Eating Pattern and Bariatric Surgery

  • Gian Franco Adami


Bariatric surgery entails profound anatomical and/or functional modifications in the upper gastrointestinal tract, and consequently a marked change in the patient’s eating habits and behavior occurs. After adjustable silicone gastric banding, vertical banded gastroplasty and Roux-en Y gastric bypass, gastric restriction represents the most powerful factor able, mechanically and/or physiologically, to induce decreased food intake. Eating behavior modifications that lead to permanent reduction of food intake cause satisfactory long-term weight loss and maintenance. On the contrary, when subjects contrast the mechanical and/or physiological effects of surgical intervention by eating frequently and rapidly, drinking after eating, consuming large amounts of condiments or calorie-rich beverages or by “grazing,” cumulative energy intake is not modified, resulting in reduced weight loss and/or weight gain. Thanks to the permanent and selective limitation of intestinal absorption of energy-rich substrates, body weight of those subjects having undergone biliopancreatic diversion is nearly completely independent of food consumption. Therefore, permanent changes in eating habits and behaviors are not necessary in order to achieve satisfactory weight loss and maintenance, which can be obtained with a completely “free” diet in the vast majority of cases. After biliopancreatic diversion, a marked improvement in eating behavior is observed, with an overall reduction in the prevalence of binge eating episodes and a sharp decrease in disinhibitive and cognitive restraint. Some studies have demonstrated that weight loss obtained via the gastric restriction procedure is accompanied by general improvement in eating behaviors, while other research has shown that after surgical intervention a high disinhibition level is maintained, usually accompanied by poor weight loss and increased weight regain. Prior to gastric restriction procedures or biliopancreatic diversion, psychological and/or behavioral preoperative factors have not proven effective in predicting weight outcome in the presence of postoperative complications, and behavioral intervention prior to surgical intervention does not improve clinical results. After biliopancreatic diversion, the vast majority of subjects succeed without therapy in adapting both to the new anatomical and functional gastrointestinal tract conditions derived from the intervention as well as to the novel somatic morphology resulting from stable weight loss. Only a small minority of patients require standard behavioral modification treatment to improve their individual quality of life. On the contrary, for the purpose of achieving satisfactory weight outcomes for a greater possible number of subjects having undergone gastric banding, gastroplasty, and gastric bypass, specific behavioral intervention aimed at improving individual eating habits and behaviors, adapted to gastric restriction, must be envisaged. Full recovery from severe obesity includes the steady reduction of body weight in keeping with the physiological range, as well as the disappearance of comorbidities specifically caused by obesity, such as impaired glucose tolerance, type 2 diabetes, blood hypertension, and dyslipidemia Generally, conservative therapy does not succeed in obtaining these results: reducing diet and eating behavior modification may lead to minor weight loss, with a concomitant benefit on comorbidities: however, weight regain within a few months with the reappearance of complications is unfortunately the rule in nearly all cases. Modern pharmacologic therapy results only in a 10% decrease in body weight. Moreover, the chronic use of antiobesity drugs can lead to severe side effects, which force the discontinuation of therapy with consequent weight regain. By contrast, bariatric (from the ancient Greek word barùs meaning heavy) surgery produces adequate weight loss, which is satisfactorily sustained in the long term along with the stable disappearance or marked improvement in metabolic and structural complications related to obesity (Buchwald et al. 2004). At present bariatric surgery represents the best therapeutic approach to the treatment of severe obesity. Because the prevalence of severe obesity is dramatically increasing in western developed countries), an even greater number of patients undergo surgery for obesity. Therefore, the need for clinicians involved in psychological and behavioral problems related to postobese individuals who have undergone bariatric procedures will undoubtedly increase in the near future. As is generally well known, body weight represents a balance between the individual’s bioenergetic entity and the environment, and any change in body weight is a result of changes in energy intake, energy expenditure, or both (Garrow 1988). Because significant modifications in energy expenditure are inconceivable, bariatric surgery strongly affects energy intake (directly and/or indirectly), then food consumption, with the obvious resulting influence on the individual’s eating habits. For a full understanding of the relationship between eating behavior and obesity surgery, as well as the modifications in eating behavior caused by obesity surgery itself, sufficient knowledge of the principle acting mechanisms of the different bariatric procedures is mandatory.


