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Evaluating the Prevalence of Binge Eating Disorder Following Bariatric Surgery
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Fatemeh Mohammadzadeh1    , Saharalsadat Mousavi2 , Somayeh Ghorbani3 , Samira Eshghinia *4 |
1- Assistant Professor, Ischemic Disorders Research Center, Faculty of Medicine, Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
2- Specialist in Internal Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
3- Assistant Professor of Biostatistics, Cancer Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
4- Associate Professor of Nutrition, Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran. , eshghinia@goums.ac.ir and dreshghinia@yahoo.com |
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Keywords: Obesity [MeSH], Bariatric Surgery [MeSH], Weight Gain [MeSH], Binge-Eating Disorder [MeSH]
Article ID: Vol27-26 |
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Type of Study: Original Articles |
Subject:
Endocrinology
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Abstract: (215 Views) |
Extended Abstract
Introduction
Obesity is a metabolic disorder with increasing worldwide prevalence and a risk factor for the development of insulin resistance, metabolic syndrome, and type 2 diabetes. It is estimated that the prevalence of this condition will reach 42% by the year 2030. In Iran, the reported prevalence of overweight is over 35% and obesity is over 21% among adults over 18 years of age.
The association of obesity with diseases such as type 2 diabetes, hypertension, dyslipidemia, ischemic heart disease, and non-alcoholic fatty liver disease (NAFLD), as well as other disorders like joint diseases and psychiatric disorders, has transformed it into a critical crisis. Bariatric surgeries for the treatment of obesity have garnered significant attention due to their rapid and substantial weight loss and the improvement of obesity-related comorbidities, such as diabetes and hypertension, compared to pharmacological treatment methods. Although these surgical procedures are considered the gold standard treatment, it is crucial to note that their utilization, without concurrent changes in lifestyle and dietary therapy, does not guarantee sustained long-term weight loss. Sustained weight loss maintenance efforts must incorporate continuous lifestyle modifications to ensure the efficacy of the surgery. Factors such as disordered eating (e.g., loss of control over eating) or non-adherence (e.g., grazing), failure to follow postoperative nutritional recommendations, a return to previous eating habits, physical inactivity, and physiological compensatory mechanisms like changes in energy-regulating hormones, all contribute to increased appetite, food cravings, and higher caloric intake. One of the most common of these disturbances is binge eating (BE), wherein the individual loses control over what or how much they eat, consuming a large amount of food in a short period of time. According to some studies, eating disorders decrease during the first two years following surgery but reappear after three years. Furthermore, study results reveal that preoperative eating disorders do not have a significant association with the amount of postoperative weight loss. This study was conducted to evaluate the prevalence of BE disorder following bariatric surgery in Gorgan, Iran.
Methods
This descriptive-analytical study was conducted on 133 patients admitted to Dr. Mousavi Hospital in Gorgan, Iran, during 2013-2019 for obesity treatment and underwent bariatric surgery performed by a single surgeon.
Following the previous study, all patients were contacted via a phone call. After providing them with explanations about the study, they were invited for an interview, physical examination, and measurement of research variables.
The inclusion criteria comprised individuals who had undergone surgery and consented to complete the study participation questionnaire. The exclusion criteria included the presence of severe psychiatric disorders, severe renal or hepatic disease, severe heart failure, and the use of medications affecting weight, such as glucocorticoids.
Upon referral of the individuals, and after obtaining informed consent, the demographic information checklist and the Binge Eating Disorder Scale (BEDS) were completed. Participants' current height and weight were measured and recorded using a standardized method with a SECA brand calibrated scale and stadiometer.
Weight regain was determined based on three definitions, including regain of 25% of the maximum weight loss; or gain of 10 kg from the maximum weight loss; or an increase of 5 units in body mass index (BMI) after the maximum weight loss.
The standardized J Gormally 13 questionnaire, designed to determine the severity of BE disorder, was utilized. The questionnaire comprises 16 statements, each presenting four options related to an eating habit. Based on the total score obtained by each individual, the severity of the BE disorder is determined. A score of less than 17 was considered without disorder, 17 to 26 as moderate disorder, and a score of 27 or more as severe disorder.
Results
The age range of the participants was 18-68 years, with 86.5% of them being female. The mean duration since the surgery was 3.99±1.5 years (range 2-8 years), with half of them having undergone surgery 3 to 5 years prior to the study. Furthermore, 117 individuals (88%) had undergone Roux-en-Y gastric bypass (RYGB) surgery, and the remainder had undergone sleeve gastrectomy (SG). Regarding marital status, 85.3% of the participants were married, 53.4% had university education, and 78.8% were housewives.
The patients’ mean preoperative weight and BMI were 124.94±22.44 kg and 45.90±6.51 kg/m2, respectively. The mean maximum postoperative weight loss was 48.37±15.57 kg, which constituted 38.30% of the preoperative weight. A total of 44 individuals (33.1%) experienced weight regain, as defined. The mean weight regain in patients was 11.43 kg (ranging from 9 to 59 kg). On average, 14.72% of the minimum postoperative weight (nadir weight) was regained in the study population.
