Screening and Treating Disordered Eating in Weight Loss Surgery: A Rapid Review of Current Practices and Future Directions
Abstract
:1. Introduction
2. Methods
3. Findings
3.1. Current Evidence for Screening and Diagnosis
Screening Measure | Studies | Main Findings |
---|---|---|
Pre-WLS Screening | ||
Binge Eating Scale (BES) | Jeong et al., 2023 [23]; Marek et al., 2015 [24]; Grupski et al., 2013 [25]; Hood et al., 2013 [26] | The BES is reliable in identifying binge-eating symptoms in WLS-seeking patients. The BES has good internal consistency, concordance validity, and reliability in WLS patients pre-surgery. |
Minnesota Multiphasic Personality Inventory 2—Restructured Form (MMPI-2-RF) | Martin-Fernandez et al., 2021 [35]; Marek et al., 2014a [36]; Marek et al., 2014b [37]; Marek et al., 2013 [38] | Higher scores on demoralization, emotional dysfunction, antisocial, hypomanic, and impulsive subscales were associated with higher rates of disordered eating or BED diagnosis. |
Minnesota Multiphasic Personality Inventory 3 (MMPI-3) | Marek et al., 2024 [39]; Marek et al., 2021 [40] | Internalizing, externalizing, and somatic/cognitive dysfunction were associated with binge-eating and LOCE. An additional Eating Concerns Subscale was found to have good clinical utility in capturing eating psychopathology in WLS patients. |
Eating Disorder Examination—Questionnaire (EDE-Q) | Parker et al., 2015 [41]; Grilo et al., 2013 [42] | The EDE-Q was found to be a poor fit to WLS patients; when the EDE-Q was modified, validity and reliability improved in both studies. |
Eating Disorder Diagnostic Scale (EDDS) | Williams et al., 2017 [43] | The EDDS was found to have good clinical utility in identifying binge-eating behaviors in WLS patients. |
Eating Expectancies Inventory (EEI) | Williams-Kerver et al., 2019 [44] | The EEI had good to excellent fit in its original factor structure. EEI scores were positively associated with EDDS symptom scores, BES scores, and binge-eating frequency. |
Three-Factor Eating Questionnaire (TFEQ) | Parker et al., 2015 [41] | A revised three-factor structure demonstrated good fit in identifying disordered eating in WLS patients pre-surgery. |
Post-WLS Screening | ||
Eating Disorder Examination—Bariatric Surgery Version (EDE-BSV) | Ivezaj et al., 2022 [21]; Wiedemann et al., 2020 [20]; de Zwaan et al., 2010 [19] | The EDE-BSV has high interrater reliability with the original EDE global and subscales, with excellent agreement for identifying LOCE episodes and associated disordered eating behaviors in WLS patients. |
Diagnostic and Statistical Manual for Mental Disorders—5th Edition (DSM-V) Clinical Assessment | Yu et al., 2023 [45]; Conceição et al., 2020 [46] | Due to dietary recommendations and anatomical changes post-surgery, DSM-V criteria for eating disorders, such as BED, are less applicable to WLS populations (e.g., “consuming large amounts of food when not physically hungry”). |
Eating Loss of Control Scale (ELOCS) | Carr et al., 2019 [33] | A two-factor modified ELOCS was found to have good fit to a post-WLS sample. Correlations with the EDE-BSV suggested good construct validity in identifying disordered eating. |
Eating Disorder After Bariatric Surgery—Questionnaire (EDABS-Q) | Globus et al., 2021 [29] | When compared to the EDE-BSV, the EDABS-Q significantly agreed with all items with high construct concordance. |
3.2. Current Evidence for Treatment
Treatment Type | Studies | Main Findings |
---|---|---|
Pre-WLS Treatment | ||
Individual Cognitive Behavioral Therapy (CBT) | Abiles et al., 2013 [48]; Gade et al., 2014 [62]; Gade et al., 2015 [63]; Cassin et al., 2016 [64]; Hjelmsæth et al., 2019 [65]; Paul et al., 2021 [49]; Paul et al., 2022 [50] | In general, CBT interventions were found to significantly improve binge-eating, eating disorder psychopathology, weight loss, and anxiety/mood symptoms post-intervention. Studies including follow-ups post-surgery found that these improvements were not maintained post-WLS. |
Group Cognitive Behavioral Therapy (CBT) | Ashton et al., 2011 [66] | Group CBT had significant weight loss at 6- and 12-month follow-ups post-WLS; moreover, group CBT led to reductions in eating disorder symptomatology for those with and without BED, but the effect was not significant. |
Dialectical Behavioral Therapy (DBT) | Delparte et al., 2019 [67] | DBT showed reductions in binge-eating, emotional eating, eating pathology, and clinical impairment as compared to treatment-as-usual at pre-surgery and at 6-month follow-ups. Weight was not reported. |
Mindfulness-Based Intervention (MBI) | Felske et al., 2020 [68] | MBI showed improvements in eating behaviors and were maintained for 12 weeks; however, improvements deteriorated with time. Weight was not reported. |
