Changes in Dietary Intake and Eating Behavior in Adolescents After Bariatric Surgery: an Ancillary Study to the Teen-LABS Consortium

  • David B. Sarwer
  • Rebecca J. Dilks
  • Jacqueline C. Spitzer
  • Robert I. Berkowitz
  • Thomas A. Wadden
  • Renee H. Moore
  • Jesse L. Chittams
  • Mary L. Brandt
  • Mike K. Chen
  • Anita P. Courcoulas
  • Carroll M. Harmon
  • Michael A. Helmrath
  • Marc P. Michalsky
  • Stavra A. Xanthakos
  • Meg H. Zeller
  • Todd M. Jenkins
  • Thomas H. Inge
Original Contributions

Abstract

Background

A growing number of studies suggest that bariatric surgery is safe and effective for adolescents with severe obesity. However, surprisingly little is known about changes in dietary intake and eating behavior of adolescents who undergo bariatric surgery.

Objective

Investigate changes in dietary intake and eating behavior of adolescents with obesity who underwent bariatric surgery (n = 119) or lifestyle modification (LM) (n = 169).

Setting

University-based health systems

Methods

A prospective investigation of 288 participants (219 female and 69 male) prior to bariatric surgery or LM and again 6, 12, and 24 months (surgery patients only) after treatment. Measures included changes in weight, macronutrient intake, eating behavior, and relevant demographic and physiological variables.

Results

Adolescents who underwent bariatric surgery experienced significantly greater weight loss than those who received LM. The two groups differed in self-reported intake of a number of macronutrients at 6 and 12 months from baseline, but not total caloric intake. Patients treated with surgery, compared to those treated with LM, also reported significantly greater reductions in a number of disordered eating symptoms. After bariatric surgery, greater weight loss from postoperative month 6 to 12 was associated with self-reported weight consciousness, craving for sweets, and consumption of zinc.

Conclusions

Adolescents who underwent bariatric surgery, compared to those who received LM, reported significantly greater reductions in weight after 1 year. They also reported greater reductions in disordered eating symptoms. These findings provide new information on changes in dietary intake and eating behavior among adolescents who undergo bariatric surgery.

Keywords

Bariatric surgery Adolescence Caloric intake Dietary restraint Hunger disinhibition 

