The Three B’s….. Body image, Binge eating and Bariatric surgery

What is Body Image?

Body Image is a term often used to describe how one thinks and feels about their body. Body image is influenced by many different factors, such as social and cultural attitudes and early life experiences. For example, if a person grows up in a society where there is great value placed on being a certain weight or shape, then the person may feel pressure to conform to these ideals. If they do not meet these ideals, they may develop a negative body image or feel overly dissatisfied with their body. Body image concerns are high in patients seeking bariatric surgery [1-2]. Patients may have experiences of avoiding particular clothes which make them more aware of their body shape, or they may spend a lot of time focusing on a particular area of their body which they are unhappy with [3].

The good news is that many patients who have bariatric surgery go on to report lower levels of body dissatisfaction [4]. This means they feel more satisfied with their body and spend more time focusing on things which are important to them. Some patients however still struggle with how they see themselves after surgery despite any weight-loss they have achieved. This is common and it can take time for a person to adjust and feel more comfortable and familiar in their post-surgery body. A small proportion of patients may fall into unhelpful ways of eating as a way of coping with body dissatisfaction [5-7]

What is Binge Eating?

Binge Eating is a type of eating which can be problematic for patients following bariatric surgery. Binge eating is characterised by skipping meals and going for long periods without eating, followed by consuming large amounts of food in a short period of time. The person may describe feeling that their eating is out of control and be distressed by this. This pattern of eating can jeopardise achieving long-term weight-loss goals and can lead to a poorer quality of life [8]

Quick Screen for Binge Eating behaviours

1. Do you regularly skip meals or go for long periods without eating? Yes / No
2. Do you consume large amounts of food (which could be seen as excessive) in a short period of time? Yes / No
3. Do you feel that your eating is out of control and are you distressed by this? Yes / No
4. Does this pattern of eating occur frequently i.e. most days in a week over a number of weeks? Yes / No

What can I do to help myself?

1. The most helpful first step is to try and eat regularly to avoid going without food for long periods during the day.
2. Try to identify patterns in your eating e.g. Does the feeling of being out of control with your eating occur on any particular days or following any specific activities or events? If a pattern emerges, experiment with changing your routine.
3. People can feel guilty or become overly self-critical following a binge. This can be part of the problem as the person may then decide to restrict their eating (to counter the amount of food consumed) which can keep the cycle going. Try to develop a compassionate stance to your eating behaviours and focus on what you can influence; currently or in the future.
4. If you are concerned about your eating, seek professional advice and support from your local General Practitioner.

By Jolyon Poole

Cognitive Behavioural Therapist (BABCP Accredited)

References

[1] de Zwaan M, Mitchell, J. E., Howell, L. M., et al. (2003). Characteristics of morbidly obese patients before gastric bypass surgery. Compr Psychiatry, 44, 5, 428-34.

[2] Sarwer, D.B., Cohn, N. I., Gibbons, L.M, et al. (2004). Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates. Obesity Surgery, 14, 9, 1148-56.

[3] Sarwer, D. B., Wadden, T.A, & Fabricatore, A. N. (2005). Psychosocial and behavioural aspects of bariatric surgery. Obesity Research, 13, 4, 639-48.

[4] Ashleigh, A. P., Heinberg, L. J., Lavery, M., et al. (2016). Psychological predictors of body image concerns 3 months after bariatric surgery. Surgery of Obesity and Related Diseases, 12, 188-193.

[5] Goldschmidt, A. B., Hilbert, A., Manwaring, J. L. et al. The significance of overvaluation of shape and weight in binge eating disorder. (2010). Behaviour Research and Therapy, 48, 187-193.

[6] Grilo, C. M., Crosby, R. D., Masheb, R. M., et al. (2009). Overvaluation of shape and weight in binge eating disorder, bulimia nervosa, and sub-threshold bulimia nervosa. Behaviour Research and Therapy, 47, 692-696.

[7] Grilo, C. M., White, M. A., Gueorguieva, R., et al. (2013). Predictive significance of the overvaluation of shape/weight in obese patients with binge eating disorder: findings from a randomized controlled trial with 12-month follow-up. Psychological Medicine, 43, 1335-1344.

[8] Kalarchian, M. A., Marcus, M. D., Wilson T., et al. (2002). Binge eating amongst gastric bypass patients at long-term follow-up. Obesity Surgery, 12, 2, 270-275.