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Grazing in adults with obesity and eating disorders: A systematic review of associated clinical features and meta-analysis of prevalence
Abstract and Figures
Grazing, the unstructured, repetitive eating of small amounts of food, is a pattern of eating which has been associated with negative outcomes following bariatric surgery. Less is known about grazing in eating disorders and in non-surgical obese samples. This review aims to critically examine the existing research on the prevalence of grazing, associated treatment outcomes, and clinical correlates in adults with eating disorders and/or obesity, in clinical and community settings. A systematic electronic database search yielded 38 studies which met inclusion criteria for the review. A meta-analysis was conducted using prevalence data from 32 studies (31 datasets). Mean pooled prevalence in obesity (n = 26 studies) was 33.20% (95% CI [27.54, 39.11]) at pre-weight loss treatment, 28.16% (95% CI [17.86, 39.73]) at follow-up, and 23.32% (95% CI [3.07, 52.04]) in the community. Nine studies provided prevalence estimates in eating disorders: 58.25% (95% CI [52.75, 63.66]) in bulimia nervosa; 67.77% (95% CI [44.96, 87.13]) in binge eating disorder; and 34.31% (95% CI [26.56, 42.49]) in anorexia nervosa. The results suggest that grazing is widely prevalent within obesity and eating disorders. There is mixed evidence to suggest that grazing (especially a “compulsive” subtype including a sense of loss of control) is associated with poorer weight loss treatment outcomes in obesity, lower mood, increased eating disorder symptomatology, and decreased mental health-related quality of life. Differences in the operationalisation of grazing may account for inconsistent findings in regards to specific correlates and risks associated with this behaviour; therefore, there is an urgent need to refine and adopt a consistent definition of grazing.
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... Obese patients and in the preoperative period of bariatric surgery may present harmful eating behaviors, such as "nibbling food, " emotional eating, binge eating and grazing, which make it difficult to control weight and can be an obstacle to treatment results, being related to worse results of bariatric surgery, especially in the long term (6)(7)(8). ...
... Regarding eating behavior, there was a difference between the prevalence of compulsive and non-compulsive grazing. It is important to note that both in patients with obesity undergoing clinical treatment and in candidates for bariatric surgery, grazing behavior can be found and is associated with worse results in weight loss and impairment of mental health (8). ...
... correlation seems not to be controlled through the use of weight loss drugs. Heriseanu et al. (8) report that grazing behavior is very prevalent in obesity and eating disorders. There is evidence to indicate that grazing (in particular the "compulsive" subtype) is associated with worse weight loss treatment outcomes in obesity, increased risk of eating disorders, and mental health worsening. ...
Blackground
To assess grazing behavior and associated factors in candidates for bariatric surgery monitored at a public hospital that is a reference in the care of people with severe obesity.
Methods
Cross-sectional analytical study, with candidates for bariatric surgery of both genders, treated in a public hospital in the Amazon. To assess grazing behavior, the Repetitive Eating Questionnaire was used, and to investigate patterns of eating behavior, the Three Factor Eating Questionnaire was used, which assesses: Emotional Eating, Cognitive Restriction and Uncontrolled Eating. Sociodemographic information was obtained through self-report and the description of medication use through the medical record. Body mass index (BMI) was also calculated by measuring weight and height. The SPSS program, v. 21.0 was used. The study was approved by the Research Ethics Committee.
Results
A total of 205 participants were evaluated, with a mean age of 37.5 ± 8.6 years, the majority (93.7%) being women and the majority (59.5%) was not also using medication to lose weight. About 66.3% of the participants had compulsive grazing. The factor with the highest score was cognitive restriction (p < 0.001). Individuals who used weight loss drugs had higher scores in the cognitive restriction factor (p = 0.015) and lower scores for uncontrolled eating (p = 0.008), compulsive grazing (p = 0.021) and non-compulsive grazing (p = 0.034).