References

  1. 1.
    Ogden CL, Carroll MD, Kit BK, et al. Prevalence and trends in body mass index among US children and adolescents 1999-2010. JAMA. 2012;307(5):483–90.CrossRefPubMedGoogle Scholar
  2. 2.
    Daniels SR, Arnett DK, Eckel RH, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation. 2005;111(15).Google Scholar
  3. 3.
    Zeller MH, Inge TH, Modi AC, et al. Severe obesity and comorbid condition impact on the weight-related quality of life of the adolescent patient. J Pediatr. 2015;166(3):651–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Sarwer DB, Dilks RJ. Invited commentary: childhood and adolescent obesity: psychological and behavioral issues in weight loss treatment. J Youth Adolesc. 2012;41(1):98–104.CrossRefPubMedGoogle Scholar
  5. 5.
    Sarwer DB, Womble LG, Berkowitz RI. Behavioral treatment of obesity. In: Gumbiner B, editor. Obesity. Philadelphia: American College of Physicians; 2001. p. 179–95.Google Scholar
  6. 6.
    Sarwer DB, Butryn ML, Forman E, et al. Lifestyle modification for the treatment of obesity. In: Still CD, Sarwer DB, Blankenship J, editors. The ASMBS Textbook of bariatric surgery. Volume 2: integrative health. New York: Springer; 2014. p. 147–55.Google Scholar
  7. 7.
    Mechanick JI, Youdim A, Jones DB, 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 for Metabolic Bariatric Surgery. Surg Obes Relat dis. 2013;9(2):159–91.CrossRefPubMedGoogle Scholar
  8. 8.
    Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. NEJM. 2016;374(2):113–23.CrossRefPubMedGoogle Scholar
  9. 9.
    Inge TH, Zeller MH, Jenkins TM, et al. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr. 2014;168(1):47–53.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Olbers T, Gronowitz E, Werling M, et al. Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS). Int J Obes. 2012;36(11):1388–95.CrossRefGoogle Scholar
  11. 11.
    Sarwer DB, Lavery M, Spitzer JC. A review of the relationships between extreme obesity, quality of life, and sexual function. Obes Surg. 2012;22(4):668–76.CrossRefPubMedGoogle Scholar
  12. 12.
    Sarwer DB, Dilks RJ, Ritter S, et al. Psychosocial considerations of the bariatric surgery patient. In: Herron DM, Sheiner D, editors. Insights into bariatric surgery, postoperative care and pregnancy. New York: Nova Science Publishers; 2013. p. 27–48.Google Scholar
  13. 13.
    Herpertz S, Kielmann R, Wolf AM, et al. Does obesity surgery improve psychosocial functioning? A systematic review. Int J Obes Relat Metab Disord. 2003;27(11):1300–14.CrossRefPubMedGoogle Scholar
  14. 14.
    Sarwer DB, Allison KC, Bailer BA, et al. Psychosocial characteristics of bariatric surgery candidates. In: Still CD, Sarwer DB, Blankenship J, editors. The ASMBS Textbook of bariatric surgery. Volume 2: integrative health. New York: Springer; 2014. p. 3–9.Google Scholar
  15. 15.
    van Hout GC, van Oudheusden I, van Heck GL. Psychological profile of the morbidly obese. Obes Surg. 2004;14(5):579–88.CrossRefPubMedGoogle Scholar
  16. 16.
    Sarwer DB, Wadden TA, Moore RH, et al. Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat dis. 2008;4(5):640–6.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Sarwer DB, Moore RH, Spitzer JC, et al. A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery. Surg Obes Relat dis. 2012;8(5):561–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J med. 2004;351(26):2683–93.CrossRefPubMedGoogle Scholar
  19. 19.
    Colles SL, Dixon JB, O'Brien PE. Hunger control and regular physical activity facilitate weight loss after laparoscopic adjustable gastric banding. Obes Surg. 2008;18(7):833–40.CrossRefPubMedGoogle Scholar
  20. 20.
    Allison KC, Wadden TA, Sarwer DB, et al. Night eating syndrome and binge eating disorder among persons seeking bariatric surgery: prevalence and related features. Obesity. 2006;14(Suppl 2):77S–82S.CrossRefPubMedGoogle Scholar
  21. 21.
    de Zwaan M, Mitchell JE, Howell LM, et al. Characteristics of morbidly obese patients before gastric bypass surgery. Compr Psychiatry. 2003;44(5):428–34.CrossRefPubMedGoogle Scholar
  22. 22.
    Hsu LK, Betancourt S, Sullivan SP. Eating disturbances before and after vertical banded gastroplasty: a pilot study. Int J eat Disord. 1996;19(1):23–34.CrossRefPubMedGoogle Scholar
  23. 23.
