Surgical Management of Obese Patients with Eating Disorders: A Survey of Current Practice

Background: This study examined the current practice of bariatric surgeons and their colleagues regarding patients with binge eating disorder (BED) and night eating syndrome (NES) who present for Roux-en-Y gastric bypass (RYGBP) for obesity. Method: We conducted a 9-item internet survey of American Society for Bariatric Surgery (ASBS) members. For each item, the numbers of respondents endorsing each possible response, including "Other" and "Unknown or not applicable," were tabulated, and percentages of the total sample of respondents were calculated. Results: Most respondents' screening process included mental health (82.0%) and nutritional (78.0%) evaluations. Most inquired about binge eating (88.0%) and other eating disturbances (83.3%), while fewer respondents (52.7%) screened for night eating. Management of patients with eating disorders varied widely. For patients with binge eating, 20.0% of respondents proceeded with surgery, 2.7% recommended against surgery, and 27.3% postponed surgery, with the remainder (50.0%) reporting that their management varied. For night eating and other eating disturbances, responses were similarly diverse. Respondents who postponed surgery reported a wide range of estimates of how often patients with eating disorders follow through with treatment for their eating problem and return for surgery: 16% (always/almost always), 36% (usually), 24% (sometimes), 12% (occasionally), and 12% (never/almost never). Conclusion: Although bariatric surgeons commonly screen for eating disorders such as BED, there are limited empirical data and no consensus regarding the optimal management of these patients.