Binge Eating Vertical Band Gastroplasty Binge Eating Disorder Biliopancreatic Diversion Adjustable Silicone Gastric Banding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Adjustable silicone gastric banding


Vertical banded gastroplasty


Roux-en Y-gastric bypass


Biliopancreatic diversion


Binge eating disorder


  1. Adami GF, Gandolfo P, Dapueto R, Jurich D, Scopinaro N. Eating behavior following biliopancreatic diversion for obesity: study with a three-factor eating questionnaire. Int J Eat Disord. 1993;14:81–6.PubMedCrossRefGoogle Scholar
  2. Adami GF, Gandolfo P, Meneghelli A, Scopinaro N. Binge eating in obesity: a longitudinal study following biliopancreatic diversion. Int J Eat Disord. 1996b;20:405–13.PubMedCrossRefGoogle Scholar
  3. Adami GF, Meneghelli A, Bressani A, Scopinaro N. Body image in obese patients before and after stable weight reduction following bariatric surgery. J Psychosom Res. 1999a;46:275–81.PubMedCrossRefGoogle Scholar
  4. Adami GF, Meneghelli A, Scopinaro N. Night eating and BED in obese patients. Int J Eat Disord. 1999b;25:335–8.PubMedCrossRefGoogle Scholar
  5. Adami GF. The influence of body weight on food and shape attitudes in severely obese patients. Int J Obes Relat Metab Disord. 2001;25 Suppl 1:S56–9.PubMedCrossRefGoogle Scholar
  6. Adami GF, Campostano A, Ravera G, Leggieri M, Scopinaro N. Alexithymia and body weight in obese patients. Behav Med. 2001;27:121–6.PubMedCrossRefGoogle Scholar
  7. Adami G, Campostano A, Cella F, Ferrandes G. Serum leptin level and restrained eating: study with the Eating Disorder Examination. Physiol Behav. 2002;75:189–92.PubMedCrossRefGoogle Scholar
  8. Adami GF, Ramberti G, Weiss A, Carlini F, Murelli F, Scopinaro N. Quality of life in obese subjects following biliopancreatic diversion. Behav Med. 2005;31:53–60.PubMedCrossRefGoogle Scholar
  9. Birketvedt GS, Florholmen J, Sundsfjord J, Østerund B, Dingers D, Bilker W, Stunkard AJ. Behavioral and neuroendocrine characteristics of the Night-Eating Syndrome. JAMA. 1999;282:657–63.PubMedCrossRefGoogle Scholar
  10. Bocchieri LE, Meana M, Fisher BL. Perceived psychosocial outcomes of gastric bypass surgery: a qualitative study. Obes Surg. 2002a;12:781–8.PubMedCrossRefGoogle Scholar
  11. Bocchieri LE, Meana M, Fisher BL. A review of psychosocial outcomes of surgery for morbid obesity. J Psychosom Res. 2002b;52:155–65.PubMedCrossRefGoogle Scholar
  12. Bryant EJ, King NA, Blundell JE. Disinhibition: its effects on appetite and weight regulation. Obes Rev. 2007;9:409–19.PubMedCrossRefGoogle Scholar
  13. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;13 292:1724–37.CrossRefGoogle Scholar
  14. Busetto L, Valente P, Pisent C, Segato G, de Marchi F, Favretti F, Lise M, Enzi G. Eating pattern in the first year following adjustable silicone gastric banding (ASGB) for morbid obesity. Int J Obes Relat Metab Disord. 1996;20:539–46.PubMedGoogle Scholar
  15. Busetto L, Segato G, De Luca M, De Marchi F, Foletto M, Vianello M, Valeri M, Favretti F, Enzi G. Weight loss and postoperative complications in morbidly obese patients with BED treated by laparoscopic adjustable gastric banding. Obes Surg. 2005;15:195–201.PubMedCrossRefGoogle Scholar
  16. Camerini G, Adami GF, Marinari GM, Campostano A, Ravera G, Scopinaro N. Failure of preoperative resting energy expenditure in predicting weight loss after gastroplasty. Obes Res. 2001;9:589–91.PubMedCrossRefGoogle Scholar
  17. Chevallier JM, Paita M, Rodde-Dunet MH, Marty M, Nogues F, Slim K, Basdevant A. Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behavior. Ann Surg. 2007;246:1034–9.PubMedCrossRefGoogle Scholar
