title: What is "grazing"? Reviewing its definition, frequency, clinical characteristics, and impact on bariatric surgery outcomes, and proposing a standardized definition.
abstract: BACKGROUND
  Grazing, characterized by a repetitive eating pattern, has received increased attention among bariatric surgery patients. However, different definitions and terminology have been used, preventing the accurate measurement of this phenomenon and comparison of data across studies.
  
  
  OBJECTIVE
  To review existing definitions and associated clinical features of grazing among different samples and to propose a standardized definition that will allow for consistency in future work.
  
  
  METHODS
  University and Clinical Research Institute.
  
  
  METHODS
  Of the 39 studies found, 9 provided an original definition and 12 provided data of its association with weight outcomes. Six were studies of nonbariatric surgery populations. Based on this literature review, the most common criteria used in previous studies to define grazing were included in a survey that was sent to 24 individuals who have published work in the field. These experts were asked to provide their opinion on what should constitute grazing.
  
  
  RESULTS
  Grazing is a frequent behavior in the bariatric surgery population as well as in eating disordered and community samples. Its association with psychopathology is not clear, but its negative impact on weight outcomes after bariatric surgery generally has been supported. Survey data provided a consensus regarding the definition of grazing as an eating behavior characterized by the repetitive eating (more than twice) of small/modest amounts of food in an unplanned manner, with what we characterize as compulsive and noncompulsive subtypes.
  
  
  CONCLUSIONS
  Given the clinical relevance of grazing among bariatric surgery patients, a unique definition is crucial to better study its associated features and impact on different populations.
authors.affiliation: University of Minho, School of Psychology, Braga, Portugal. Electronic address: econceicao@psi.uminho.pt.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Conceição
authors.affiliation: Neuropsychiatric Research Institute, Fargo, North Dakota; University of North Dakota, School of Medicine and Health Sciences, Fargo, North Dakota.
authors.forename: James E
authors.initials: JE
authors.lastname: Mitchell
authors.affiliation: Neuropsychiatric Research Institute, Fargo, North Dakota; University of North Dakota, School of Medicine and Health Sciences, Fargo, North Dakota.
authors.forename: Scott G
authors.initials: SG
authors.lastname: Engel
authors.affiliation: University of Minho, School of Psychology, Braga, Portugal.
authors.forename: Paulo P P
authors.initials: PP
authors.lastname: Machado
authors.affiliation: Neuropsychiatric Research Institute, Fargo, North Dakota.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lancaster
authors.affiliation: Neuropsychiatric Research Institute, Fargo, North Dakota; University of North Dakota, School of Medicine and Health Sciences, Fargo, North Dakota.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Wonderlich
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects* / Q000523:psychology; D005247:Feeding Behavior; D001068:Feeding and Eating Disorders / Q000523:psychology; D006801:Humans; D009767:Obesity, Morbid / Q000523:psychology / Q000601:surgery*; D011183:Postoperative Complications / Q000523:psychology; D062410:Snacks; D009626:Terminology as Topic; D016896:Treatment Outcome
keywords: Bariatric surgery; Concept definition; Eating disorders; Grazing; Picking and nibbling