The prevalence of BE disorder was observed in 59 individuals (44.4%) of the total sample, of whom 33 had moderate disorder and 26 had severe disorder. Among patients with weight regain, the prevalence of moderate and severe BE disorder was 65.9%, which was significantly higher (P<0.003) than in patients without weight regain, where the prevalence was 33.7%.
Weight regain was observed in 20.3%, 48.5%, and 50% of individuals who did not have BE disorder, those with moderate BE, and those with severe BE, respectively. The odds ratio (OR) of weight regain were determined to be 3.70 times higher in individuals with moderate BE compared to those without the disorder, and 3.93 times higher in individuals with severe BE compared to those without the disorder.
The variables of gender, education, and occupation had no statistically significant association with BE disorder. Additionally, no statistically significant association was observed when examining the relationship between the type of surgery and this disorder in the studied patients.
After controlling for the confounding effects of marital status, age, and type of surgery, it was determined that the OR of having moderate or severe BE disorder in obese, non-working individuals (housewives) undergoing bariatric surgery was 3.62 times higher than their employed counterparts.
Among individuals experiencing weight regain, the OR of having BE disorder was 9 times higher for housewives compared to employed individuals (employees or self-employed) (P<0.026).
Conclusion
Based on the results of this study, the overall prevalence of postoperative BE disorder was determined to be 44.4%, and among individuals experiencing weight regain, it was 65.9%. The OR of experiencing weight regain was 3.8 times higher in individuals with BE disorder compared to those without the disorder.
Postoperative weight regain is significantly associated with psychiatric disorders, including eating disorders. Specifically, individuals seeking bariatric surgery show a higher prevalence of these disorders compared to the general population. In our study, there was no information available regarding the psychiatric status or eating disorders of the participants before the surgery.
In our study, 44.4% of individuals experienced postoperative BE disorder. However, since we did not assess patients' eating disorders preoperatively, its prevalence cannot be compared to the preoperative rate.
Based on the available information, postoperative eating disorders can also affect patient weight loss.
The results of this study demonstrate the presence of weight regain following surgery, which corroborates the concept that surgery is not a definitive cure for obesity and necessitates continuous monitoring and therapeutic interventions. This is because neuropsychological pathways are not altered by the surgery.
Since the present study only examined patients admitted to a private clinic, the resulting findings may differ from those obtained at other governmental, educational, and international healthcare centers due to variations in pre- and postoperative protocols. Furthermore, 88.8% of the patients in this study underwent RYGB, while the most frequently used technique in both public and private centers currently is SG, which may contribute to the differences between the results obtained in the current study and those of other research.
In this cross-sectional study, BE disorder was significantly associated with weight regain. Certain factors, such as being a housewife, influenced the occurrence of both BE and weight regain, which could be due to housewives’ greater access to food.
Ethical Statement
This study was approved by the Research Ethics Committee of Golestan University of Medical Sciences (IR.GOUMS.REC.1401.504). Throughout the study and afterward, patient data and their identities were kept confidential. The procedures employed in the study did not result in any adverse effects for the patients. Patients who experienced weight regain were provided free consultations with an endocrinology subspecialist and a nutrition specialist.
Funding
This article has been extracted from Dr. Saharalsadat Mousavi's thesis for the successful completion of the Internal Medicine Residency Program at the School of Medicine, Golestan University of Medical Sciences, and was funded by the Vice-Chancellor for Research and Technology, Golestan University of Medical Sciences.
A summary of this study was presented at the 9th National Congress on Prevention and Treatment of Obesity in Iran, held from December 18 to 20, 2024 at Shahid Beheshti University.
Conflicts of Interest
No conflict of interest.
Acknowledgments
We would like to thank the esteemed Vice-Chancellor of Research and Technology, Golestan University of Medical Sciences, for supporting this study, as well as to all the participants for their cooperation. Special thanks are also extended to the respected surgeon, Dr. Sina Safamanesh, and his accompanying team in the operating room of Mousavi Hospital.
Authors' Contributions
Fatemeh Mohammadzadeh (M.D): Project administration and design, Project execution, Data collection, Interpretation of the results, Approval of the final manuscript.
Saharalsadat Mousavi (M.D): Project execution, Data collection, Drafting of the initial manuscript.
Somayeh Ghorbani (Ph.D): Project administration and design, Data analysis, Interpretation of the results, Drafting of the initial manuscript, Approval of the final manuscript.
Samira Eshghinia (Ph.D): Project administration and design, Project execution, Interpretation of the results, Drafting of the initial manuscript, Approval of the final manuscript.
Key Message: BE disorder is a significant factor in patient weight regain in the years following surgery, particularly among housewives.
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