    Kalarchian MA, Marcus MD, Wilson GT, et al. Binge eating among gastric bypass patients at long-term follow-up. Obes Surg. 2002;12(2):270–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Chao AM, Wadden TA, Faulconbridge LF, et al. Binge-eating disorder and the outcome of bariatric surgery in a prospective, observational study: two-year results. Obesity. 2016;4(11):2327–233.CrossRefGoogle Scholar
  25. 25.
    Kim RJ, Langer JM, Baker AW, et al. Psychosocial status in adolescents undergoing bariatric surgery. Obes Surg. 2008;18(1):27–33.CrossRefPubMedGoogle Scholar
  26. 26.
    Inge TH, Zeller M, Harmon C, et al. Teen-Longitudinal Assessment of Bariatric Surgery: methodological features of the first prospective multicenter study of adolescent bariatric surgery. J Pediatr Surg. 2007;42(11):1969–71.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Widhalm K, Fritsch M, Wildhalm H, et al. Bariatric surgery in morbidly obese adolescents: long-term follow-up. Int J Pediatr Obes. 2011;6:65–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Johnson A, Reddy S, Walsh S, et al. The relationship between diet of adolescents before sleeve gastrectomy and success with weight loss and behavioral changes six months postsurgery. Bariatric Surgical Practice and Patient Care. 2016;11(1):15–9.CrossRefGoogle Scholar
  29. 29.
    Utzinger LM, Gowey MA, Zeller M, et al. Loss of control eating and eating disorders in adolescents before bariatric surgery. Int J eat dis. 2016;49(10):947–52.CrossRefGoogle Scholar
  30. 30.
    Cushing CC, Peugh JL, Brode CS, et al. Longitudinal trends in food cravings following Roux-en-Y gastric bypass in an adolescent sample. Surg Obes Relat dis. 2015;11(1):14–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Berkowitz RI, Rukstalis MR, Bishop-Gilyard CT, et al. Treatment of adolescent obesity comparing self-guided and group lifestyle modification programs: a potential model for primary care. J Pediatr Psych. 2013;38(9):978–86.CrossRefGoogle Scholar
  32. 32.
    Stefater MA, Jenkins T, Inge TH. Bariatric surgery for adolescents. Pediatr Diabetes. 2013;14(1):1–12.CrossRefPubMedGoogle Scholar
  33. 33.
    Michalsy MP, Inge TH, Teich S, et al. Adolscent bariatric surgery program characteristics: the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study experience. Semin Pediatr Surg. 2014;23(1):5–10.CrossRefGoogle Scholar
  34. 34.
    Dixon L. The Minnesota Nutrition Data System: A tool designed by researchers for researchers. In: Society for Nutrition Education; 1996; 1996.Google Scholar
  35. 35.
    Modi AC, Zeller MH, Xanthakos SA, et al. Adherence to vitamin supplementation following adolescent bariatric surgery. Obesity. 2013;21(3):E190–5.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Stunkard AJ, Messick S. Eating inventory manual. San Antonio: Harcourt Brace Jovanovitch, Inc.; 1988.Google Scholar
  37. 37.
    Fairburn CG, Cooper Z. The eating disorder examination. In: Fairburn CG, Wilson GT, editors. Binge eating: nature, assessment, and treatment. 12th ed. New York: Guilford; 1993. p. 317–32.Google Scholar
  38. 38.
    Wilson GT. Assessment of binge eating. In: Fairburn CG, Wilson GT, editors. Binge eating: nature, assessment and treatment. New York: Guilford Press; 1993. p. 227–49.Google Scholar
  39. 39.
    Vander Wal JS, Stein RI, Blashill AJ. The EDE-Q, BULIT-R, and BEDT as self-report measures of binge eating disorder. Eat Behav. 2011;12(4):267–71.CrossRefPubMedGoogle Scholar
  40. 40.
    Allison KC, Lundgren JD, O'Reardon JP, et al. The Night Eating Questionnaire (NEQ): psychometric properties of a measure of severity of the night eating syndrome. Eat Behav. 2008;9(1):62–72.CrossRefPubMedGoogle Scholar
  41. 41.
    Harb A, Levandovski R, Oliveira C, et al. Night eating patterns and chronotypes: a correlation with binge eating behaviors. Psychiatry res. 2012;200(2–3):489–93.CrossRefPubMedGoogle Scholar
  42. 42.
    White MA, Whisenhunt BL, Williamson DA, et al. Development and validation of the food craving inventory. Obes res. 2002;10(2):107–14.CrossRefPubMedGoogle Scholar
  43. 43.
    Littell RC, Milliken GA, Stroup WW, et al. SAS System for Mixed Models. Cary: SAS Institute Inc.; 1996. 633 ppGoogle Scholar
  44. 44.
    Pinheiro J, Bates DM. Mixed effects models in S and S-plus. New York: Springer-Verlag; 2000.CrossRefGoogle Scholar
  45. 45.
    Harbury CM, Verbruggen EE, Callister R, et al. What do individuals with morbid obesity report as usual dietary intake? A narrative review of available evidence. Clin Nutr. 2016;13:e15–22.Google Scholar
  46. 46.
