Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Obesity (Silver Spring). 2011 Jun;19(6):1220-8. doi: 10.1038/oby.2010.336. Epub 2011 Jan 20.
Previous studies have suggested that binge eating disorder (BED) impairs weight loss following bariatric surgery, leading some investigators to recommend that patients receive behavioral treatment for this condition before surgery. However, many of these investigations had significant methodological limitations. The present observational study used a modified intention-to-treat (ITT) population to compare 1-year changes in weight in 59 surgically treated participants, determined preoperatively to be free of a current eating disorder, with changes in 36 individuals judged to have BED. Changes in weight and binge eating in the latter group were compared with those in 49 obese individuals with BED who sought lifestyle modification for weight loss. BED was assessed using criteria proposed for the Diagnostic and Statistical Manual (DSM) 5. At 1 year, surgically treated participants without BED lost 24.2% of initial weight, compared with 22.1% for those with BED (P > 0.309). Both groups achieved clinically significant improvements in several cardiovascular disease (CVD) risk factors. Participants with BED who received lifestyle modification lost 10.3% at 1 year, significantly (P < 0.001) less than surgically treated BED participants. The mean number of binge eating days (in the prior 28 days) fell sharply in both BED groups at 1 year. These two groups did not differ significantly in BED remission rates or in improvements in CVD risk factors. The present results, obtained in carefully studied participants, indicate that the preoperative presence of BED does not attenuate weight loss or improvements in CVD risk factors at 1 year in surgically treated patients. Longer follow-up of participants is required.
先前的研究表明，暴食障碍（BED）会影响减重手术的效果，这导致一些研究人员建议患者在手术前接受针对这种情况的行为治疗。然而，这些研究中的许多都存在显著的方法学局限性。本观察性研究使用改良的意向治疗（ITT）人群，比较了 59 名接受手术治疗且术前无当前饮食障碍的患者与 36 名被判断患有 BED 的患者在术后 1 年的体重变化。将后者组的体重和暴食行为变化与寻求生活方式改变以减轻体重的 49 名肥胖且患有 BED 的个体进行了比较。使用为《精神障碍诊断与统计手册（DSM）》第 5 版提出的标准评估 BED。术后 1 年时，无 BED 的手术治疗参与者体重减轻了初始体重的 24.2%，而患有 BED 的参与者体重减轻了 22.1%（P > 0.309）。两组都在几个心血管疾病（CVD）风险因素方面取得了显著的临床改善。接受生活方式改变的 BED 患者在术后 1 年体重减轻了 10.3%，显著低于手术治疗的 BED 患者（P < 0.001）。两组 BED 患者在术后 1 年内的暴食天数（过去 28 天内）都显著减少。两组的 BED 缓解率或 CVD 风险因素的改善均无显著差异。这些在经过精心研究的参与者中获得的结果表明，术前存在 BED 并不会削弱手术治疗患者在术后 1 年内的体重减轻或 CVD 风险因素的改善。需要对参与者进行更长时间的随访。