Conclusion
Linear regression showed that emotional eating and uncontrolled eating were predictors of both compulsive grazing and non-compulsive grazing behavior. It was observed that grazing behavior, cognitive restriction, emotional eating and uncontrolled eating are present and correlated in the studied patients. In addition, the use of weight loss drugs seems to help reduce dysfunctional eating behaviors in patients with severe obesity.
... Despite having similar characteristics, more frequent grazing behavior and disordered eating, higher levels of anxiety and depression symptoms are observed in the compulsive type compared to the non-compulsive subtype (Goodpaster et al. 2016). Grazing is encountered in various populations, including eating disorders (Heriseanu et al. 2017), obesity (Micanti et al. 2017), university students (Lane and Szabo 2013), children ) and non-clinical populations (Conceição et al. 2017a). In addition to studies reporting the prevalence of grazing in the community population as 48.24% (Heriseanu et al. 2019a), and 23.32% (Heriseanu et al. 2017), there are indications that the prevalence of this eating behavior in the community has reached up to 81% during the coronavirus pandemic (Ramalho et al. 2022). ...
... Grazing is encountered in various populations, including eating disorders (Heriseanu et al. 2017), obesity (Micanti et al. 2017), university students (Lane and Szabo 2013), children ) and non-clinical populations (Conceição et al. 2017a). In addition to studies reporting the prevalence of grazing in the community population as 48.24% (Heriseanu et al. 2019a), and 23.32% (Heriseanu et al. 2017), there are indications that the prevalence of this eating behavior in the community has reached up to 81% during the coronavirus pandemic (Ramalho et al. 2022). In addition, grazing is also commonly encountered in clinical samples (Teodoro et al. 2021). ...
Research indicates a close association between grazing, classified as disordered eating, and both obesity and eating disorders. This study aims to adapt the Grazing Questionnaire into Turkish. The research encompassed exploratory (N= 181) and confirmatory (N= 180) factor analyses with a sample of 361 community-based participants aged 18 to 30. Principal component analysis revealed a two-factor structure (uncontrollability, grazing behaviors) explaining 63.40% of the total variance, with eigenvalues surpassing 1. The Cronbach’s alpha coefficient stood at .86. In assessing construct validity, the Grazing Questionnaire exhibited meaningful correlations with the Binge Eating Scale (r= .60, p< .01), body mass index (r= .23, p< .01), and subscales of the Leahy Emotional Schema Scale. Discriminant validity, evaluated through independent samples t-test analysis, showcased significant distinctions between groups with an eating disorder diagnosis or psychological support and those without such diagnoses or support in terms of grazing behaviors. These findings affirm that the Turkish version of the Grazing Questionnaire serves as a valid and reliable tool for evaluating individuals’ grazing behaviors and the feeling of loss of control during eating within a community-based sample. Moreover, the scale's structure aligns closely with its original form. Psychologists and psychiatrists can employ the the Grazing Questionnaire as an effective measurement tool to assess and identify distinctive features associated with eating behaviors.
... There is a growing literature regarding its relationship with diseases like depression and anxiety [4]. Besides, obesity has a relationship with some eating disorders such as binge eating and night eating, and maladaptive eating attitudes such as emotional eating and grazing [5][6][7]. All of these maladaptive eating attitudes not only cause obesity but also cause patients, who have lost weight due to medical treatments or obesity surgery, to gain weight or lose less weight than targeted during the follow-up period [4,8]. ...
... Similar to the literature, our study found that after the group intervention, eating disorders (binge eating disorder, night eating) [5,23], maladaptive eating attitudes (grazing, emotional eating, external eating), and depression and anxiety levels decreased [1,4,11,12,22,24]. Depression and maladaptive eating attitudes such as grazing and emotional eating have negative effects on weight loss and focusing on emotion regulation interventions instead of diet is recommended in the treatment of emotional eating in particular [7,8]. There are studies associating restrained eating attitude with more weight loss in follow-ups [11], and accordingly, our study has revealed that it increases through interventions [12,24]. ...
