'Disordered Eating' Drops After Teens Undergo Bariatric Surgery

Marlene Busko

November 06, 2020

Among young patients with severe obesity and disordered eating behaviors — continuous eating, overeating, and binge eating — those who had bariatric surgery saw an improvement in the eating behaviors.

Kristina M. Decker, PhD, a postdoctoral fellow at Cincinnati Children's Hospital Medical Center, Ohio, presented these findings during the ObesityWeek® Interactive meeting

Decker and her fellow researchers examined rates of disordered eating in more than 200 adolescents (aged 13 to 18) who were severely obese, of whom 141 underwent bariatric surgery and the remainder did not.

At baseline (presurgery), the teens in both groups had rates of disordered eating ranging from 11% to 50%, with higher rates in those who went on to have bariatric surgery.

Six years later, rates of disordered eating were much lower in those who had bariatric surgery.

The data nevertheless "underscore that young adults with persistent severe obesity are at high risk for poor health and well-being," Decker told Medscape Medical News in an email.

"This means disordered eating behaviors should be closely monitored" in all such patients, both those who undergo surgery and those who don't, she stressed.

Robust Findings Due to Long Follow-Up and Controls

The findings are not unexpected, based on adult bariatric literature, but are "novel because of the age of the patients," senior author Margaret H. Zeller, PhD, Cincinnati Children's Hospital Medical Center and professor, University of Cincinnati, Ohio, added.

Invited to comment, psychologist Kajsa Järvholm, PhD, of the Childhood Obesity Unit at Skåne University Hospital, Malmö, Sweden, who has published related work, said that this is "a needed study."

Notably, it had "long-term follow-up and a control group," and it "confirms that adolescents are in better control of their eating after surgery."

However, an important additional takeaway for clinicians is that "disordered eating is associated with other mental health problems and self-worth. Clinicians treating obesity must address problems related to eating disorders to improve outcomes and well-being," she stressed.

How Does Bariatric Surgery Impact Overeating, Binge Eating, in Teens?

"For teens with severe obesity, metabolic and bariatric surgery is the most effective treatment for improved cardiometabolic functioning, weight loss, and improved quality of life," Decker stressed.

However, pre- and postsurgical disordered eating behaviors have been associated with a lower percentage change in body mass index (BMI), although this has not been well studied.

To investigate how disordered eating is affected by bariatric surgery in adolescents with severe obesity, researchers used data from Teen-LABS, which enrolled 242 participants aged 19 and under who mainly underwent Roux-en-Y gastric bypass (67%) or sleeve gastrectomy (28%) from 2007 to 2012 at five adolescent bariatric surgery centers.  

The current analysis examined data from 141 participants in Teen-LABS who underwent bariatric surgery at a mean age of 16.8 years. Mean BMI was 51.5 kg/m2, most were girls (80%), and they had diverse race/ethnicity (66% were White).

Researchers also identified a control group of 83 adolescents of a similar age and gender who had diverse race/ethnicity (54% White) and a mean BMI of 46.9 kg/m2.

At year 6, data were available for 123 young adults in the surgery group (who by then had a mean BMI of 39.7 kg/m2) and 63 young adults in the nonsurgery group (who had a mean BMI of 52.6 kg/m2).

At baseline and year 6, participants replied to questionnaires that identified three eating disorders: continuous eating (eating in an unplanned and repetitious way between meals and snacks), objective overeating (eating a "large" amount of food without loss of control), and objective binge eating (eating a "large" amount of food with loss of control).

At baseline, rates of continuous eating, overeating, and binge eating were higher in the surgical group (50%, 40%, and 30%, respectively) than the nonsurgical group (40%, 22%, and 11%, respectively).  

Six years later, when participants were aged 19 to 24 years, rates of continuous eating, overeating, and binge eating had declined in the surgical group (to 17%, 5%, and 1%, respectively). In the nonsurgical group, only continuous eating and overeating declined (to 24% and 7%, respectively), and binge eating increased slightly (to 13%).

Disordered Eating Associated With Low Self-Worth, Anxiety, and Depression

In young adulthood in both groups, disordered eating was associated with lower self-worth. In the surgical group, it was also associated with lower weight-related quality of life, and in the nonsurgical group, it was also associated with anxiety and/or depression.

"The current findings cannot tell us whether disordered eating is a direct result or caused by anxiety, depression, low self-worth, or poor quality of life," Decker said.

"These findings do give us insight about what other areas of clinical concern might present together [in] young adults (eg, disordered eating, low self-esteem)."

Bariatric surgery affects the amount of food people can eat at one time, she noted in reply to a question from the audience. If people eat too much at a time they can experience vomiting, dumping syndrome (where certain food is "dumped" into the small intestine without being digested, causing nausea and vomiting), and plugging (a sense of food becoming stuck).

The home environment and transition to adulthood might impact disordered eating in young adults, she said in reply to another question, but these issues were not examined in this study.  

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