones D, Garvey WT, Hurley DL, McMahon M, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by american association of clinical endocrinologists, the obesity society, and American society fo. Obesity. 2013;21:S1–S27. https://doi.org/10.1002/oby.20461.

  30. 30.

    Segal A, Kinoshita Kussunoki D, Aparecida Larino M. Post-surgical refusal to eat: anorexia nervosa, bulimia nervosa or a new eating disorder? A case series. Obes Surg. 2004;14:353–60.

  31. 31.

    Deitel M. Anorexia nervosa following bariatric surgery. Obes Surg. 2002;12:729–30.

  32. 32.

    Scioscia TN, Bulik CM, Levenson J, Kirby DF. Anorexia nervosa in a 38-year-old woman 2 years after gastric bypass surgery. Psychosomatics. 1999;40:86–8.

  33. 33.

    Conceição EM, Orcutt M, Mitchell J, Engel S, LaHaise K, Jorgensen M, et al. Eating disorders after bariatric surgery: a case series. Int J Eat Disord. 2013;46:274–9.

  34. 34.

    de Zwaan M, Hilbert A, Swan-Kremeier L, Simonich H, Lancaster K, Howell LM, et al. Comprehensive interview assessment of eating behavior 18–35 months after gastric bypass surgery for morbid obesity. Surg Obes Relat Dis. 2010;6:79–85.

  35. 35.

    Halliday TA, Sundqvist J, Hultin M, Walldén J. Post-operative nausea and vomiting in bariatric surgery patients: an observational study. Acta Anaesthesiol Scand. 2017;61:471–9.

  36. 36.

    Kalarchian MA, King WC, Devlin MJ, White GE, Marcus MD, Garcia L, et al. Surgery-related gastrointestinal symptoms in a prospective study of bariatric surgery patients: 3-year follow-up. Surg Obes Relat Dis. 2017;13:1562–71.

  37. 37.

    Niego SH, Kofman MD, Weiss JJ, Geliebter A. Binge eating in the bariatric surgery population: a review of the literature. Int J Eat Disord. 2007;40:349–59.

  38. 38.

    Wimmelmann CL, Dela F, Mortensen EL. Psychological predictors of weight loss after bariatric surgery: a review of the recent research. Obes Res Clin Pract. 2014;8:e299–313.

  39. 39.

    Mond JM, Latner JD, Hay PH, Owen C, Rodgers B. Objective and subjective bulimic episodes in the classification of bulimic-type eating disorders: another nail in the coffin of a problematic distinction. Behav Res Ther. 2010;48:661–9.

  40. 40.

    Goldschmidt AB, Conceição EM, Thomas JG, Mitchell JE, Raynor HA, Bond DS. Conceptualizing and studying binge and loss of control eating in bariatric surgery patients—time for a paradigm shift? Surg Obes Relat Dis. 2016;12:1622–5.

  41. 41.

    Scholtz S, Bidlake L, Morgan J, Fiennes A, El-Etar A, Lacey JH, et al. Long-term outcomes following laparoscopic adjustable gastric banding: postoperative psychological sequelae predict outcome at 5-year follow-up. Obes Surg. 2007;17:1220–5.

  42. 42.

    White MA, Kalarchian MA, Masheb RM, Marcus MD, Grilo CM. Loss of control over eating predicts outcomes in bariatric surgery patients: a prospective, 24-month follow-up study. J Clin Psychiatry. 2010;71:175–84.

  43. 43.

    Conceição EM, Mitchell JE, Vaz AR, Bastos AP, Ramalho S, Silva C, et al. The presence of maladaptive eating behaviors after bariatric surgery in a cross sectional study: importance of picking or nibbling on weight regain. Eat Behav. 2014;15:558–62.

  44. 44.

    Allison KC, Wadden TA, Sarwer DB, Fabricatore AN, Crerand CE, Gibbons LM, et al. Night eating syndrome and binge eating disorder among persons seeking bariatric surgery: prevalence and related features. Obesity. 2006;14:77S–82S.

  45. 45.

    Mitchell JE, King WC, Courcoulas A, Dakin G, Elder K, Engel S, et al. Eating behavior and eating disorders in adults before bariatric surgery. Int J Eat Disord. 2015;48:215–22.

  46. 46.

    Colles S, Dixon J. Night eating syndrome: impact on bariatric surgery. Obes Surg. 2006;16:811–20.

  47. 47.

    Adami GF, Meneghelli A, Scopinaro N. Night eating and binge eating disorder in obese patients. Int J Eat Disord. 1999;25:335–8.

