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Loss of control while eating refers to a sense of being unable to control what or how much one is eating. Objectively large loss-of-control eating indicates that the loss of control is coupled with the consumption of an unambiguously large quantity of food (overeating). Conversely, subjectively large loss-of-control eating is not accompanied by overeating. Loss-of-control eating, regardless of episode size, is associated with obesity, eating-related and general psychopathology, and decreased quality of life, and it affects at least 30% of individuals who undergo bariatric surgery.

Past studies of bariatric surgery samples have primarily focused on estimating the prevalence of—and post-surgical changes in—objectively large loss-of-control eating episodes, and have relied almost exclusively on retrospective methodologies. Yet, post-surgical loss-of-control eating, independent of overeating, is associated with poorer weight outcomes, suggesting a need to focus on more comprehensive assessment of eating pathology in the context of surgery. In a recent study published in Obesity, investigators including Andrea Goldschmidt, PhD (Associate Professor of Psychiatry), compared rates of loss-of-control eating—reported via ecological momentary assessment versus retrospective self-report questionnaire—among adults before bariatric surgery and for one year after surgery.

Study participants, adults (age 21 years or older) with severe obesity, reported on loss-of-control eating (e.g., “Over the past 28 days, how many times did you have a sense of having lost control over your eating [at the time that you were eating]?”) and more specifically on objectively large loss-of-control eating (e.g., “On how many of those times have you eaten what other people would regard as an unusually large amount of food [given the circumstances]?”) in the past 28 days via items drawn from via Eating Disorder Examination-Questionnaire, a self-report measure of eating-related psychopathology. Participants also reported on any recent loss-of-control eating and overeating episodes via ecological momentary assessment surveys delivered at four semirandom times per day immediately prior to and in the year following bariatric surgery.

The investigators found that objectively large loss-of-control eating and subjectively large loss-of-control eating declined in frequency over the postsurgical period. However, contrary to the scientists’ hypotheses, ecological momentary assessment surveys produced lower estimates of objectively large loss-of-control eating than the Eating Disorder Examination-Questionnaire, with these differences only reaching statistical significance at six months post-surgery. Although reports of subjectively large loss-of-control eating were higher on ecological momentary assessment relative to Eating Disorder Examination-Questionnaire at all times pre- and post-surgery, consistent with expectations, these differences were not statistically significant at any time point.

“Clinicians and researchers should consider using a variety of methods to assess loss-of-control eating in the context of bariatric surgery, to better understand who may be at risk for suboptimal weight outcomes after surgery,” said Dr. Goldschmidt, the study’s corresponding author.

Real-time versus retrospective self-report assessment of loss-of-control eating in adults undergoing bariatric surgery
Goldschmidt AB, Smith KE, Thomas JG, Espel-Huynh HM, Jones DB, Vithiananthan S, Bond DS.
Obesity (Silver Spring).2023;31:363–373 https://doi.org/10.1002/oby.23628