The hidden burden: how binge-eating symptoms impact postmetabolic and bariatric surgery success

Binge-eating symptoms after metabolic and bariatric surgery (MBS) may impair dietary intake, postoperative outcomes, and health-related quality of life, yet their manifestations remain insufficiently characterized OBJECTIVES: To evaluate whether binge-eating symptoms are associated with dietary intake, postoperative outcomes, and health-related quality of life in women after MBS, and to characterize reported binge-eating episodes quantitatively and qualitatively SETTING: Obesity Outpatient Unit of Policlinic Piquet Carneiro, State University of Rio de Janeiro.

This cross-sectional study included 66 women at least 12 months after MBS without nutritional follow-up in the previous 6 months, classified as controls (Binge Eating Scale (BES) <17; n = 37) or with binge-eating symptoms (BES ≥17; n = 29). Anthropometric, body composition, dietary, and quality-of-life data were obtained; dietary intake and episodes were assessed using 24-hour recalls and classified by NOVA (the NOVA food classification system, based on the extent and purpose of industrial processing).

Women with binge-eating symptoms showed lower excess weight loss, higher body fat percentage, higher energy and carbohydrate intake, and lower relative protein intake than controls. High quality of life was less frequent, and BES score was inversely associated with Bariatric Analysis and Reporting Outcome System (BAROS) score (rho = -.418, P = .0005). Episodes were energy-dense, carbohydrate-predominant, emotionally triggered, and often occurred without hunger, mainly at home and later in the day. Overall NOVA distribution did not differ between groups; however, episodes themselves were markedly dominated by ultra-processed foods (81.3% of caloric content), versus unprocessed/minimally processed foods (12.5%) and processed foods (6.3%).

Binge-eating symptoms after MBS were associated with poorer dietary intake, less favorable postoperative outcomes, and poorer health-related quality of life.