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Loss of control

Loss of control eating and bariatric surgery in adolescents

the presence of loss of control eating before surgery did not appear to impact long-term weight loss and engaging in loss of control eating post-surgery was associated with significantly poorer weight loss outcomes

Pre-surgical loss-of-control (LOC) eating not related to relative weight loss after surgery, post-operative LOC eating may adversely affect long-term weight outcomes in adolescents, according to a study by researchers led by Dr Thomas H Inge, director of the Bariatric Surgery Center at Children's Hospital Colorado (Children's Colorado). The investigators found that rates of LOC eating decreased from pre-surgery to six-months posts-surgery but increased thereafter and the recommended that this behaviour may warrant additional empirical and clinical attention.

Although loss-of-control is common in adults undergoing bariatric surgery and is associated with poorer weight outcomes, its long-term course in adolescent bariatric surgery patients and associations with weight outcomes are unclear. Therefore, the study’s researchers examined the impact of eating behaviours on success rates related to bariatric surgery in adolescents. The five-year study involved 242 adolescents, ages 13-19 years, who underwent bariatric surgery at five different centres across the US from 2007 to 2012. The outcomes were reported in the paper, ‘Adolescent Loss-of-Control Eating and Weight Loss Maintenance After Bariatric Surgery’, published in the journal Pediatrics.

Thomas Inge

"With approximately 10 percent of adolescents in the US suffering from severe obesity, bariatric surgery is increasingly being recommended as an effective long-term treatment," said Inge. "However, several behaviours, including loss of control eating, that are common in adolescents with obesity may undermine bariatric surgery outcomes. This research demonstrates that patients should not only undergo nutritional and mental health assessments before bariatric surgery, but also continuing to focus on these important factors after surgery is important to achieving the best possible long-term outcomes."

The study specifically examined loss of control eating, which is characterized by a sense that an individual cannot control what or how much they are eating. Reported by up to 30 percent of adolescents with obesity, loss of control eating typically takes one of two forms - either eating objectively large amounts of food or eating continuously.

At baseline, objectively large LOC eating was reported by 15.4% of adolescents and continuous LOC eating by 27.8% of adolescents. Although both forms of LOC eating were significantly lower at all post-surgical time points relative to pre-surgery (range = 0.5%–14.5%; p<0.05), both behaviours gradually increased from six-month to four-year follow-up (p<0.05). Pre-surgical LOC eating was not related to percent BMI change over follow-up (p=0.79) but, LOC eating at year one, two and three was associated with lower percent BMI change from baseline at the next consecutive assessment (p<0.05). Therefore, the presence of loss of control eating before surgery did not appear to impact long-term weight loss and engaging in loss of control eating post-surgery was associated with significantly poorer weight loss outcomes.

"Loss of control eating is related to a variety of psychological health concerns, including depression and anxiety," said Dr Richard E Boles, paediatric psychologist in the Bariatric Surgery Center at Children's Colorado. "Physicians, therefore, not only need to be aware that loss of control eating is a common behaviour in adolescents seeking bariatric surgery, but they also should understand what drives this behaviour in their patients. They should ask their patients if they ever experience a feeling of being unable to control what or how much they are eating and closely monitor these symptoms at follow-up visits to determine the need to refer them for more intensive psychological treatment."

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