Control of eating after bariatric surgery

Whilst bariatric surgery is an effective intervention for life-threatening obesity, a substantial proportion of patients will continue to struggle to control their eating after surgery. Food cravings – the intense desire for a specific food or food group – are a key trigger for maladaptive eating, and are related to external cues and internal mental imagery. However, there is little known about the phenomenological experience of food cravings in people who have received bariatric surgery, or if there are any differences between types of bariatric surgery. This study recruited 43 bariatric patients between one and ten years post-surgery who reported all food cravings experienced over the course of one week using critical incident analysis methodology, resulting in a dataset of 128 cravings. The experience of people with gastric banding versus restructuring surgeries were compared, and mixed-model analyses were used to identify key predictive factors for the intensity and the resistibility of food cravings. Two to four cravings were experienced weekly: most often preceded by thinking about the food, most frequently for savoury foods, occurring in the early afternoon and within the first two hours after a meal. The majority of cravings (75%) resulted in an eating episode. Days in which a craving occurred were characterised by greater hunger, irritability and lower eating control. People with restructuring surgeries rated cravings as stronger and more difficult to resist, and more often ate after the craving than people with gastric bands, but this is likely to be due to differences between sample. Participants identified internal sensory imagery as part of their craving experience, and external sensory cues (seeing, smelling and eating the craved food) best predicted craving intensity. It is hoped that this study will help bariatric surgery candidates, those living with surgery and their clinicians to understand and anticipate food cravings, and lead to the development of effective interventions.