... It should be noted that participants with higher baseline weight showed greater weight gain, in line with some previous studies (Froom et al., 1999;Lycett et al., 2011;Swan et al., 1997) and in contrast to others (Bush et al., 2014;Pankova et al., 2018). Higher body weight is linked with unhealthy lifestyle habits, such as sedentarism (Agrawal et al., 2013;Mortensen et al., 2006) and poor eating habits (Heriseanu et al., 2017;Kolay et al., 2021). Thus, the implementation of general weight control strategies in our intervention (e.g., psychoeducation on the Mediterranean diet, strategies to improve eating behaviors and prevent problematic eating, exercise counseling) may not have been effective enough to achieve weight maintenance among those with higher baseline weight. ...
Introduction: A more comprehensive understanding of the factors regarding weight control in individuals with overweight or obesity after quitting smoking is needed. The study aimed to analyze the changes of in-treatment variables during a smoking cessation intervention and examine their impact on weight.
Methods: A total of 120 individuals who smoke with overweight or obesity (MBMI = 31.75 ± 4.31; 54.16 % female) participated in a cognitive-behavioral therapy for smoking cessation and weight control or the same treatment plus contingency management. Weight, smoking variables (cotinine and continuous abstinence), eating behaviors (appetite, grazing), exercise, and sleep were assessed weekly throughout the treatment.
Results: More participants gained weight over time with reduced nicotine use or abstinence. There was a tendency during treatment to increase appetite and exercise time, while grazing episodes and sleeping hours remained stable. Higher baseline weight (p < .001), greater cotinine reduction (p = .021) and time (p = .009) were associated with greater weight gain, while more hours of exercise (p = .003), no appetite changes (p = .003) and diminished appetite (p < .001) were associated with less gain over the treatment. Both treatment conditions showed similar results in all in-treatment variables.
Discussion: Individuals with overweight and obesity with higher baseline weight and higher baseline cotinine levels during smoking cessation interventions may require special attention to improve weight outcomes. Exercise and appetite regulation may be useful for mitigating weight gain in smoking cessation interventions for individuals with overweight or obesity.
... In an attempt to characterize the abnormal eating patterns of patients with FA, it has been proposed that compulsive, repetitive, and unstructured (unplanned) consumption of small amounts of food for a significant portion of the day (grazing) is not only associated with the presence of FA but also appears to explain the severity of its symptoms (45). However, a systematic review reported that grazing is present in 33% of patients with obesity, and in patients with binge eating disorder, the prevalence can reach more than 67% (46). ...
Introduction
The study of food addiction (FA) has become relevant due to its high prevalence, the negative impact on quality of life, and its association with neuropsychological and psychiatric symptoms. Several studies have provided scientific support for these associations, however, the results are contradictory. Additionally, studies have unsuccessfully elucidated the true nature of the failures in executive functioning in people with FA symptomatology, particularly when it comes to executive deficits. Therefore, the purpose of this research was to establish whether the presence of executive dysfunction, depressive symptoms and binge eating problems, as well as high reward sensitivity entails a greater severity in FA traits and high body mass index (BMI) in a sample of Mexican adults.
Methods
The sample consisted of Mexican men and women between 21–59 years (n = 36); who completed self-report questionnaires and performance tests to measure the study variables. Additionally, BMI was estimated with self-reported height and weight.
Results
Our results showed that a high number of FA symptoms were associated with higher executive dysfunction scores, greater reward sensitivity, and more severe depressive and binge eating problems. Furthermore, factors that are more strongly associated with higher scores of FA include severe executive deficits, greater activation of the punishment avoidance system, and persistence in the search for reward when the depressive symptoms increased. The factors that best explained changes in the estimated BMI of women were a decreased crystallized intellectual capacity and the inability to control food intake as the number of FA symptoms increased.
