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Post-op restrictive eating behaviours

Study examines post-op restrictive eating behaviours in females

The authors hope that the findings will prove helpful for healthcare professionals identifying patients with post-op problematic restrictive eating behaviours

A study examining restrictive eating behaviours in females following bariatric surgery has found patients reported three interacting entities leading to them developing these behaviours. The themes, according to researchers from Royal Holloway, University of London and Chelsea and Westminster NHS Foundation Trust, London, UK, were: ‘Experiences of Weight Stigma and Weight History on Self’, ‘The Impact of Loose Skin’ and ‘Thoughts About Food and Disordered Eating Patterns’.

The authors believe the study, ‘Exploring the Experiences of Women Who Develop Restrictive Eating Behaviours After Bariatric Surgery’, published in Obesity Surgery, is the first to specifically explore restrictive eating disorders after bariatric surgery using a qualitative approach. They hope that the findings will prove helpful for healthcare professionals identifying patients with post-op problematic restrictive eating behaviours.

The study focused on female patients as the prevalence of eating disorders is higher in females (10:1 female-to-male ratio) and the vast majority (74%) of bariatric surgery patients are female. The study recruited five participants (at least nine months post-bariatric surgery) who were exhibiting restrictive eating behaviours and they were asked to complete qualitative face-to-face, semi-structured interviews (the data was analysed using interpretative phenomenological analysis, IPA). The authors explained that all participants had a minimum of nine months post-surgery allowing enough time for them to progress to a post-surgery diet and establish eating patterns. The average time since surgery was 35.60 months (SD= 5.34 months), approximately 2.9 years (range 9/10 months up to eight years).

Outcomes

Experiences of weight stigma and weight history on self

The authors report that this theme was comprised of three sub-ordinate themes:

  • Influence of past life experiences related to weight on the present
  • Fear of putting on weight and going back to before, and
  • Struggling with my mind - internal battles

All participants described how past experiences had influenced their current post-op life experience and reported long-standing weight issues, most describing themselves as being overweight from a young age. These long-standing memories were associated with bullying and negative reactions from people regarding their weight before surgery, leading to fears around regaining the weight post-operatively. They reported being anxious about their weight and more specifically, weight regain, and the authors noted that these past experiences had been internalised and contributed to the development of restrictive eating behaviours.

The impact of loose skin

The authors report that participants found their loose skin reminded them of what they were like for surgery, that the excess skin hid their weight loss and was ‘unsightly’. Indeed, they women complained the skin ‘hung’ on their body differently prior to surgery explaining that the texture of ‘empty’ skin was different to when it was ‘full’. All of this had a negative impact on their self-confidence and acted as a reminder of their past eating and pre-surgery weight. Although they were all aware that restricting food would not improve the excess skin, it nevertheless led to fearing they were more susceptible to regaining weight.

Thoughts about food and disordered eating patterns

Post-surgery, the participants described food in a more functional manner, reducing the amounts that ate. They report seeing food as a threat, as well as feeling guilty and not deserving food. Food was not to be enjoyed, rather a punishment. To avoid food or limit calorific intake the participants reported calorie counting, restriction, self-induced vomiting and the use of laxative-like medicine.

“Understanding of post-surgery eating pathology is increasing, but the overall body of literature is still limited and the prevalence of post-surgical excessive dietary restriction remains unknown,” the authors concluded. “…These interviews highlight the important role of weight stigma, and this would be a useful route to be explored in future research. It is hoped that this study may help clinicians distinguish AN eating pathology from necessary post-surgery dietary adjustment, so that people suffering from these conditions are provided with an appropriate framework to identify and legitimise their symptoms. This study demonstrates that expanding our understanding of this presentation is critical in order to support early identification and improve people’s lives and mental well-being following bariatric surgery.”

To access this paper, please click here

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