Randomized Controlled Trial of Treatments for Loss-of-Control Eating Following Bariatric Surgery

Overview

Journal Obesity (Silver Spring)

Specialties Endocrinology
Nutritional Sciences
Physiology

Date 2021 Mar 11

PMID 33694287

Citations 9

Authors

Carlos M Grilo

Valentina Ivezaj

Andrew J Duffy

Ralitza Gueorguieva

Affiliations

Soon will be listed here.

Abstract

Objective: Loss-of-control (LOC) eating postoperatively is a consistent predictor of suboptimal longer-term bariatric surgery outcomes. This randomized controlled trial examined the effectiveness of two guided self-help treatments (cognitive behavioral therapy [gshCBT] and behavioral weight loss [gshBWL]) compared with a control (CON) for reducing LOC eating and weight.

Methods: A total of 140 patients with recurrent LOC eating approximately 6 months after bariatric surgery were randomly assigned (5:5:2 ratio) to one of three conditions: gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24). Three-month treatments were delivered by trained allied health clinicians to increase generalizability to bariatric surgery settings. Independent assessments were performed by doctoral research-clinicians using established interviews/measures; posttreatment outcomes were obtained for 89% of patients.

Results: Mixed models revealed significant improvements for LOC eating frequency and weight loss but no significant differences between treatments; race neither predicted (main effect) nor moderated (interaction effect) treatment outcomes. Intent-to-treat categorical analyses of abstinence from LOC eating (30% for gshCBT, 27% for gshBWL, 38% for CON) and proportion attaining 5% weight loss (20%, 22%, 17%) revealed no significant differences between treatments; non-White participants had a higher proportion achieving LOC eating abstinence but a lower proportion attaining 5% weight loss compared with White participants.

Conclusions: In this 12-week randomized controlled trial following bariatric surgery, significant LOC eating reductions and weight loss did not differ significantly between treatments. Race was associated with posttreatment categorical outcomes.

Citing Articles

Understanding the Components of Eating Behaviour-Focused Weight Management Interventions Adjunct to Metabolic Bariatric Surgery: Systematic Review of Published Literature.

Yousefi R, Ben-Porat T, ONeill J, Boucher V, Stojanovic J, Fortin A Curr Obes Rep. 2025; 14(1):3.

PMID: 39753946 DOI: 10.1007/s13679-024-00596-7.

Racial differences after bariatric surgery: 24-month follow-up of a randomized, controlled trial for postoperative loss-of-control eating.

Ivezaj V, Dilip A, Duffy A, Grilo C Surg Obes Relat Dis. 2023; 20(3):261-266.

PMID: 37949690 PMC: 10922356. DOI: 10.1016/j.soard.2023.09.017.

Shape discrepancy, weight bias internalization, and eating-disorder psychopathology in patients with loss-of-control eating after bariatric surgery.

Dunford A, Ivezaj V, Grilo C Surg Obes Relat Dis. 2023; 20(3):291-296.

PMID: 37926627 PMC: 10922050. DOI: 10.1016/j.soard.2023.09.028.

Covariates of a healthy diet and physical activity self-management one year after Bariatric surgery: A cross-sectional study.

Maghsoodlo M, Shakibazadeh E, Barzin M, Salimi Y, Mokhtari Z, Yaseri M PLoS One. 2023; 18(10):e0287137.

PMID: 37851605 PMC: 10584161. DOI: 10.1371/journal.pone.0287137.

Predictors of early weight loss in post-bariatric surgery patients receiving adjunctive behavioural treatments for loss-of-control eating.

Smith C, Dilip A, Ivezaj V, Duffy A, Grilo C Clin Obes. 2023; 13(4):e12603.

PMID: 37257889 PMC: 10524670. DOI: 10.1111/cob.12603.

