Elsevier

Nutrition

Volume 49, May 2018, Pages 13-16
Nutrition

Applied nutritional investigation
Emotional eating behavior hinders body weight loss in women after Roux-en-Y gastric bypass surgery

https://doi.org/10.1016/j.nut.2017.11.017Get rights and content

Highlights

  • The Three-Factor Eating Questionnaire was used to assess the eating behavior of women seen in the public health system ≥2 y after Roux-en-Y gastric bypass.

  • Emotional eating was negatively associated with the percentage of excess weight loss, regardless of postoperative time.

  • Results indicate the relevance of monitoring the emotional components of eating behavior during the long-term nutritional follow-up of Roux-en-Y gastric bypass patients.

Abstract

Objective

Successful weight loss and maintenance after Roux-en-Y gastric bypass (RYGB) may be related to eating behavior. The aim of this study was to assess the eating behavior domains that prevail in women during the RYGB postoperative period and their associations with surgery outcome.

Methods

This cross-sectional study investigated eating behavior in 95 women (47.3 ± 9.8 y old)  ≥ 2 y after Roux-en-Y gastric bypass. Patients were grouped according to surgery outcome: successful group (SG; n = 67), defined as having lost ≥ 50% of the preoperative excess weight loss (EWL), and an unsuccessful group (UG; n = 28). Mean postoperative time was 59.5 ± 21.2 mo (55.7 ± 19.9 in the SG and 68.6 ± 21.9 in the UG). The short version of the Three-Factor Eating Questionnaire was used to assess cognitive restraint, emotional eating, and uncontrolled eating behaviors. Multivariate analysis was used to investigate associations between eating behavior scores and EWL.

Results

The highest score in both groups was for the cognitive restraint domain, followed by emotional and uncontrolled eating. Emotional eating was negatively associated with percentage of EWL (β = −0.286; P = 0.033), regardless of age, educational attainment, and postoperative time.

Conclusion

The cognitive restraint domain was the main type of eating behavior observed, and patients with higher emotional eating score were at a higher risk for having insufficient weight loss after RYGB. These results indicate the relevance of monitoring emotional components during the long-term nutritional follow-up of bariatric patients to achieve better surgery outcomes.

Introduction

Bariatric surgery is considered the treatment of choice for severe obesity [1], and the Roux-en-Y gastric bypass (RYGB) is one of the most common procedures as it promotes greater excess weight loss (EWL) and control of comorbidities [2], [3]. Although this surgery's success is measured by many factors, including improvement of comorbidities, quality of life, and mortality, EWL after RYGB has been used as a simple and effective measurement instrument. The surgery is considered successful when the EWL is ≥ 50% of the preoperative excess body weight [1].

Individuals with eating disorders tend to lose less weight after surgery, and eating behavior has been pointed out as one of the factors that affect surgery outcome [4]. Bariatric surgery can have beneficial effects on eating behavior, but it has been suggested that these effects may decrease over time [5].

To analyze the eating behavior of adults with obesity, Stunkard and Messick [6] developed the Three-Factor Eating Questionnaire (TFEQ), which covers three domains: emotional eating, cognitive restraint, and uncontrolled eating. Later, a shorter version with 21 questions (TFEQ-R21) was translated and validated in Brazil [7], [8]. Conceição et al. [9] suggested that disordered eating behavior in the bariatric population may affect treatment outcome. The anatomic and physiological changes induced by bariatric surgery directly interfere in the patients' food intake capacity. Thus, a disordered eating behavior present in the preoperative period may manifest differently after surgery, which may hinder the correct diagnosis and management of these patients [9]. This topic has not been sufficiently clarified, taking into account possible confounding factors.

The present study aimed to assess the prevalence of the three TFEQ-R21 eating behavior domains in Brazilian women ≥2 y after undergoing RYGB in the public health system. Additionally, we investigated whether there was an association between these domains and the percentage of postoperative EWL.

Section snippets

Materials and methods

This cross-sectional study was conducted at the Severe Obesity Outpatient Clinic of the University Hospital of Brasília, Brazil, from June to December 2013, as part of a randomized controlled trial (protocol number U1111-1136-0576). Women who had undergone RYGB between 2 and 10 y before the study were invited to participate. Only women were enrolled because they compose the majority of patients who seek public bariatric surgery services. Pregnant women or those taking drugs that could influence

Results

Ninety-five women were included in the study, with 67 in the SG and 28 in the UG. Mean age was 47.3 ± 9.7 y, and 59% had 8 to 12 y of formal education. EWL was 63.1% (74.8% in SG and 35% in UG; P = < 0.0001). Mean postoperative time was 59.5 ± 21.2 mo. Participants from the UG had a lower education level, a higher postoperative time, and a higher BMI than those in the SG (Table 1).

Table 2 shows eating behavior according to surgery outcome. Cognitive restraint prevailed in both groups. The UG

Discussion

In the present study, emotional eating was negatively associated with % EWL, regardless of postoperative time. Emotional eating is characterized by an eating pattern influenced by changes in mood in response to stress, usually associated with challenging situations, so that individuals turn to food for comfort [8]. Some patients consider surgery as an external solution to excess weight better than personal effort [4], and the inability to control eating behavior after surgery, especially the

Conclusion

Cognitive restraint was the main eating behavior domain observed in women a long period after RYGB surgery. Women with higher emotional eating scores are at risk for having insufficient postsurgery weight loss. In this analysis, however, there was no association between cognitive restraint or uncontrolled eating behavior with EWL. These results indicate the relevance of monitoring the components of eating behavior, especially the emotional domain, during the long-term nutritional follow-up of

Acknowledgments

The authors acknowledge the Foundation for Scientific and Technological Enterprises (FINATEC) and the University of Brasilia for their support for English-language proofreading.

References (27)

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    Further support for a role for emotional eating in GLP-1 induced weight loss comes from studies investigating the effects of Roux-en-Y gastric bypass (RYGB) surgery. Suboptimal weight loss two years post-surgery was associated with emotional eating scores (Novelli et al., 2018). Interestingly, the effects of RYGB on food intake and weight loss could be mediated by altered activation in feeding regulating areas in the brain in response to food stimuli (Ten Kulve et al., 2017; Madsbad, Dirksen, and Holst, 2014).

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    For instance, larger decreases in Disinhibition and Hunger (Alarcon Del Agua et al., 2017; Konttinen et al., 2015), decreases in Hunger alone (Figura, Rose, Ordemann, Klapp, & Ahnis, 2016) or decreases in Disinhibition alone (Amundsen, Strømmen, & Martins, 2017; Bond et al., 2009; Livhits et al., 2011) were related to greater short and long-term weight loss post-surgery. Furthermore, evidence also suggests that higher Uncontrolled Eating (incorporating aspects of Disinhibition and Hunger) (Abu Dayyeh, Jirapinyo, & Thompson, 2017; Engstrom et al., 2015; Hogenkamp, Sundborn, Nilsson, Benedict, & Schioth, 2015) and higher Emotional Eating (Novelli, Fonseca, Gomes, Dutra, & Baiocchi de Carvalho, 2018) are associated with less weight loss success following surgery. In addition, higher External Eating and Emotional Eating, as measured by the DEBQ, have also been related to less weight loss success (Pepino et al., 2014).

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    2023, Handbook of Metabolic and Bariatric Surgery
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This study was sponsored by CNPQ under process number 476459/2011-7; notice/universal call 14/20111. The authors have no conflicts of interest to declare.

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