    NHANES data 2005–2006 drawn from analyses of usual dietary intakes conducted by the National Cancer Institute. http://riskfactor.cancer.gov/diet/foodsources/.
  47. 47.
    Pratt JS, Lenders CM, Dionne EA, et al. Best practice updates for pediatric/adolescent weight loss surgery. Obesity (Silver Spring). 2009;17(5):901–10.CrossRefGoogle Scholar
  48. 48.
    Savage JS, Mitchell DC, Smiciklas-Wright H, et al. Plausible reports of energy intake may predict body mass index in pre-adolescent girls. J am Diet Assoc. 2008;108(1):131–5.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Bailey RL, Mitchell DC, Miller C, et al. Assessing the effect of underreporting energy intake on dietary patterns and weight status. J am Diet Assoc. 2007;107(1):64–71.CrossRefPubMedGoogle Scholar
  50. 50.
    Poslusna K, Ruprich J, de Vries JH, et al. Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice. Br J Nutr. 2009;101(Suppl 2):S73–85.CrossRefPubMedGoogle Scholar
  51. 51.
    Ventura AK, Loken E, Mitchell DC, et al. Understanding reporting bias in the dietary recall data of 11-year-old girls. Obesity (Silver Spring). 2006;14(6):1073–84.CrossRefGoogle Scholar
  52. 52.
    LoMenzo E, Szomstein S, Rosenthal RJ. Mechanism of Action of the Bariatric Procedures. In: Nguyen, NT, Blackstone RP, Morton JM, Ponce J, Rosenthal RJ (Eds). The ASMBS Textbook of Bariatric Surgery. 1: 61–72, 2014.Google Scholar
  53. 53.
    Sarwer DB, Spitzer JC, Wadden TA, et al. Sexual functioning and sex hormones in men who underwent bariatric surgery. Surg Obes Relat dis. 2015;11(3):643–51.CrossRefPubMedGoogle Scholar
  54. 54.
    Sarwer DB, Spitzer JC, Wadden TA, et al. Sexual functioning and sex hormones in persons with extreme obesity and seeking surgical and nonsurgical weight loss. Surg Obes Relat dis. 2013;9(6):997–1007.CrossRefPubMedGoogle Scholar
  55. 55.
    Sarwer DB, Spitzer JC, Wadden TA, et al. Changes in sexual functioning and sex hormone levels in women following bariatric surgery. JAMA Surg. 2014;149(1):26–33.CrossRefPubMedGoogle Scholar
  56. 56.
    U.S. Department of Agriculture, Agricultural Research Service. 2011. USDA National Nutrient Database for Standard Reference, Release 24. Nutrient Data Laboratory Home Page, http://www.ars.usda.gov/ba/bhnrc/ndlexternal link disclaimer.
  57. 57.
    Ishikawa Y, Kudo H, Kagawa Y, et al. Increased plasma levels of zinc in obese adult females on a weight-loss program based on a hypocaloric balanced diet. In Vivo. 2005;19(6):1035–7.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • David B. Sarwer
    • 1
    • 2
  • Rebecca J. Dilks
    • 1
  • Jacqueline C. Spitzer
    • 1
    • 2
  • Robert I. Berkowitz
    • 3
    • 4
    • 5
  • Thomas A. Wadden
    • 1
  • Renee H. Moore
    • 1
    • 6
  • Jesse L. Chittams
    • 7
  • Mary L. Brandt
    • 8
  • Mike K. Chen
    • 9
  • Anita P. Courcoulas
    • 10
  • Carroll M. Harmon
    • 11
  • Michael A. Helmrath
    • 12
  • Marc P. Michalsky
    • 13
  • Stavra A. Xanthakos
    • 14
  • Meg H. Zeller
    • 15
  • Todd M. Jenkins
    • 12
  • Thomas H. Inge
    • 12
  1. 1.Department of Psychiatry, Center for Weight and Eating DisordersPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Center for Obesity Research and Education, College of Public HealthTemple UniversityPhiladelphiaUSA
  3. 3.Department of Child and Adolescent Psychiatry and Behavioral SciencesThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  4. 4.Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Department of Pediatrics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaUSA
  7. 7.University of Pennsylvania School of NursingPhiladelphiaUSA
  8. 8.Division of Pediatric Surgery, Michael E. DeBakey Department of SurgeryBaylor College of Medicine, Texas Children’s HospitalHoustonUSA
  9. 9.Division of Pediatric Surgery, Children’s Hospital of AlabamaUniversity of AlabamaBirminghamUSA
  10. 10.Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  11. 11.Women and Children’s Hospital of BuffaloBuffaloUSA
  12. 12.Division of Pediatric Surgery, Cincinnati Children’s Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiUSA
  13. 13.Department of Pediatric SurgeryThe Ohio State University College of Medicine and Nationwide Children’s HospitalColumbusUSA
  14. 14.Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiUSA
  15. 15.Division of Behavioral MedicineCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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