Adolescent Loss-of-Control Eating and Weight Loss Maintenance After Bariatric Surgery

Pediatrics. 2018 Jan;141(1):e20171659. doi: 10.1542/peds.2017-1659. Epub 2017 Dec 13.


Background: Loss-of-control (LOC) eating is common in adults undergoing bariatric surgery and is associated with poorer weight outcomes. Its long-term course in adolescent bariatric surgery patients and associations with weight outcomes are unclear.

Methods: Adolescents (n = 234; age range = 13-19 years) undergoing bariatric surgery across 5 US sites were assessed for postsurgery follow-up at 6 months and 1, 2, 3, and 4 years. Descriptive statistics and generalized linear mixed models were used to describe the prevalence of LOC eating episodes involving objectively large amounts of food and continuous eating, respectively. Generalized linear mixed models investigated the association of any LOC eating with short- and long-term BMI changes.

Results: At baseline, objectively large LOC eating was reported by 15.4% of adolescents, and continuous LOC eating by 27.8% of adolescents. Both forms of LOC eating were significantly lower at all postsurgical time points relative to presurgery (range = 0.5%-14.5%; Ps < .05). However, both behaviors gradually increased from 6-month to 4-year follow-up (Ps < .05). Presurgical LOC eating was not related to percent BMI change over follow-up (P = .79). However, LOC eating at 1-, 2-, and 3-year follow-up was associated with lower percent BMI change from baseline at the next consecutive assessment (Ps < .05).

Conclusions: Although presurgical LOC eating was not related to relative weight loss after surgery, postoperative LOC eating may adversely affect long-term weight outcomes. Rates of LOC eating decreased from presurgery to 6-months postsurgery but increased thereafter. Therefore, this behavior may warrant additional empirical and clinical attention.

Trial registration: NCT00474318.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adaptation, Psychological
  • Adolescent
  • Bariatric Surgery / adverse effects*
  • Bariatric Surgery / psychology*
  • Body Mass Index*
  • Cohort Studies
  • Feeding Behavior / psychology*
  • Feeding and Eating Disorders / epidemiology
  • Feeding and Eating Disorders / etiology*
  • Feeding and Eating Disorders / physiopathology
  • Female
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Male
  • Obesity, Morbid / diagnosis
  • Obesity, Morbid / psychology
  • Obesity, Morbid / surgery*
  • Postoperative Care / methods
  • Risk Assessment
  • Time Factors
  • Weight Loss / physiology
  • Young Adult

Associated data