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The role of dumping syndrome in weight loss after gastric bypass surgery

Abstract

Background

Roux-en-Y gastric bypass is the most commonly performed operation for the treatment of morbid obesity in the US. Dumping syndrome is an expected and desired part of the behavior modification caused by gastric bypass surgery; it can deter patients from consuming energy-dense food. In this study we assessed the role dumping has in weight loss and its relationship with the patient’s eating behavior.

Methods

Fifty patients who underwent gastric bypass between January 2008 and June 2008 were enrolled. Two questionnaires, the dumping syndrome questionnaire and the Three-Factor Eating Questionnaire (TFEQ), were used to record the patients’ responses. The diagnosis of dumping syndrome was based on the Sigstad scoring system, where a score of 7 and above was considered positive. TFEQ evaluated the patients’ eating behavior under three scales: cognitive restraint, uncontrolled eating, and emotional eating. The results were analyzed with descriptive and parametric statistics where applicable.

Results

The prevalence of dumping syndrome was 42 %, with 66.7 % of the subjects being women. The nondumpers were observed to have a greater mean decrease in body mass index than the dumpers at 1 and 2 years (18.5 and 17.8 vs. 14.4 and 13.7 respectively). There was no definite relationship between the presence of dumping syndrome and the eating behavior of the patient. However, the cognitive restraint scores, greater than 80 %, were associated with an average decrease in BMI of 19 and 20.8 at 1 and 2 years compared with 14.6 and 12.4 in those with scores less than 80 % (p = 0.01 and p = 0.03, respectively).

Conclusion

The presence of dumping syndrome after gastric bypass does not influence weight loss, though eating behaviors may directly influence it.

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Acknowledgments

This study was supported in part by an unrestricted educational grant (reference no. 60028311) from Covidien (Mansfield, MA). However, the sponsor did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data, or in the preparation, review, and approval of the manuscript.

Disclosure

Drs. Banerjee, Mikami and Needleman and Mr. Ding have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Ambar Banerjee.

Appendices

Appendix 1

Sigstad clinical diagnostic index for the diagnosis of dumping syndrome

Shock +5
Almost fainting, syncope, unconsciousness +4
Desire to lie or sit down +4
Breathlessness, dyspnea +3
Weakness, exhaustion +3
Sleepiness, drowsiness, yawning, apathy, falling asleep +3
Palpitation +3
Restlessness +2
Dizziness +2
Headaches +1
Feeling of warmth, sweating, pallor, clammy skin +1
Nausea +1
Fullness in the abdomen, meteorism +1
Borborygmus +1
Eructation −1
Vomiting −4
  1. A score of +7 or more indicated the presence of dumping syndrome

Appendix 2

The three-factor eating questionnaire—revised 18-item

1. When I smell a sizzling steak or juicy piece of meat, I find it very difficult to keep from eating, even if I have just finished a meal.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
2. I deliberately take small helpings as a means of controlling my weight.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
3. When I feel anxious, I find myself eating.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
4. Sometimes when I start eating, I just can’t seem to stop.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
5. Being with someone who is eating often makes me hungry enough to eat also.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
6. When I feel blue, I often overeat.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
7. When I see a real delicacy, I often get so hungry that I have to eat right away.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
8. I get so hungry that my stomach often seems like a bottomless pit.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
9. I am always hungry so it is hard for me to stop eating before I finish the food on my plate.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
10. When I feel lonely, I console myself by eating.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
11. I consciously hold back at meals in order not to gain weight.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
12. I do not eat some foods because they make me fat.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
13. I am always hungry enough to eat at any time.
Definitely true (4) Mostly true (3) Mostly false (2) Definitely false (1)
14. How often do you feel hungry?
Only at meal times (1) Sometimes between meals (2) Often between meals (3) Almost always (4)
15. How frequently do you avoid “stocking up” on tempting foods?
Almost never (1) Seldom (2) Usually (3) Almost always (4)
16. How likely are you to consciously eat less than you want?
Unlikely (1) Slightly likely (2) Moderately likely (3) Very likely (4)
17. Do you go on eating binges though you are not hungry?
Never (1) Rarely (2) Sometimes (3) At least once a week (4)
18. On a scale of 1 to 8, where 1 means no restraint in eating (eating whatever you want, whenever you want it) and 8 means total restraint (constantly limiting food intake and never “giving in”), what number would you give yourself?
  1. The 1–2 scores were coded 1; 3–4 scores were coded 2; 5–6 scores were coded 3; 7–8 scores were coded 4
  2. The cognitive restraint scale was composed of items 2, 11, 12, 15, 16, and 18. The uncontrolled eating scale was composed of items 1, 4, 5, 7, 8, 9, 13, 14, and 17. The emotional eating scale was composed of items 3, 6, and 10

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Banerjee, A., Ding, Y., Mikami, D.J. et al. The role of dumping syndrome in weight loss after gastric bypass surgery. Surg Endosc 27, 1573–1578 (2013). https://doi.org/10.1007/s00464-012-2629-1

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Keywords

  • Dumping syndrome
  • Roux-n-Y gastric bypass
  • Morbid obesity
  • Weight loss