Nonnormative eating behaviors and eating disorders linked to lower Quality of life after obesity surgery: JAMA

Individuals with severe obesity presenting for obesity surgery (OS) frequently show nonnormative eating behaviors (NEBs) and eating disorders (EDs), but the long-term course and prospective associations with weight loss and health-related quality of life (HRQOL) remain unclear.

A study was conducted to examine the prevalence and prospective relevance of presurgical and postsurgical NEBs and EDs according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosed through clinical interview, for weight loss and HRQOL up to 6 years following OS.

In the prospective, multicenter Psychosocial Registry for Obesity Surgery cohort study, patients seeking OS were recruited at 6 OS centers in Germany and assessed at baseline before surgery and at 6 months and 1 to 6 years after surgery. From a consecutive sample of 1040 volunteers with planned OS from March 1, 2012, to December 31, 2020, a total of 748 (71.92%) were included in this study. Across follow-up, 93 of the 748 patients (12.43%) dropped out. Data were analyzed from April to November 2021.

Both NEBs and EDs were identified using the Eating Disorder Examination interview. Main outcomes were the percentage of total body weight loss (%TBWL) and HRQOL

Results:

• In 748 patients undergoing OS, 48.38 [8.09]; 513 [68.58%] female), the mean (SD) %TBWL was 26.70% (9.61%), and the mean (SD) HRQOL improvement was 35.41 (20.63) percentage points across follow-up.
• Both NEBs and EDs were common before surgery, with postsurgical improvements of varying degrees.
• Whereas NEBs and EDs did not reveal significant prospective associations with %TBWL, loss-of-control eating at follow-up was concurrently associated with lower %TBWL
• Loss-of-control eating and binge-eating disorder of low frequency and/or limited duration at follow-up showed significant prospective associations with lower HRQOL.

This cohort study found prospective relevance of loss-of-control eating and binge-eating disorder of low frequency and/or limited duration for reduced long-term HRQOL following OS. These findings underline the importance of monitoring both NEBs, especially loss-of-control eating, and EDs in the long term postsurgically to identify patients in need of targeted prevention or psychotherapy.

Reference:

Hilbert A, Staerk C, Strömer A, et al. Nonnormative Eating Behaviors and Eating Disorders and Their Associations With Weight Loss and Quality of Life During 6 Years Following Obesity Surgery. JAMA Netw Open. 2022;5(8):e2226244. doi:10.1001/jamanetworkopen.2022.26244

Keywords:

Hilbert A, Staerk C, Strömer A, Nonnormative, Eating, Behaviors, Eating, Disorders, Associations, Weight, Loss, and Quality, Life, During, 6 Years, Following, Obesity, Surgery, JAMA,