Obesity treatment - examining the influence of eating behavior

Abstract

Background: Obesity is a complex, multifactorial chronic disease linked to severe co-morbidity, reduced quality of life, and lower life expectancy. Despite numerous treatment options, sustained long-term weight loss remains challenging for many. Aim: To assess how self-reported baseline eating behavior and binge eating disorder (BED) influence weight loss outcomes in clinical treatment for individuals with severe obesity (BMI ≥35 kg/m2). Four studies were conducted, each examining aspects of eating behavior, BED, and psychological factors (motivation, locus of control, self-efficacy) in relation to weight loss outcome over 1 to 5 years and treatment adherence. Methods: All studies were carried out at Sahlgrenska University Hospital among patients beginning treatment for severe obesity between 2012 and 2017. Paper I and II were retrospective clinical cohort studies with 12-month follow-up after a structured weight loss program. Nocturnal eating (NE) and BED were assessed by self-reporting questionnaire QEWP-R (Paper I), and personality traits by a visual analogue scale (VAS) (Paper II). Paper III and IV were prospective cohort studies, involving medical treatment and bariatric surgery with 2- and 5-year follow-up, respectively. BED and eating behavior were assessed using the QEWP-R and TFEQ-R21 questionnaires. Results: BED was not associated with weight loss outcomes at any follow-up point or treatment modality. Nocturnal eating (NE) was linked to less weight loss up to 2 years, but not at 5 years. Higher self-efficacy was associated with achieving ≥15% weight loss after 12 months of medical (diet and lifestyle) treatment. Higher level of emotional eating (EE) was associated with less weight loss outcomes following sleeve gastrectomy (SG) up to 2 years, but not at 5 years. No association was seen between eating behavior and recurrent weight gain. Drop-outs and those lost to follow-up were younger, lost less weight at earlier timepoints, and reported NE and higher levels of EE, and uncontrolled eating. Conclusion: Several eating behaviors, but not BED, were associated with weight loss outcomes up to 2 years but not in those conducting the 5-year follow-up. Weight loss early in treatment appears to be a stronger predictor of long-term success than eating behaviors alone. Addressing problematic eating behavior early in treatment may improve weight loss outcomes in individuals with severe obesity.