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This episode brings an important topic to the forefront of the pre- and especially post bariatric surgery journey- the phenomena of Loss of Control (LOC) eating. In order to help us understand what Loss of control eating and is not, I had the pleasure of talking with two experts in the field, clinical psychologists and researchers, Valentina Ivezaj, Ph.D. and Jessica Lawson, Ph.D.
Dr. Ivezaj is an Assistant Professor in the Program for Obesity, Weight, and Eating Research (POWER) in the Department of Psychiatry at Yale University School of Medicine. Dr. Ivezaj’s major and longstanding clinical-research interests focus on psychosocial factors associated with bariatric surgery outcomes. She is also interested in the development and testing of interventions to improve bariatric outcomes among diverse groups, with a focus on improving access and expanding reach among underserved populations. Currently, Dr. Ivezaj is playing a central role in several longitudinal studies of bariatric patients. First, she serves as project coordinator for a NIDDK-funded randomized controlled trial testing different behavioral treatments delivered following bariatric surgery aimed at improving eating behaviors and enhancing longer-term outcomes. Second, she serves as co-Investigator on a multi-site study examining bariatric surgery outcomes in an ethnically/racially-diverse patient cohort. Third, she serves as co-Investigator on a multi-site study examining the relationship between weight bias and bariatric surgery outcomes. Fourth, Dr. Ivezaj was funded to prospectively examine obesity-related functional and psychosocial impairment before and after body contouring surgery among bariatric surgery patients. Finally, Dr. Ivezaj is also involved in collaborative research in community and clinical settings investigating binge eating, food addiction, and obesity in non-surgical populations.
Dr. Lawson, is a clinical research postdoctoral associate at Yale School of Medicine in the Program for Obesity, Weight and Eating Research. Dr. Lawson has specialized training in clinical health psychology with a focus on health behavior change, behavioral weight management, and bariatric surgery psychosocial assessment. She is interested in extending treatment options for bariatric surgery patients particularly in the post-operative period and is currently collaborating on several studies assessing psychosocial outcomes following bariatric surgery with a specific focus on sleep. Dr. Lawson is passionate and committed to helping patients learn and practice evidence based strategies that support and maintain healthy lifestyles.
Discussed in this episode:
- What drew Drs Ivezaj and Lawson into focusing their careers on obesity research.
- LOC is a predictor of poor weight loss outcomes post bariatric surgery.
- LOC eating is NOT simply overeating or regret about eating something or regret about overeating. It may involve both but it is not required to have LOC.
- LOC eating IS the subjective experience of a sense of loss of control while eating or having difficulty stopping while eating or being unable to prevent yourself from overeating. Like a snow ball rolling down the hill.
- Frequency of events matters.
- The connection of LOC to Binge Eating Disorder (BED)
- Two Diagnostic Criteria of Binge Eating Disorder: 1) Eating an objectively, unusually large quantity of food and 2) Have the sensation of loss of control while eating.
- LABS study: Post-op BED was predictive of poor weight loss outcomes.
- Early from the date of surgery (1-2 years) people may struggle with LOC eating but not be eating large volumes of food. However, over time, if portion sizes increase substantially, LOC eating may evolve into BED.
- Research shows that the likelihood of reporting LOC increases as more time passes after bariatric surgery. However, most of this research has been conducted on Gastric Band and Gastric Bypass patients. We do not know as much about those who have had Sleeve Gastrectomy.
- Studies have shown that in the general population between <1%- 2.6% are affected by BED.
- Compared to the general population, people seeking bariatric surgery are affected by BED more than the general population.
- BED is strongly associated with obesity.
- Most individuals with obesity do NOT have BED, but many individuals with BED may have obesity.
- Pre-surgical BED is not associated with long-term, poor weight loss outcomes post bariatric surgery, however the data is mixed. The most rigorous study, the LABs study, did not find that pre-surgical BED or any other pre-surgical psychiatric disorder was associated with poor weight outcomes by two and three years post-bariatric surgery.
- There is debate whether someone with BED pre-surgery should be delayed from having surgery because many people with BED do very well after surgery.
- Some studies have shown that pre-surgical LOC eating is a predictor of post-surgical LOC eating but still that the post-surgical LOC is related to suboptimal weight outcomes but not the (people) pre-surgical LOC eating. Therefore these might be people we screen and follow closely.
- What is known about the risk factors and/or causes of LOC eating.
- Objective Screening tool: Eating Loss of Control Scales.
- Subjective Screening tool: Describe your experience of LOC eating.
- 0-10 scale: 0 is a feeling of No Control of the eating episode; 10 is a feeling of Total Control of the eating Episode.
- Treatment Options. There is not a lot of evidence for treatment options after bariatric surgery.
- Cognitive Behavioral Treatment (CBT): Helps people have more structured eating, track foods, establish alternative pleasurable activities besides eating, increase awareness of cognitive distortion (negative thoughts and feelings).
- The emotional toll of LOC eating.
- What more can we do? How better can we show up for our patients?
- Cognitive Restructuring starts with awareness. What is the Trigger? What is the Negative Automatic Thought that results? What Cognitive Distortion does this create? Challenge the Negative Thought (Evidence For and Against). Restructure: Create a new version of the thought and then consider if it is believable or not.
- What are the strengths and limits of CBT.
- Other treatments options:
- Behavioral Weight Loss (BWL) focuses on reducing calories, increasing physical activity, and stimulus control.
- Interpersonal Therapy (IPT)
- Medication: Vyvanse (Lisdexamfetamine)
- People struggling with LOC eating can feel a sense of inevitability, hopelessness, and defeat.
- Do not give up!
- Resource: Chris Fairburn’s book- Overcoming Binge Eating .
- Reeger’s concluding thoughts
Connecting with Reeger:
email: reeger@weightlosssurgerypodcast.com
In Kindness,
Reeger
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