Obesity Surgery

, Volume 29, Issue 6, pp 1773–1780 | Cite as

Loss of Control Eating and Binge Eating in the 7 Years Following Bariatric Surgery

  • Kathryn E. Smith
  • Molly Orcutt
  • Kristine J. Steffen
  • Ross D. Crosby
  • Li Cao
  • Luis Garcia
  • James E. Mitchell
Original Contributions



Although bariatric surgery is an effective intervention for severe obesity, a subset of patients demonstrates suboptimal weight outcomes. Postoperative loss of control eating (LOCE) and binge eating may influence weight outcomes, though research has not examined differences by surgical procedure, or factors that predict postoperative LOCE. This study aimed to [1] characterize LOCE and binge eating disorder (BED) over a 7-year period following bariatric surgery; [2] examine concurrent, prospective, and cumulative relationships between LOCE and weight loss; [3] assess whether these associations are moderated by surgery type; and [4] evaluate predictors of LOCE.


Participants were 2156 patients who underwent laparoscopic adjustable gastric banding (LAGB) or Roux-n-Y gastric bypass (RYGB) in the multi-center Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study. Generalized linear mixed models examined relationships between LOCE and percent weight loss and predictors of LOCE.


LOCE and BED initially declined then increased after surgery, with a notable number of de-novo cases (25.6% and 4.8%, respectively). LOCE was related to less concurrent but not prospective or cumulative percent weight loss. Self-monitoring of eating, higher daily eating frequency, older age, male gender, and higher self-esteem were associated with a lower likelihood of LOCE.


Results suggest that LOCE and binge eating are clinically relevant behaviors that may impede weight loss, and findings highlight the importance of ongoing assessment of maladaptive eating following surgery.


Bariatric surgery Gastric bypass Gastric banding Binge eating disorder Loss of control eating Weight loss 


Funding Information

LABS-2 was funded by a cooperative agreement by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grants (University of Pittsburgh, Data Coordinating Center); U01-DK66667 and UL1-RR024996 (Columbia- Presbyterian in collaboration with Cornell University Medical Center Clinical and Translational Research Center [CTRC]); U01-DK66568 and M01RR-00037 (University of Washington in collaboration with Cornell University Medical Center CTRC); U01-DK66471 (Neuropsychiatric Research Institute); U01-DK66526 (East Carolina University); U01-DK66585 and UL1- RR024153 (University of Pittsburgh Medical Center in collaboration with Cornell University Medical Center CTRC); and U01-DK66555 (Oregon Health & Science University).

