Obesity with Eating Disorders and Bariatric Surgery

Obesity is associated with reduced health-related quality of life, medical problems, and mental disorders. This chapter focuses on the most common forms of disordered eating in individuals with obesity. Additionally, this chapter explores the particular implications of eating disorder psychopathology on patients seeking bariatric metabolic surgery, which is the most effective treatment for severe obesity with regard to sustained weight loss, increased quality of life, reduced long-term all-cause mortality, and incidence of obesity-related diseases. There is clear evidence that binge eating disorder is the most common eating disorder in individuals with obesity in general, and those seeking surgical treatment in particular. Other nontraditional eating disorders such as night eating syndrome and “food addiction,” that are not yet recognized as formal diagnoses in DSM-5, are also prevalent in this population. While the presence of binge eating disorder, night eating syndrome, or addictive-like eating is not inherently a contraindication for bariatric surgery, detecting dysfunctional eating patterns such as loss-of-control eating following surgery is important because it may have a detrimental impact on weight loss and weight loss maintenance. Existing longitudinal data do not support the assumption of postoperative addiction transfer, which is the replacement of “food addiction” by other addictive behaviors following surgery. Cognitive behavioral therapy interventions have been effective in reducing eating pathology prior to bariatric surgery and should also be provided for those individuals who exhibit disordered eating following surgery.