Obesity is prevalent worldwide and is associated with potential life-threatening comorbidities such as heart disease and diabetes.

Although weight loss surgery may be a viable option to “treat” obesity, the behavioral component may be a culprit and if overlooked could lead to an unsuccessful long-term surgical success. There are various eating behaviors that may be linked to obesity such as:

  • Binge eating disorder (BED)
  • Night eating syndrome (NES)
  • Emotional Eating

The majority of patients with a Binge Eating Disorder should seek treatment for obesity and not an eating disorder or eating behaviors that are problematic.

Bariatric surgery has become a popular intervention to treat obesity. While bariatric surgery may potentially be a healthy and effective intervention for one, it may not be the best first line of intervention for one with an underlying pattern of disordered eating or undiagnosed eating disorder.

A conservative estimate of 10% of bariatric patients meet the criteria for a binge eating disorder, the most common ED among bariatric surgery candidates.

There is also a possibility for bariatric patients to develop anorexia nervosa (AN) after surgery. The post-op stomach cannot tolerate more than 1 cup of food per sitting, which requires a restricted intake.

Although binge eating right after surgery is not possible due to the size of the stomach and feeling of fullness, many post op patients still struggle with loss of control (LOC) and subjective binge episodes.

However, as the stomach can stretch over time, this allows for eating a larger amount of food than previously, with the potential for weight re-gain and binge eating. Studies conclude that fasting ghrelin (the hunger hormone) levels decrease in the short term (3 months) and increase longer term (3 months) post-op – stomach size was not taken into consideration.

It is important to monitor bariatric patients who are at risk for LOC after surgery as they need additional support – LOC is a key marker of BED.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) has been an effective intervention pre-op for many patients with BED as it was reported that those who completed the CBT group class prior to surgery, no longer met BED criteria before surgery.

As eating behaviors can change within 12 months or less, it is recommended that these individuals are monitored and intervened as soon as possible as this is when they also tend to be more motivated.

As some bariatric candidates are medically impaired and need the surgery as soon as possible, it is important to catch the ED as soon as possible so this can be treated prior to surgery.

Treating the underlying cause of obesity first (such as binge eating) should be paid attention to by health professionals and refer as appropriate. If your binge eating disorder is treated before obesity, then the individual can prevent further weight gain or health complications as they will be able to develop healthier eating habits. Developing a healthier relationship with food will ultimately help the individual reach a healthy weight. If the individual loses weight post surgery, but does not treat their ED, the vicious cycle will continue – the individual will most likely regain their weight and may potentially re-develop the ED.

As ED are common among pre and post op bariatric patients, ED should be monitored closely pre and post op with a behavioral specialist. CBT should be a part of bariatric programs pre-op, and post-op. Please reach out if you have questions about how Behavioral Therapists at Behavioral Nutrition can help monitor for ED before or after bariatric surgery.