Post-WLS Treatment | ||
Individual Cognitive Behavioral Therapy (CBT) | Sockalingam et al., 2017 [52] Sockalingam et al., 2019 [53] Rudolph & Hilbert, 2020 [56] Grilo et al., 2022 [69]; Sockalingam et al., 2022 [54] Smith et al., 2023 [70]; Sockalingam et al., 2023 [55] | In general, individual CBT was associated with significant improvements in disordered eating behaviors, eating-related psychopathology, anxiety/depression symptoms, and weight loss. In several cases, these improvements were found to be maintained for up to 1 year following the intervention. |
Group Cognitive Behavioral Therapy (CBT) | Lent et al., 2019 [71]; Himes et al., 2015 [57] | Group CBT had mixed findings. One study found no improvements in eating behaviors, weight, or mood as compared to controls. However, another study found significant reductions in eating behaviors and decreases in weight regain. Follow-up data were not recorded. |
Dialectical Behavioral Therapy (DBT) | Gallé et al., 2017a [61]; Gallé et al., 2017b [72]; Himes et al., 2015 [57]; Hany et al., 2022 [60] | DBT has shown significant improvements in eating behaviors, emotional eating, weight, and psychiatric comorbidities post-intervention. These improvements were maintained for up to 1 year following the intervention. |
Mindfulness-Based Interventions (MBI) | Chacko et al., 2016 [73]; Wnuk et al., 2018 [74] | MBIs have shown significant improvements in eating behaviors, eating disorder psychopathology, and depressive symptoms; however, perceived stress has been found to increase post-intervention. One study found that improvements were maintained at a 4-month follow-up. Weight outcomes were not reported |
Acceptance and Commitment Therapy or Acceptance-Based Therapy (ACT; ABT) | Weineland et al., 2012a [58] Weineland et al., 2012b [59] Bradley et al., 2017 [75] | ACT was found to significantly improve disordered eating behaviors, body dissatisfaction, quality of life, and weight acceptance; these improvements were maintained at a 6-month follow-up. Weight outcomes were not reported. |
Schema Therapy | Sobhani et al., 2023 [76] | Those receiving schema therapy reported less maladaptive cognitive reasoning, more adaptive cognitive reasoning, and reductions in weight. This effect was maintained at a 6-month follow-up. Eating disorder behaviors were not reported. |
Bariatric Surgery and Education (BaSE) Psychoeducational Group | Wild et al., 2015 [77] | There were no differences between the intervention and control groups in weight loss, health-related quality of life, or depression scores. Improvements were not maintained at a 1-year follow-up. Those with higher depression scores in the intervention showed slight improvements in quality of life and depressive symptoms. |
Postbariatric Surgery (PBS) Protocol for Inpatient Eating Disorder Treatment | Schreyer et al., 2019 [78] | Preliminary findings suggest a positive association with the intervention, weight maintenance, and weight regain for those with restrictive eating disorders post-WLS. Eating disorder outcomes were not reported. Follow-up data were not reported. |
Adapted Motivational Interviewing Intervention (AMI) | David et al., 2016 [79] | The intervention group showed significant improvements in binge-eating symptoms and dietary adherence across 12-week follow-ups as compared to the control group. AMI increased reported readiness, confidence, and self-efficacy in post-WLS guidelines. |
4. Future Directions for Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Price, C.; Fraser, K.; Bartel, S.; Vallis, M.; Jad, A.; Keshen, A. Screening and Treating Disordered Eating in Weight Loss Surgery: A Rapid Review of Current Practices and Future Directions. Obesities 2025, 5, 19. https://doi.org/10.3390/obesities5020019
Price C, Fraser K, Bartel S, Vallis M, Jad A, Keshen A. Screening and Treating Disordered Eating in Weight Loss Surgery: A Rapid Review of Current Practices and Future Directions. Obesities. 2025; 5(2):19. https://doi.org/10.3390/obesities5020019
Chicago/Turabian StylePrice, Colby, Kaela Fraser, Sara Bartel, Michael Vallis, Ahmed Jad, and Aaron Keshen. 2025. "Screening and Treating Disordered Eating in Weight Loss Surgery: A Rapid Review of Current Practices and Future Directions" Obesities 5, no. 2: 19. https://doi.org/10.3390/obesities5020019
APA StylePrice, C., Fraser, K., Bartel, S., Vallis, M., Jad, A., & Keshen, A. (2025). Screening and Treating Disordered Eating in Weight Loss Surgery: A Rapid Review of Current Practices and Future Directions. Obesities, 5(2), 19. https://doi.org/10.3390/obesities5020019