title: Grazing and loss of control related to eating: two high-risk factors following bariatric surgery.
abstract: BACKGROUND
  Gastric restrictive surgery induces a marked change in eating behavior. However, the relationship between preoperative and postoperative eating behavior and weight loss outcome has received limited attention.
  
  
  OBJECTIVE
  This study assessed a range of eating behaviors before and 1 year after laparoscopic adjustable gastric banding (LAGB) and explored the nature and extent of change in eating patterns, their clinical associates, and impact on weight loss.
  
  
  METHODS
  A 12-month observational study assessed presurgical and postsurgical binge eating disorder (BED), uncontrolled eating, night eating syndrome (NES), grazing, nutrient intake and eating-related behaviors, and markers of psychological distress. A total of 129 subjects (26 male and 103 female, mean age 45.2 +/- 11.5 and BMI 44.3 +/- 6.8) participated in this study.
  
  
  RESULTS
  Presurgical BED, uncontrolled eating, and NES occurred in 14%, 31%, and 17.1% of subjects, which reduced after surgery to 3.1%, 22.5%, and 7.8%, respectively (P = 0.05 for all). Grazing was prevalent before (26.3%) and after surgery (38.0%). Preoperative BED most frequently became grazers (P = 0.029). The average percentage weight loss (%WL) was 20.8 +/- 8.5%; range -0.67 to 50.0% and percentage of excess weight loss (%EWL) 50.0 +/- 20.7%; range -1.44 to 106.9% (P < 0.001). Uncontrolled eating and grazing after surgery showed high overlap and were associated with poorer %WL (P = 0.008 and P < 0.001, respectively) and elevated psychological distress.
  
  
  CONCLUSIONS
  Consistent with recent studies, uncontrolled eating and grazing were identified as two high-risk eating patterns after surgery. Clearer characterization of favorable and unfavorable postsurgical eating behaviors, reliable methods to assess their presence, and empirically tested postsurgical intervention strategies are required to optimize weight loss outcomes and facilitate psychological well-being in at-risk groups.
authors.affiliation: Monash University, Centre for Obesity Research and Education (CORE), Alfred Hospital, Melbourne, Victoria, Australia. susan.colles@med.monash.edu.au
authors.forename: Susan L
authors.initials: SL
authors.lastname: Colles
authors.forename: John B
authors.initials: JB
authors.lastname: Dixon
authors.forename: Paul E
authors.initials: PE
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D001069:Appetite Regulation; D005247:Feeding Behavior; D001068:Feeding and Eating Disorders / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D011446:Prospective Studies; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss