Q & A: Gastric Surgery and Risky Eating Behavior

Q: One of my patients recently had gastric bypass surgery and has lost a tremendous amount of weight. However, he still has some of his bad eating habits. Does this make a difference? (L.C., Tampa)

A: What you are describing is, unfortuantely, not rare. According to a recent study, gastric bypass patients who have a variety of disturbed eating patterns may be at risk of returning to those old patterns after successful surgery (Obes Surg 2004;14:98). Binge eating is frequently linked to a poorer outcome after surgery, with weight regain. In this study, patients completed a self-report questionnaire before they had gastric bypass surgery, and then were followed up after surgery. Those who were identified as having high-risk eating behaviors were reinterviewed after they had surgery. Many high-risk patients reported they had lost control over their eating, and as a result were regaining weight. Some reported eating continuously throughout the day and evening, or “grazing,” because they could no longer eat large amounts of food. This pattern emerged about 6 months after surgery. The author suggests that different forms of overeating need to be assessed in this population because former binge eaters may turn into “grazers” after gastric surgery. Recognizing risky eating behavior and intervening with education and therapy is essential for these at-risk patients.