  48. 48.

    Hsu LKG, Benotti PN, Dwyer J, Roberts SB, Saltzman E, Shikora S, et al. Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med. 1998;60:338–46.

  49. 49.

    Hsu LKG, Betancourt S, Sullivan SP. Eating disturbances before and after vertical banded gastroplasty: a pilot study. Int J Eat Disord. 1996;19:23–34.

  50. 50.

    Novelli IR, Fonseca LG, Gomes DL, Dutra ES, Baiocchi de Carvalho KM. Emotional eating behavior hinders body weight loss in women after Roux-en-Y gastric bypass surgery. Nutrition. 2018;49:13–6.

  51. 51.

    Mitchell JE, Christian NJ, Flum DR, Pomp A, Pories WJ, Wolfe BM, et al. Postoperative behavioral variables and weight change 3 years after bariatric surgery. JAMA Surg. 2016;151:752–7.

  52. 52.

    Saunders R. “Grazing”: a high-risk behavior. Obes Surg. 2004;14:98–102.

  53. 53.

    Colles SL, Dixon JB, O’Brien PE. Grazing and loss of control related to eating: two high-risk factors following bariatric surgery. Obesity. 2008;16:615–22.

  54. 54.

    Conceição EM, Crosby R, Mitchell JE, Engel SG, Wonderlich SA, Simonich HK, et al. Picking or nibbling: frequency and associated clinical features in bulimia nervosa, anorexia nervosa, and binge eating disorder. Int J Eat Disord. 2013;46:815–8.

  55. 55.

    Conceição EM, Mitchell JE, Engel SG, Machado PPP, Lancaster K, Wonderlich SA. What is “grazing”? Reviewing its definition, frequency, clinical characteristics, and impact on bariatric surgery outcomes, and proposing a standardized definition. Surg Obes Relat Dis. 2014;10:973–82.

  56. 56.

    Conceição EM, Mitchell JE, Machado PPP, Vaz AR, Pinto-Bastos A, Ramalho S, et al. Repetitive eating questionnaire [Rep(eat)-Q]: enlightening the concept of grazing and psychometric properties in a Portuguese sample. Appetite. 2017;117:351–8.

  57. 57.

    Berg P, McCallum R. Dumping syndrome: a review of the current concepts of pathophysiology, diagnosis, and treatment. Dig Dis Sci. 2016;61:11–8.

  58. 58.

    Malik S, Mitchell JE, Steffen K, Engel S, Wiisanen R, Garcia L, et al. Recognition and management of hyperinsulinemic hypoglycemia after bariatric surgery. Obes Res Clin Pract. 2016;10:1–14.

  59. 59.

    Aouad P, Hay P, Soh N, Touyz S. Prevalence of chew and spit and its relation to other features of disordered eating in a community sample. Int J Eat Disord. 2018;51:968–72.

  60. 60.

    Aouad P, Hay P, Soh N, Touyz S. Chew and spit (CHSP): a systematic review. J Eat Disord. 2016;4:23.

  61. 61.

    Cooper Z, Fairburn C. The eating disorder examination: a semi-structured interview for the assessment of the specific psychopathology of eating disorders. Int J Eat Disord. 1987;6:1–8.

  62. 62.

    Parker K, Brennan L. Measurement of disordered eating in bariatric surgery candidates: a systematic review of the literature. Obes Res Clin Pract. 2015;9:12–25.

  63. 63.

    ASMBS (2018) Estimate of bariatric surgery numbers, 2011-2017.

Download references

Author information

Correspondence to Gail A. Williams-Kerver.

Ethics declarations

Conflict of Interest

Gail A. Williams-Kerver reports a grant from National Institute of Mental Health (T32 MH082761).

Kristine Steffen reports grants from Sanford Profile/NDSU Grants, NIH, and Shire Pharmaceuticals.

James E. Mitchell reports Longitudinal Assessment of Bariatric Surgery (LABS) Study; Grant/Award Number U01-DK66471 from National Institute of Diabetes and Digestive and Kidney Diseases.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Eating Disorders

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Williams-Kerver, G.A., Steffen, K.J. & Mitchell, J.E. Eating Pathology After Bariatric Surgery: an Updated Review of the Recent Literature. Curr Psychiatry Rep 21, 86 (2019). https://doi.org/10.1007/s11920-019-1071-7

Download citation


  • Bariatric surgery
  • Eating pathology
  • Eating disorders
  • Eating behaviors
  • Weight loss outcomes