  18. Colles SL, Dixon JB. Night eating syndrome: impact on bariatric surgery. Obes Surg. 2006;16:811–20.PubMedCrossRefGoogle Scholar
  19. 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;16:615–22.CrossRefGoogle Scholar
  20. de Zwaan M, Mitchell JE, Howell LM, Monson N, Swan-Kremeier L, Crosby RD, Seim HC. Characteristics of morbidly obese patients before gastric bypass surgery. Compr Psychiatry. 2003;44:428–34.PubMedCrossRefGoogle Scholar
  21. Dingemans AE, Bruna MJ, van Furth EF. BED; a review. Int J Ob Relat Metab Disord. 2002;26:299–307.CrossRefGoogle Scholar
  22. Dymek MP, Le Grange D, Neven K, Alverdy J. Quality of life and psychosocial adjustment in patients after Roux-en-Y gastric bypass: a brief report. Obes Surg. 2001;11:32–9.PubMedCrossRefGoogle Scholar
  23. Favretti F, Segato G, Ashton D, Busetto L, De Luca M, Mazza M, Ceoloni A, Banzato O, Calo E, Enzi G. Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results. Obes Surg. 2007;17:168–75.PubMedCrossRefGoogle Scholar
  24. Fichter MM, Quadflieg N, Gnutzmann A. BED: treatment outcome over a 6-year course. J Psychosom Res. 1998;44:385–405.PubMedCrossRefGoogle Scholar
  25. Garrow JS. Aetiology of obesity in man. In: Obesity and related diseases. Edinburg: Churchill Livingstone; 1988. p. 101–133.Google Scholar
  26. Herman CP, Polivy L, Leone T. The psychology of overeating. In: Mela D, editor. Food, diet and obesity. Cambridge: Woodhead; 2005. p. 115–136.CrossRefGoogle Scholar
  27. Herpertz S, Kielmann R, Wolf AM, Hebebrand J, Senf W. Do psychosocial variables predict weight loss or mental health after obesity surgery? A systematic review. Obes Res. 2004;12:1554–69.PubMedCrossRefGoogle Scholar
  28. Hsu LKG, Betancourt S, Sullivan SP. Eating disturbances before and after VBG: a pilot study. Int J Eat Disord. 1996;19:3–34.CrossRefGoogle Scholar
  29. Hsu LKG, Benotti PN, Dwyer J, Roberts SB, Saltzman E, Shikora S, Rolls BJ, Rand W. Nonsurgical factors that ­influence the outcome of bariatric surgery: a review. Psychosom Med. 1998;60:338–46.PubMedGoogle Scholar
  30. Hudson SM, Dixon JB, O’Brien PE. Sweet eating is not a predictor of outcome after Lap-Band placement. Can we finally bury the myth? Obes Surg. 2002;12:789–94.PubMedCrossRefGoogle Scholar
  31. Kalarchian MA, Marcus MD, Wilson GT, Labouvie EW, Brolin RE, LaMarca LB. Binge eating among gastric bypass patients at long-term follow-up. Obes Surg. 2002;12:270–5.PubMedCrossRefGoogle Scholar
  32. Leahey TM, Bond DS, Irwin SR, Crowther JH, Wing RR. When is the best time to deliver behavioral intervention to bariatric surgery patients: before or after surgery? Surg Obes Relat Dis. 2009;5:99–102.PubMedCrossRefGoogle Scholar
  33. Lang T, Hauser R, Buddeberg C, Klaghofer R. Impact of gastric banding on eating behavior and weight. Obes Surg. 2002;12:100–7.PubMedCrossRefGoogle Scholar
  34. Larsen JK, Geenen R, Maas C, de Wit P, van Antwerpen T, Brand N, van Ramshorst B. Personality as a predictor of weight loss maintenance after surgery for morbid obesity. Obes Res. 2004;12:1828–34.PubMedCrossRefGoogle Scholar
  35. Lindroos AK, Lissner L, Sjostrom L. Weight change in relation to intake of sugar and sweet foods before and after weight reducing gastric surgery. Int J Obes Relat Metab Disord. 1996;20:634–43.PubMedGoogle Scholar
  36. MacLean LD, Shibata HR. The present status of bypass operations for obesity. Surg Annu. 1977;9:213–30.PubMedGoogle Scholar
  37. Malone M, Alger-Mayer S. Binge status and quality of life after gastric bypass surgery: a one-year study. Obes Res. 2004;12:473–81.PubMedCrossRefGoogle Scholar
