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Dissertation

An Examination of Recurrent Binge Eating and Body Image Dissatisfaction in Preoperative Bariatric Surgery Patients Enrolled in The Longitudinal Assessment of Bariatric Surgery

28 June 2018

Abstract

Obesity is often a serious medical condition with many biopsychosocial risk factors and co-occurring conditions. Published data suggests that rates of obesity are increasing in the United States and around the globe. Obese individuals often have multiple medical conditions that place them at increased risk of premature death. These conditions include cardiac disease, pulmonary disease, diabetes mellitus-type II and others. In addition, obese individuals are at increased risk of eating, mood and anxiety disorders. The most effective treatment for reducing weight in obese individuals and maintaining weight loss over time is bariatric surgery. While individuals undergoing this treatment can expect to lose 25-30% of their original body weight and experience other biopsychosocial benefits, 20-30% will not. This subset of patients will not experience significant weight loss, may regain lost weight, and often report lower quality of life and treatment satisfaction. Understanding the relationships between biopsychosocial risk factors common to presurgical bariatric patients may improve post-surgical outcomes.

The first aim of the current study was to examine the relationships between recurrent binge eating behavior and BMI, eating symptomatology, body image dissatisfaction, and depression. The second aim was to examine differences between two models of the Eating Disorder Examination interview. The first model being the original four-factor model commonly utilized to assess eating pathology and proposed by Fairburn and Cooper (1993); the second model is a three-factor model proposed by Grilo, Henderson, Bell and Crosby (2013). It was hypothesized there would be significant differences between sample groups (i.e., individuals endorsing recurrent binge eating and those that did not), across all biopsychosocial variables noted in the study. It was also predicted that there would be differences between groups using the different EDE models. Study participants included patients enrolled in the LABS-2 project at Oregon Health and Sciences University (OHSU) medical center in Portland, Oregon between 2007-2010. Participants (N = 59) included both female (n = 45) and male (n = 14) patients. Of these, 57 (96.6%) identified as Caucasian/White, one (1.8%) identified as French Canadian/Native American, and one (1.8%) identified as “mixed” (i.e., race/ethnicity).

Results of the study indicated medium to large effect sizes associated with group differences on many dependent variables, EDE original 4-factor model: Eating Concern (d = .58), Shape Concern (d = .57), EDE 3-factor Global Score (d = .51), BSQ (d = .46), ASI-R (d = .52), Composite BID score (d = .51). However, only the Global Score from the original EDE four-factor model produced a significant difference between groups, (d = .77, u = 381.5, z = 1.98, p < .05). This suggests meaningful differences on eating symptomatology for those engaging in recurrent binge eating compared to those that do not. More generally, results suggest that the small sample size may have limited the statistical power of the study. Results further suggest the possibility of significant differences between individuals that endorse and do not endorse recurrent binge eating behaviors on eating symptomatology and body image dissatisfaction, but not BMI and depression. As such, screening for these patient characteristics may inform pre- and post-surgical treatment intended to promote favorable surgical outcomes. Future research may include a larger sample size to increase statistical power along with recruitment and participation of broader demographic profiles. Research may examine specific sub-constructs of each dependent variable to refine targets of treatment.


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