Discussion
In summary, the cognitive functioning profile characterized by general failure of the executive functioning, as well as a greater activation of the Punishment Avoidance System and persistence in the search for reward, were associated with greater severity of FA symptoms, especially when the depressive symptomatology was severe. In parallel, the psychopathology in participants associated with FA confirms the contribution of anxious and depressive symptomatology and borderline personality traits which could facilitate the expression of clinically relevant FA symptoms in women. Finally, we found that decreased crystallized intellectual capacity and inability to control food intake were linked to higher BMI when the number of FA symptoms increased.
... The high centrality of binge eating and grazing behaviour is consistent with previous studies demonstrating that binge eating and grazing are highly prevalent in patients with obesity and BED compared to those without BED (Masheb et al., 2011). This is not surprising as both grazing and binge eating exhibit LOC overeating, despite differences in the amount and duration of food intake (Conceição et al., 2017;Heriseanu et al., 2017;Succurro et al., 2015). Patients often report that the experience of LOC and the perception of overeating, even when trying to stop, are the core defining characteristics (Berner et al., 2020), as prioritized in the ICD-11. ...
Food addiction (FA) has been associated with binge eating disorder (BED) and obesity at varying levels of severity and treatment outcomes. Despite much debate and scientific interest in FA, the mechanisms that underlie its co-occurrence with both conditions are not yet well understood. In order to understand this relationship , this study explores FA in a clinical sample of individuals with BED and obesity using network analysis (NA). A total of 303 patients (151 with BED and 152 with obesity) completed a battery of tests that investigated eating psychopathology, eating behaviours, emotional dysregulation, depression and FA. Two different NAs were conducted to investigate the interaction between these variables and FA. The BED and obesity groups were comparable in age (38 ± 14 vs. 42 ± 13 years), body mass index (38.8 ± 8.5 vs 42.4 ± 7.8), sex and de-mographics. According to the expected influence values, binge eating severity and depression were identified as the central nodes in both networks. In the BED group, binge eating severity was the central node and showed strong connections to both FA and grazing. In contrast, in the obesity group, depression was the central node, but its connections were weak, with only marginal associations to FA. These results suggest that FA represents an important and distinct construct of the two populations. In patients with BED, FA is intimately connected to other loss-of-control-related eating behaviours, such as binge eating and grazing. Conversely, in those with obesity, depression explains the relationship of FA with pathological eating behaviours. The presence of FA seems to be a distinguishing characteristic in the psychopathology of patients suffering from obesity with and without BED, and this could have implications for the prevention, treatment and management of these disorders.
... ). Compulsive grazing is associated with greater eating disorder psychopathology, increased distress, lower mental health-related quality of life, and reduced treatment success in patients with high body weight [5,[7][8][9]. Non-compulsive grazing, referring to eating repetitively in a distracted fashion, is common in the population (depending on the definition used, rates range between 38% and 90% [5,10]) and is generally not associated with deleterious effects. Thus far, research on conditions co-occurring with grazing has focused on eating disorders and high body weight and has been predominantly conducted in high-income countries. ...
Grazing is a clinically relevant eating behaviour, especially when it presents with a sense of loss of control (compulsive grazing). There is evidence that other disordered eating patterns are associated with problematic substance use and impulsivity-related conditions, such as attention-deficit/hyperactivity disorder (ADHD). This overlap contributes to higher psychopathology and treatment complications. Less is known about grazing, and most information originates in high-income countries. Hence, we sought to investigate relationships between grazing, tobacco and alcohol use, ADHD, and impulsivity in a large representative sample from Brazil. Data were collected by trained interviewers from adults (N = 2297) through an in-person household survey based on a stratified and clustered probability sample. We found significant associations between compulsive grazing and problematic alcohol use (OR = 3.02, 95% CI: 1.65, 5.53), ADHD (OR = 8.94, 95% CI: 5.11, 15.63), and smoking (OR = 1.67, 95% CI: 1.12, 2.47), with impulsivity contributing to the first two relationships. The substantial association with ADHD suggests that other executive functions may promote disordered eating, possibly expressed through difficulties in adhering to regular meals. Clinically, these findings highlight the importance of assessing problematic eating patterns, such as compulsive grazing, in those presenting with difficulties with substance use or impulsivity, and vice versa.
