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Eating habits and surgery

More data needed on how surgery helps eating habits

The review found many gaps in the knowledge, highlighting the need for further studies

Research from the Faculty of Health Sciences, University of Adelaide, Australia, has revealed that some types of bariatric surgery can have short to medium-term success in changing people's eating habits. The review also found many gaps in the knowledge, highlighting the need for further studies.

Currently 28% of Australians (4.9 million) are obese. Many are turning to bariatric surgery, which is considered to be the most effective available long-term intervention for weight and related health issues. As part of her research, PhD student Melissa Opozda conducted a review of 23 previous studies from 1990-2015. The findings, ‘Changes in problematic and disordered eating after gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy: a systematic review of pre-post studies’, are published in the journal Obesity Reviews.

"Before surgery, people commonly report long-term problem eating patterns, including binge eating disorder, grazing, night eating, and emotional eating. They hope that surgery will lead not only to weight loss but also to better eating habits," said Opozda. "Despite the large number of surgical procedures being performed each year to treat obesity, there is just not enough research to date to clearly understand the effects of these surgeries on how people eat."

There are three main types of bariatric surgery carried out in Australia: Roux-en-Y gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy. Despite differences in their mechanisms and outcomes, little is known about whether postsurgical changes in eating behaviours also differ by bariatric procedure.

"As these surgeries involve very different changes to the body and have different weight and health outcomes, we wanted to look at the evidence on whether they might also have different effects on the problem eating behaviours that we know are common before weight-loss surgery," said one of Opozda's supervisors, Professor Gary Wittert from the University of Adelaide's School of Medicine. "The review found short and medium-term reductions in binge eating, short to medium-term reductions in emotional eating, and potential short to long-term reductions in bulimic symptoms after gastric bypass. However, there was little research on sleeve gastrectomy, and few consistent findings about gastric banding.”

Following a systematic search, 23 studies on changes in binge eating disorder (BED) and related behaviours, bulimia nervosa and related behaviours, night eating syndrome, grazing and emotional eating after Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB) and vertical sleeve gastrectomy (VSG) were reviewed.

Significant methodological problems and a dearth of literature regarding many behaviours and VSG were seen. Regarding BED and related behaviours, although later re-increases were noted, short to medium-term reductions after RYGB were common, and reported changes after AGB were inconsistent.

Short to medium-term reductions in emotional eating, and from a few studies, short to long-term reductions in bulimic symptoms, were reported after RYGB. Reoccurrences and new occurrences of problem and disordered eating, especially BED and binge episodes, were apparent after RYGB and AGB. Further conclusions and comparisons could not be made because of limited or low-quality evidence. Long-term comparison studies of changes to problematic and disordered eating in RYGB, AGB and VSG patients are needed. It is currently unclear whether any bariatric procedure leads to long-term improvement of any problematic or disordered eating behaviours.

"The existing research suggests that for some patients, binge eating behaviours may reoccur and even occur for the first time after both gastric bypass and gastric banding. This is a worrying finding that needs further investigation," said Professor Anna Chur-Hansen from the School of Psychology, another of Ms Opozda's supervisors.

People aged 18 and older who have undertaken one of the major forms of weight loss surgery in Australia are invited to take part in the new Bariatric Eating Experiences Study, in the form of an online questionnaire here

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