References

White M, Kalarchian M, Masheb R, Marcus M, Grilo C . Loss of control over eating predicts outcomes in bariatric surgery patients: a prospective, 24-month follow-up study. J Clin Psychiatry. 2009; 71(2):175-84. PMC: 2831110. DOI: 10.4088/JCP.08m04328blu. View

McHorney C, Ware Jr J, Lu J, Sherbourne C . The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994; 32(1):40-66. DOI: 10.1097/00005650-199401000-00004. View

King W, Hinerman A, Belle S, Wahed A, Courcoulas A . Comparison of the Performance of Common Measures of Weight Regain After Bariatric Surgery for Association With Clinical Outcomes. JAMA. 2018; 320(15):1560-1569. PMC: 6233795. DOI: 10.1001/jama.2018.14433. View

Grilo C, Masheb R, Wilson G . Different methods for assessing the features of eating disorders in patients with binge eating disorder: a replication. Obes Res. 2001; 9(7):418-22. DOI: 10.1038/oby.2001.55. View

Stewart F, Avenell A . Behavioural Interventions for Severe Obesity Before and/or After Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg. 2015; 26(6):1203-14. DOI: 10.1007/s11695-015-1873-6. View

Courcoulas A, King W, Belle S, Berk P, Flum D, Garcia L . Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study. JAMA Surg. 2017; 153(5):427-434. PMC: 6584318. DOI: 10.1001/jamasurg.2017.5025. View

Peterson C, Mitchell J, Crow S, Crosby R, Wonderlich S . The efficacy of self-help group treatment and therapist-led group treatment for binge eating disorder. Am J Psychiatry. 2009; 166(12):1347-54. PMC: 3041988. DOI: 10.1176/appi.ajp.2009.09030345. View

Sjostrom L . Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2012; 273(3):219-34. DOI: 10.1111/joim.12012. View

Busetto L, Dicker D, Azran C, Batterham R, Farpour-Lambert N, Fried M . Obesity Management Task Force of the European Association for the Study of Obesity Released "Practical Recommendations for the Post-Bariatric Surgery Medical Management". Obes Surg. 2018; 28(7):2117-2121. DOI: 10.1007/s11695-018-3283-z. View

10.

Grilo C, Masheb R . A randomized controlled comparison of guided self-help cognitive behavioral therapy and behavioral weight loss for binge eating disorder. Behav Res Ther. 2005; 43(11):1509-25. DOI: 10.1016/j.brat.2004.11.010. View

11.

Ware Jr J, Sherbourne C . The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992; 30(6):473-83. View

12.

Mond J, Latner J, Hay P, Owen C, Rodgers B . Objective and subjective bulimic episodes in the classification of bulimic-type eating disorders: another nail in the coffin of a problematic distinction. Behav Res Ther. 2010; 48(7):661-9. DOI: 10.1016/j.brat.2010.03.020. View

13.

Miller D, Freedson P, Kline G . Comparison of activity levels using the Caltrac accelerometer and five questionnaires. Med Sci Sports Exerc. 1994; 26(3):376-82. View

14.

DeBar L, Striegel-Moore R, Wilson G, Perrin N, Yarborough B, Dickerson J . Guided self-help treatment for recurrent binge eating: replication and extension. Psychiatr Serv. 2011; 62(4):367-73. PMC: 3962509. DOI: 10.1176/ps.62.4.pss6204_0367. View

15.

Hilbert A, Petroff D, Herpertz S, Pietrowsky R, Tuschen-Caffier B, Vocks S . Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder. J Consult Clin Psychol. 2018; 87(1):91-105. DOI: 10.1037/ccp0000358. View

16.

Freedland K, Mohr D, Davidson K, Schwartz J . Usual and unusual care: existing practice control groups in randomized controlled trials of behavioral interventions. Psychosom Med. 2011; 73(4):323-35. PMC: 3091006. DOI: 10.1097/PSY.0b013e318218e1fb. View

17.

Ivezaj V, Barnes R, Cooper Z, Grilo C . Loss-of-control eating after bariatric/sleeve gastrectomy surgery: Similar to binge-eating disorder despite differences in quantities. Gen Hosp Psychiatry. 2018; 54:25-30. PMC: 6245943. DOI: 10.1016/j.genhosppsych.2018.07.002. View

18.

Manning S, Pucci A, Carter N, Elkalaawy M, Querci G, Magno S . Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc. 2014; 29(6):1484-91. PMC: 4422859. DOI: 10.1007/s00464-014-3829-7. View

19.

Grilo C, Masheb R, White M, Gueorguieva R, Barnes R, Walsh B . Treatment of binge eating disorder in racially and ethnically diverse obese patients in primary care: randomized placebo-controlled clinical trial of self-help and medication. Behav Res Ther. 2014; 58:1-9. PMC: 4074556. DOI: 10.1016/j.brat.2014.04.002. View

20.

Godin G, Shephard R . A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985; 10(3):141-6. View