... Conceição et al. (2014) argued that the unplanned nature of grazing behavior is associated, at some level, with a lack of loss of control over eating, and conceptualized grazing on a continuous scale of loss of control eating. Along these lines, there is increasing evidence to support NCG in association with low levels of loss of control, and CG associated with higher levels (Conceição et al., 2018;Heriseanu et al., 2017). Our results bring further support for this association between grazing and loss of control and eating disorder psychopathology as proposed by Conceição et al. (2014). ...
Objective:
The Repetitive Eating Questionnaire (Rep(eat)-Q) is a brief self-report measure developed to assess grazing behavior-an understudied problematic eating behavior associated with eating disorder psychopathology and poor weight management. This study aimed to adapt and test the psychometric properties and factor structure of the Rep(eat)-Q in a Brazilian community sample.
Method:
We used the International Test Commission guidelines for the adaptation of psychological measures between cultures. Participants were recruited from the community and on a university campus and completed a set of questionnaires including the Rep(eat)-Q, psychological measures, and sociodemographic data.
Results:
A total of 718 (86.4% female) completed the Rep(eat)-Q and were eligible for the confirmatory factor analysis (CFA). Only 542 completed the entire survey (Rep(eat)-Q and other psychological measures) and were eligible for the analysis of the validity evidence based on the relations to other variables. CFA revealed support for a two first-order model as originally proposed, however, a hierarchical (i.e., second-order) model is proposed. We found support for second-order scalar invariance across sex. Both first- and second-order internal consistency estimates presented very good evidence. Analysis (n = 542) revealed moderate to strong correlations (≥.58 to .77) between grazing (total score and subscales) and binge eating and other psychological measures, presenting good convergent evidence.
Discussion:
This study reports good psychometric properties of the Rep(eat)-Q for the Brazilian community sample.
Public significance:
Grazing is a problematic eating behavior and the Rep(eat)-Q is one of the measures to assess grazing. The article aimed to adapt and test the psychometric properties of the Rep(eat)-Q in a Brazilian community sample. The results support a two-factor structure and suggest that the Rep(eat)-Q possesses good psychometric properties to be used with the Brazilian populations.
Introduction:
Binge-eating disorder (BED) is a complex and disabling eating disorder (ED) associated with considerable burden and impairments in quality of life and physical/mental health. It has been recognized as a formal ED category since 2013, however BED is still underdetected and undertreated.
Areas covered:
This review summarizes the advances in the understanding of the pathophysiology of BED as well as the evidence on the efficacy of the existing treatments. The authors searched Scopus, PubMed, ClinicalTrials.Gov, and ANZCTR with terms including 'assessment' OR 'treatment' OR 'diagnosis' OR 'mechanisms' AND 'binge eating' OR 'binge-eating disorder' for manuscripts published between January 2013 and April 2023.
Expert opinion:
Most of the trials on treatments of BED have been in people of high weight with weight loss as an outcome. Nevertheless, less is known about the treatment of this condition in people with body mass index (BMI) within the normal range where weight stabilization may be a more appropriate goal. Moreover, there is a need for an enhanced appreciation of the role of combination treatment to improve overall outcomes. Also, there are important opportunities for future research in understanding the mechanisms of action and effectiveness of BED treatments.
