Coping with loss and changing eating behaviours
following bariatric surgery
AUGIS September 2010
Surgery is No Panacea
 It is well documented that there are certain variables which determine
the results of bariatric surgery. In fact some go as far as to say that it is
one’s ability to maintain changes that leads to permanent weight loss
after surgery rather than the quality of the procedure. (Niego 2007).
 By determining which variables effect the weight loss outcomes we can
work towards supporting individuals who have undergone surgery to
enable them to achieve their weight loss goals.
 If we can establish how the individual deal with changing their
behaviours we can tailor our practise to meet their needs (Canetti
2009).
Model of change
The Transtheoretical Model, Prochaska and DiClemente (1983)
Precontemplation
 Denial
 Referral/diagnosis is not self
motivated
Case Study:
 Sally 33yo
 Roux-en-y gastric bypass 18
months ago
 Hx Binge Eating pre-operatively,
beginning to show signs of binge
eating again
Definitions of Binge Eating
 A binge occurs when a food addict consumes a greater than
average amount of food in a specific amount of time.
(Greater than average will vary from person to person)
 A disorder characterised by repeated episodes of excessive
eating (over longer than 6 months) such that the binging
does not stop until the person is uncomfortably full.
 Binge eating disorder is characterised by a loss of control
over eating behaviours. The binge eater consumes
unnaturally large amounts of food in a short time period.
Contemplation
 Self initiated referral
 Starting to considered there is
an issue
 Event/incident
 Potential to stop here and
relapse
 Recognising lack of control
 Barriers: socioeconomics,
culture, education,
understanding.
 Consider- is individual aware
that effort is needed? Consider
health beliefs.
The Health Belief model
Becker et al , (1984)
Preparation
 What to do about it?
 Forming plans
 Seek professional help,
WW/SW, fad diets,
counselling, CBT, hypnosis
 Has self awareness- does the
individual have ability to
change awareness into
action?
 Starting to feel in control
Action
 Start making changes
 Motivated
 Feels in control
 Starting to see results
Relapse





Can happen at anytime
Loss of control
Maladaptive eating patterns
Anxiety
Depression
 Pre-operative demand for food
in emotional situations, so in a
situation where volume of food
is restricted can contribute to
emotional alterations such as
anxiety and depression
(Zilberstein 2009).
Weight regain
 Related to inability to change habits rather than surgery.
“I Expected that it would become easier to
choose what to eat; that I would be able to
choose the sandwich instead of the chocolate… I
thought that I would be able to manage it easily…”
(Zijlstra et al 2008)
“I know I should be eating those tiny meals but
my brain actually wants to eat more- I miss big meals…”
Sally 2010
 Consider contemplation and health beliefs;
When interviewing individuals who have undergone WLS
yes/no answers
46% feel they could loose weight if they change eating behaviours (54% don’t!)
17% feel exercise will help them to loose weight, 83% don’t.
(Pinto 2009)
These statistics illustrate sensations of lack of control and self efficacy.
Implication for practice
 To improve treatment we must identify variables
which predict weight loss outcomes.
 Model of change helps provide a theoretical insight
into the change process and may help to facilitate
customised programmes so individuals with
disordered eating are not necessarily discounted for
surgery (Gorin and Raftopoulos 2008).
References
Canetti L et al. Psychosocial Preditors of Weight Loss and Psychological Adjustment Following
Bariatric Surgery and a Weight Loss Programme: The Mediating Role of Emotional Eating.
International Journal of Eating Disorders. 2009. 42:2 109-117
Chesler B, et al. Implications of Emotional Eating Beliefs and Reactance to Dietary Advice for the
Treatment of Emotional Eating and Outcome Following Roux-en-y Gastric Bypass: A Case
Report. Clinical Case Studies. 2009 8:277-295
Gorin A, Raftopoulos. Effect of Mood and Eating Disorders on the Short Term Outcome of
Laparoscopic Roux-en-y Gastric Bypass. Obesity Surgery. 2008. 19:1685-1690
Janz N, Becker M. The health Belief model: A Decade Later. Health Education Quarterly. 1984. 11:
1-47
Madan A, Beech B, Tichansky D. Eating patterns in Patients undergoing Bariatric Surgery.
Conference Abstract. 2009.
Niego S et al. Binge Eating in the Bariatric Surgery Population: A Review of the Literature.
International Journal of Eating Disorders. 2007. 40:4 349- 359.
Pinto L et al. Study of Factors Related to the Regaining of Weight in Patients Submitted to
Bariatric Surgery. Conference Abstract 2009
Rusch M, Andris D. maladaptive eating Patterns after weight loss surgery. Nutrition in Clinical
Practise. 2007. 22:41-44.
Zilberstein B et al. Compulsive Behaviour After Bariatric Surgery. Conference Abstract. 2009
Zjlstra H et al. Patient’s Explanations for Unsuccessful Weight Loss After Laparoscopic Adjustable
Gastric Banding. Patient Education and Counselling. 2009. 75 108-113.