  38. Mason EE, Doherty C, Cullen JJ, Scott D, Rodriguez EM, Maher JW. Vertical gastroplasty: evolution of VBG. World J Surg. 1998;22:919–24.PubMedCrossRefGoogle Scholar
  39. Marceau P, Biron S, Hould FS, Lebel S, Marceau S, Lescelleur O, Biertho L, Simard S. Duodenal switch: long-term results. Obes Surg. 2007;17:1421–30.PubMedCrossRefGoogle Scholar
  40. Mitchell JEm Lancaster KL, Burgard MA, Howell LM, Krahn DD, Crosby RD, Wonderlich SA, Gosnell BA. Long-term follow-up patients’ status after gastric bypass. Obes Surg. 2001;11:464–8.PubMedCrossRefGoogle Scholar
  41. Munoz DJ, Lal M, Chen EY, Mansour M, Fischer S, Roehrig M, Sanchez-Johnsen L, Dymek-Valenitine M, Alverdy J, le Grange D. Why patients seek bariatric surgery: a qualitative and quantitative analysis of patient motivation. Obes Surg. 2007;17:1487–91.PubMedCrossRefGoogle Scholar
  42. Norris L. Psychiatric issues in bariatric surgery. Psychiatr Clin North Am. 2007;30:717–38.PubMedCrossRefGoogle Scholar
  43. Powers PS, Perez A, Boyd F, Rosemurgy A. Eating pathology before and after bariatric surgery: a prospective study. Int J Eat Disord. 1999;25:293–300.PubMedCrossRefGoogle Scholar
  44. Ronchi A, Marinari GM, Sukkar SG, Scopinaro N, Adami GF. Behavioral characteristics of severely obese patients seeking bariatric surgery: ross-sectional study with alimentary interview. Behav Med. 2008;33:145–50.PubMedCrossRefGoogle Scholar
  45. Sarwer DB, Wadden TA, Fabricatore AF. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13:639–48.PubMedCrossRefGoogle Scholar
  46. Sarwer DB, Wadden TA, Moore RH, Baker AW, Gibbons LM, Raper SE, Williams NN. Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2008;4:640–6.PubMedCrossRefGoogle Scholar
  47. Saunders R. “Grazing”: a high-risk behavior. Obes Surg. 2004;14:98–102.PubMedCrossRefGoogle Scholar
  48. Scopinaro N, Adami GF, Marinari GM, Gianetta E, Traverso E, Friedman D, Camerini G, Baschieri G, Simonelli A. Biliopancreatic diversion. World J Surg. 1998;22:936–46.PubMedCrossRefGoogle Scholar
  49. Scopinaro N, Marinari GM, Pretolesi F, Papadia F, Murelli F, Marini P, Adami GF. Energy and nitrogen absorption after biliopancreatic diversion. Obes Surg. 2000;10:436–41.PubMedCrossRefGoogle Scholar
  50. Sharon R, Irwin DW. A cognitive-behavioral mindfulness group therapy intervention for the treatment of binge eating in bariatric surgery patients. Cogn Behav Pract. 2003;15:364–75.Google Scholar
  51. Silver HJ, Torquati A, Jensen GL, Richards WO. Weight, dietary and physical activity behaviors two years after gastric bypass. Obes Surg. 2006;16:859–64.PubMedCrossRefGoogle Scholar
  52. Sugerman HJ, Londrey GL, Kellum JM, Wolf L, Liszka T, Engle KM, Birkenhauer R, Starkey JV. Weight loss with VBG and Roux-Y gastric bypass for morbid obesity with selective versus random assignment. Am J Surg. 1989;157:93–102.PubMedCrossRefGoogle Scholar
  53. van Hout GC, Jakimowicz JJ, Fortuin FA, Pelle AJ, van Heck GL. Weight loss and eating behavior following VBG. Obes Surg. 2007;17:1226–34.PubMedCrossRefGoogle Scholar
  54. Wadden TA, Sarwer DB, Womble LG, Foster GD, McGuckin BG, Schimmel A. Psychosocial aspects of obesity and obesity surgery. Surg Clin North Am. 2001;81:1001–24.PubMedCrossRefGoogle Scholar
  55. Wadden TA, Sarwer DB. Behavioral assessment of candidates for bariatric surgery: a patient-oriented approach. Obesity (Silver Spring). 2006;14 Suppl 2:53S–62S.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of GenovaGenovaItaly

Personalised recommendations