Background
This systematic review is an evaluation of the empirical literature relating to the disordered eating behaviour Chew and Spit (CHSP). Current theories postulate that CHSP is a symptom exhibited by individuals with recurrent binge eating and Bulimia Nervosa. AimsThe review aimed to identify and critically assess studies that have examined the distribution of CHSP behaviour, its relationship to eating disorders, its physical and psychosocial consequences and treatment. MethodsA systematic database search with broad inclusion criteria, dated to January 2016 was conducted. Data were extracted by two authors and papers appraised for quality using a modified Downs and Black Quality Index. ResultsNine studies met the inclusion criteria. All were of clinical samples and majority (n = 7) were of low quality. The pathological action of chewing food but not swallowing was reported more often in those with restrictive type eating disorders, such as Anorexia Nervosa, than binge eating type disorders. CHSP also was reported to be an indicator of overall severity of an eating disorder and to appear more often in younger individuals. No studies of treatment were found. Conclusions
Conclusions were limited due to the low quality and small numbers of studies based on clinical samples only. Further research is needed to address gaps in knowledge regarding the physiological, psychological, social, socioeconomic impact and treatment for those engaging in CHSP.
Background
Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric surgery procedure and currently the second most performed technique worldwide. Follow-up data on depression, stress and eating behaviour are scarce. The aim of this longitudinal study was to investigate the medium-term effects of LSG on mental health and eating behaviour and their influence on weight loss by using a comprehensive interview-based assessment.
Methods
Seventy-five individuals, who had undergone LSG at a university hospital, were included in the study. Symptoms of disordered eating were assessed using a structured clinical interview (eating disorder examination) and the Three-Factor Eating Questionnaire with depressive symptoms and stress assessed via the Patient Health Questionnaire.
Results
Mean interval from LSG to follow-up (FU) examination was 48 ± 13.3 months. The total body weight loss was 24.2 ± 12.0 %. Depressive symptom scores improved from pre-operative to FU (9 [IQR 5–14] vs. 6 [IQR 2–10], p = 0.002) as did stress scores (8.7 ± 4.6 vs. 6.3 ± 4.7, p = 0.001). At FU, 11 % of patients reported loss-of-control eating and 39 % grazing, paralleled by increased body mass index, stress and depressive symptoms. Prior to LSG, nine patients fulfilled the diagnostic criteria of binge eating disorder but only one at FU.
Conclusions
Post-surgical mental health appears to be highly relevant in terms of weight loss maintenance. It is likely that the surgical outcome could be positively influenced if patients at risk of developing mental health issues or eating disorders were identified and monitored in order to offer targeted interventions.
Purpose:
The aim of this study is to show that the differences among eating behaviours are related to the emotional dysregulation connected to the mental dimensions being part of the obese psychopathology. Eating behaviours can be considered a diagnostic feature at the initial screening for determining the obesity treatment: nutritional or bariatric surgery.
Methods:
1828 Obese subjects underwent psychiatric assessment before entering obesity nutritional treatment or bariatric surgery following the multidisciplinary programme. 1121 subjects were selected and enrolled in this study: 850 were inpatients visited or hospitalised at the Obesity Centre or at the Bariatric Surgery Units, 271 were outpatients visited at the Eating Disorder and Obesity Unit. Psychiatric examination was used to exclude psychiatric disorders and investigate eating behaviours distinguished on the basis of food intake rhythm in: gorging, snacking, grazing and binge. They are related to the mental dimensions: impulsiveness, body image, mood and anxiety, taking part in the emotional regulation system. Specific psychometric tools were used to investigate the different mental dimensions of the single eating behaviours and their differences. Statistical analysis of the psychopathological features was performed using ANOVA, ANCOVA, Levene test, Bonferroni's and Tamhane post hoc test. Significance was set at p < 0.05.
Results:
Data analysis shows significant differences of psychopathology among all the eating behaviours and an increase in the emotional dysregulation determining maladaptive behaviours.
Discussion:
Eating behaviours are connected to the balance of the different features of mental dimensions implicated in the emotional regulation system. They could provide significant clinical information and therefore be part of the obesity diagnostic criteria and therapeutic programme.
