Does Bariatric Binge-Eating Size Matter? Conceptual Model and Empirical Support

Abstract

Objective: Bariatric surgery affects the quantity of food individuals can eat, yet some individuals still experience loss of control (LOC) while eating. This cross-sectional study examined a new classification system for binge/LOC eating following bariatric surgery. Methods: A total of 168 individuals who underwent bariatric surgery 6 months earlier and reported LOC eating were administered the Eating Disorder Examination–Bariatric Surgery Version interview and self-report measures of depressive symptoms, functional impairment, and physical and mental health-related quality of life. Three groups were created based on the largest LOC-eating episode determined by the Eating Disorder Examination–Bariatric Surgery Version interview as follows: (1) “traditional” objective binge-eating episodes, defined as eating unusually large quantities of food while having LOC; (2) “bariatric-objective binge eating,” meaning unusually large quantities for postsurgical bariatric patients with LOC; and (3) “bariatric-subjective binge eating,” meaning small quantities of food with LOC after surgery. Results: In total, 75% (n = 126) met criteria for the bariatric-objective binge episodes group, 10% (n = 17) met criteria for the traditional objective binge-eating group, and 15% (n = 25) met criteria for the bariatric-subjective binge episodes group. The three groups differed significantly, with a graded pattern by binge size, in global eating-disorder psychopathology, depressive symptoms, and functional impairment but not quality of life. Conclusions: These findings provide empirical support for a new classification system for bariatric binge/LOC eating. Binge size was associated with distinct psychopathology. Longitudinal follow-up is needed to ascertain effects on clinical outcomes.