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The Prognostic Significance of Regular Binge Eating in Extremely Obese Gastric Bypass Patients: 12-Month Postoperative Outcomes

J Clin Psychiatry 2006;67(12):1928-1935

Objective: The prognostic significance of binge eating for extremely obese patients who undergo bariatric surgery is uncertain. We examined the relation of preoperative binge eating to preoperative presentation and 12-month postoperative outcomes.

Methods: 139 extremely obese gastric bypass surgery patients completed assessments of binge eating and eating disorders (Eating Disorder Examination-Questionnaire version), body dissatisfaction (Body Shape Questionnaire), depression (Beck Depression Inventory), and self-esteem (Rosenberg Self-Esteem Scale) before surgery and again 12 months postsurgery.

Results: At baseline, 60% of patients denied binge eating, 16% reported binge eating infrequently (less than once weekly), and 24% reported binge eating at least weekly. At 12 months postsurgery, 8.8% reported infrequent binge eating and only 0.7% reported binge eating weekly. At baseline, infrequent binge eaters and regular binge eaters differed little from each other but had significantly elevated eating and psychosocial problems relative to non-binge eaters. Statistically significant and clinically robust improvements in weight and in all measures of functioning were observed at 12 months postsurgery across all groups. At 12-month follow-up, patients who reported regular binge eating at baseline had significantly higher levels of eating-specific concerns (but not psychosocial concerns) than the infrequent binge eaters and non-binge eaters; the infrequent and non-binge eaters did not differ from each other. Significant time-by-binge eating interactions indicated that the regular versus infrequent binge-eating groups improved differently over time; infrequent binge eaters had sharper improvements than regular binge eaters and non-binge eaters.

Conclusion: Binge eating is common in extremely obese bariatric surgery candidates and is associated with heightened eating and psychological problems. Regular binge eating preoperatively, however, does not appear to be a potent negative prognostic indicator for gastric bypass surgery. Our findings, which are limited to 12 months postsurgery, highlight substantial improvements in weight and psychosocial functioning, and these robust improvements differ little by binge-eating status.