We have performed an exploratory study of eating disorders among female adolescents (N = 38) and young adult (N = 38) students living in Paris, France. A high percentage of the subjects in the adolescent (68.4%) and young adult (50%) groups displayed one or more atypical eating behaviors with grazing being prominent (60.5% and 42.1%, respectively) in both groups. Bulimia nervosa (DSM‐III‐R) was found only in the older group (3/38 vs. 0/38). Binge eating was significantly more frequent among the older subjects (12/38 vs. 1/38). Nicotine dependence and daily grazing with a history of grazing during childhood were reported in all subjects with bulimia nervosa (DSM‐III‐R). These data, while requiring replication in larger samples, indicate that atypical eating behaviors are common in the populations sampled. Furthermore, daily grazing (especially with a history of grazing during childhood) and nicotine dependence may be strongly associated with the development of bulimia nervosa. © 1994 by John Wiley & Sons, Inc.
Objective:
Severe obesity is the fastest growing pediatric subgroup of excess weight levels. Psychological dysregulation (i.e., impairments in regulating cognitive, emotional, and/or behavioral processes) has been associated with obesity and poorer weight loss outcomes. The present study explored associations of dysregulation with weight-related variables among adolescent and young adult (AYA) females with severe obesity.
Methods:
Fifty-four AYA females with severe obesity (MBMI=48.71 kg/m2; Mage=18.29, R=15-21 years; 59.3% White) completed self-report measures of psychological dysregulation and weight-related constructs including meal patterns, problematic eating behaviors, and body and weight dissatisfaction, as non-surgical comparison participants in a multi-site study of adolescent bariatric surgery outcomes. Pearson and bivariate correlations were conducted and stratified by age group to analyze associations between dysregulation subscales (affective, behavioral, cognitive) and weight-related variables.
Results:
Breakfast was the most frequently skipped meal (consumed 3-4 times/week). Eating out was common (4-5 times/week) and mostly occurred at fast-food restaurants. Evening hyperphagia (61.11%) and eating in the absence of hunger (37.04%) were commonly endorsed, while unplanned eating (29.63%), a sense of loss of control over eating (22.22%), eating beyond satiety (22.22%), night eating (12.96%), and binge eating (11.11%) were less common. Almost half of the sample endorsed extreme weight dissatisfaction. Dysregulation was associated with most weight-related attitudes and behaviors of interest in young adults but select patterns emerged for adolescents.
Conclusions:
Higher levels of psychological dysregulation are associated with greater BMI, problematic eating patterns and behaviors, and body dissatisfaction in AYA females with severe obesity. These findings have implications for developing novel intervention strategies for severe obesity in AYAs that may have a multidimensional impact on functioning (e.g., psychosocial health, weight loss behaviors).
Background: Graze eating is defined as repetitive, unplanned eating of small amounts of food throughout the day. Little consensuses exists regarding whether graze eating, like Binge Eating Disorder (BED), is characterized by feelings of loss of control (LOC). Further, little is known about how patients who graze eat with and without LOC differ psychologically.
Objectives: The present study seeks to better characterize graze eating by examining differences between graze eating with LOC (+LOC) and without LOC (-LOC) among pre-surgical bariatric patients.
Setting: A large, Midwestern academic medical center.
Methods: The sample consisted of 288 adult bariatric surgery candidates (mean age = 45.8, SD = 12.57) who underwent a pre-surgical psychological evaluation. Graze eating, BED, and other mental health diagnoses were evaluated using a semi-structured interview. Participants were also administered the MMPI-2-RF and Binge Eating Scale (BES). Data were collected using a retrospective chart review.
Results: Among the 33% (n = 95) of the sample who reported pre-operative graze eating, 32% (n = 30) also endorsed LOC. Graze eating, particularly with LOC, was associated with DSM-IV-TR
diagnoses of anxiety disorders and BED, and multiple measures of internalizing dysfunction on
the MMPI-2-RF.
Conclusions: Bariatric surgery candidates who demonstrate graze eating
experience a greater degree of overall distress and psychopathology including anxiety and
depression. The minority who experience grazing +LOC appear to have even greater risk of
psychopathology. Moreover, there appears to be significant overlap with BED. Future research
should explore whether these two maladaptive eating patterns benefit from similar treatment.