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Courcoulas AP, King WC, Belle SH, et al. Seven-year weight trajectories and health outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) study. JAMA Surg. 2018;153(5):427–34. Scholar
  2. 2.
    Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648–51. Scholar
  3. 3.
    Odom J, Zalesin KC, Washington TL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20(3):349–56. Scholar
  4. 4.
    Meany G, Conceicao E, Mitchell JE. Binge eating, binge eating disorder and loss of control eating: effects on weight outcomes after bariatric surgery. Eur Eat Disord Rev. 2014;22(2):87–91. Scholar
  5. 5.
    Association AP. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: Author; 2013.CrossRefGoogle Scholar
  6. 6.
    Duncan AE, Ziobrowski HN, Nicol G. The prevalence of past 12-month and lifetime DSM-IV eating disorders by BMI category in US men and women. Eur Eat Disord Rev. 2017;25(3):165–71. Scholar
  7. 7.
    Mitchell JE, King WC, Courcoulas A, et al. Eating behavior and eating disorders in adults before bariatric surgery. Int J Eat Disord. 2015;48(2):215–22. Scholar
  8. 8.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl 1):S1–27. Scholar
  9. 9.
    Colles SL, Dixon JB, O’Brien PE. Grazing and loss of control related to eating: two high-risk factors following bariatric surgery. Obesity (Silver Spring). 2008;16(3):615–22. Scholar
  10. 10.
    Conceicao EM, Mitchell JE, Pinto-Bastos A, et al. Stability of problematic eating behaviors and weight loss trajectories after bariatric surgery: a longitudinal observational study. Surg Obes Relat Dis. 2017;13(6):1063–70. Scholar
  11. 11.
    Devlin MJ, King WC, Kalarchian MA, et al. Eating pathology and experience and weight loss in a prospective study of bariatric surgery patients: 3-year follow-up. Int J Eat Disord. 2016;49(12):1058–67. Scholar
  12. 12.
    Mitchell JE, Christian NJ, Flum DR, et al. Postoperative behavioral variables and weight change 3 years after bariatric surgery. JAMA Surg. 2016;151(8):752–7. Scholar
  13. 13.
    Chao AM, Wadden TA, Faulconbridge LF, et al. Binge-eating disorder and the outcome of bariatric surgery in a prospective, observational study: two-year results. Obesity (Silver Spring). 2016;24(11):2327–33. Scholar
  14. 14.
    Wadden TA, Faulconbridge LF, Jones-Corneille LR, et al. Binge eating disorder and the outcome of bariatric surgery at one year: a prospective, observational study. Obesity (Silver Spring). 2011;19(6):1220–8. Scholar
  15. 15.
    Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc. 2011;111(1):92–102. Scholar
  16. 16.
    Loth KA, Goldschmidt AB, Wonderlich SA, et al. Could the resource depletion model of self-control help the field to better understand momentary processes that lead to binge eating? Int J Eat Disord. 2016;49(11):998–1001. Scholar
  17. 17.
    Heatherton TF, Wagner DD. Cognitive neuroscience of self-regulation failure. Trends Cogn Sci. 2011;15(3):132–9. Scholar
  18. 18.
    Haedt-Matt AA, Keel PK. Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment. Psychol Bull. 2011;137(4):660–81. Scholar
  19. 19.
    Saunders JB, Aasland OG, Babor TF, et al. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption--II. Addiction. 1993;88(6):791–804.CrossRefGoogle Scholar
  20. 20.
    Marek RJ, Heinberg LJ, Lavery M, et al. A review of psychological assessment instruments for use in bariatric surgery evaluations. Psychol Assess. 2016;28(9):1142–57. Scholar
  21. 21.
    Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.CrossRefGoogle Scholar
  22. 22.
    Krukowski RA, Friedman KE, Applegate KL. The utility of the Beck Depression Inventory in a bariatric surgery population. Obes Surg. 2010;20(4):426–31. Scholar
  23. 23.
    Kolotkin RL, Crosby RD, Kosloski KD, et al. Development of a brief measure to assess quality of life in obesity. Obes Res. 2001;9(2):102–11. Scholar
  24. 24.
    Dymek MP, Le Grange D, Neven K, et al. Quality of life after gastric bypass surgery: a cross-sectional study. Obes Res. 2002;10(11):1135–42. Scholar
  25. 25.
    Kolotkin RL, Crosby RD, Gress RE, et al. Two-year changes in health-related quality of life in gastric bypass patients compared with severely obese controls. Surg Obes Relat Dis. 2009;5(2):250–6. Scholar
  26. 26.
    Kolotkin RL, Crosby RD, Pendleton R, et al. Health-related quality of life in patients seeking gastric bypass surgery vs non-treatment-seeking controls. Obes Surg. 2003;13(3):371–7. Scholar
  27. 27.
    Smyth JM, Wonderlich SA, Heron KE, et al. Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment. J Consult Clin Psychol. 2007;75(4):629–38. Scholar
  28. 28.
    Stice E. A prospective test of the dual-pathway model of bulimic pathology: mediating effects of dieting and negative affect. J Abnorm Psychol. 2001;110(1):124–35.CrossRefGoogle Scholar
  29. 29.
    Munoz DJ, Chen E, Fischer S, et al. Considerations for the use of the Beck Depression Inventory in the assessment of weight-loss surgery seeking patients. Obes Surg. 2007;17(8):1097–101.CrossRefGoogle Scholar
  30. 30.
    Goldschmidt AB, Conceicao EM, Thomas JG, et al. Conceptualizing and studying binge and loss of control eating in bariatric surgery patients-time for a paradigm shift? Surg Obes Relat Dis. 2016;12(8):1622–5. Scholar
  31. 31.
    Bodell LP, Forney KJ, Chavarria J, et al. Self-report measures of loss of control over eating: psychometric properties in clinical and non-clinical samples. Int J Eat Disord. 2018;51(11):1252–60. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kathryn E. Smith
    • 1
    • 2
  • Molly Orcutt
    • 1
    • 2
    • 3
  • Kristine J. Steffen
    • 1
    • 4
  • Ross D. Crosby
    • 1
    • 2
  • Li Cao
    • 1
  • Luis Garcia
    • 1
    • 5
    • 6
  • James E. Mitchell
    • 1
    • 2
  1. 1.Sanford Center for Bio-behavioral ResearchFargoUSA
  2. 2.Department of Psychiatry and Behavioral ScienceUniversity of North Dakota School of Medicine and Health SciencesFargoUSA
  3. 3.Fargo VA Health Care SystemFargoUSA
  4. 4.Department of Pharmaceutical Sciences, College of Pharmacy, Nursing, and AlliancesNorth Dakota State UniversityFargoUSA
  5. 5.Sanford HealthFargoUSA
  6. 6.Department of SurgeryUniversity of North Dakota School of Medicine and Health SciencesGrand ForksUSA

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