Binge Eating Disorder: Bariatric Surgery or the Sleeve?

Written by: Margot Rittenhouse, MS, PLPC, NCC on November 2, 2022Reviewed by: Jacquelyn Ekern, MS, LPC

Binge Eating Disorder, commonly referred to as BED, is the most common eating disorder diagnosis in the United States. Those that struggle with BED often have complicated relationships with their bodies, particularly if their binge behaviors have led to weight gain. Whether due to social or medical stigma of living in a larger body or pressure from medical professionals, it seems individuals with BED are more likely than the average person to seek out bariatric surgeries to alter their eating behaviors and weight [1].

While not always a problematic decision, this often means individuals are treating the symptoms of BED rather than the causes. Understanding the relationship between BED, mental health and well-being, and bariatric surgery is important before making decisions related to bariatric surgeries.

What is Binge Eating Disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), BED is characterized by recurrent episodes of binge eating at least 2 days a week for 6 months [2]. Binge eating is eating, within a 2-hour period, eating a larger amount of food than the average person would eat within a similar period of time under similar circumstances [2].

These binges are often related to eating until uncomfortably full, eating alone, eating food rapidly, and feeling guilty or ashamed afterward [2]. Those with BED do not engage in any compensatory behaviors after binge episodes.

BED does not only occur in those living in larger bodies, however, weight gain and obesity can be a physical consequence of this mental illness.

Bariatric Surgeries

As one article published by Johns Hopkins medical school details, “bariatric surgery remains the most effective treatment we have for severe obesity [3].” According to the American Society for Metabolic and Bariatric Surgery (ASMBS), “the goal of these operations is to modify the stomach and intestines to treat obesity and related diseases. The operations may make the stomach smaller and also bypass a portion of the intestine. This results in less food intake and changes how the body absorbs food for energy resulting in decreased hunger and increased fullness. These procedures improve the body’s ability to achieve a healthy weight [4].”

Despite these surgeries becoming more common, many do not understand what they are or why they are recommended by medical professionals. To begin, bariatric surgeries are not recommended as a form of cosmetic surgery. The intention may be to have an individual lose weight, however, this is not for aesthetics but, instead, is to improve their physical and medical health.

It is crucial to impart this as the intention of this article is not to encourage bariatric surgeries for cosmetic purposes but to provide psycho education for those considering bariatric surgery who may also have BED.

Bariatric surgeries endorsed by the ASMBS include:

  • Laparoscopic Sleeve Gastrectomy
  • Roux-en-Y Gastric Bypass (“Gastric Bypass”)
  • Adjustable Gastric Band (AGB)
  • Biliopancreatic Diversion with Duodenal Switch (BPD-DS)
  • Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S) [4].

Bariatric Surgeries are not without their risks and each of the above procedures have their own disadvantages, some of which are vitamin and mineral deficiencies, ulcer development, bowel movement issues or obstructions, and feelings of sickness after eating or drinking [4].

Bariatric Surgery & BED

Whether BED or obesity comes first is a chicken-and-the-egg situation. Individuals can experience obesity as a result of BED behaviors, however, individuals that are obese are also at a higher risk for developing BED [5]. This is likely due to engaging in restrictive behaviors in an attempt to alter their body and eventually binging after long periods of nutrient deprivation.

Between 6 to 69% of those with BED have had some type of bariatric surgery [1]. This may be due to having BED behaviors prior to surgery, however, the behaviors can also develop after surgery. In addition, some experience unintentional eating disorder behaviors after surgery. For example, an individual might vomit after meals due to being overly full or this being how their body is reacting to the food post-surgery [1]. Individuals might also engage in restriction to avoid feelings of sickness due to eating or drinking [1].

Regardless of how the dynamic between BED and bariatric surgeries develops, it is important to recognize that bariatric surgery is not a comprehensive treatment for BED. As mentioned above, it may work to reduce weight gain caused by binge behaviors, however, it does not address the underlying issue that maintains BED behaviors.

Individuals might engage in binge behaviors for many reasons, some of which include attempting to cope using food, experiencing addiction to physical sensations of eating, having a history of food insecurity, experiencing trauma, and many more. Without addressing these aspects, individuals with BED behaviors that undergo bariatric surgery can be at a huge risk.

These individuals might turn to other behaviors that are equally ineffective and/or maladaptive. Additionally, they may continue binge behaviors despite their sleeve, band, etc. which can cause severe physical damage to the body and could even lead to death.

Ultimately, eating disorders are complex psychological and physical disorders that require extensive treatment from a multidisciplinary team. As the AMBS specifies, “Successful bariatric surgery requires a team-based approach including your surgeon, dietitian, psychologist, nurse case manager, and obesity medicine specialist who will focus on taking you through each step of the journey [4].”

If you struggle with BED and are considering or being recommended to have bariatric surgery, it is important to find a team educated in both eating disorders and bariatric surgeries in order to approach this discussion safely and comprehensively.

References

[1] Conceicao, E., et al. (2014). Characterization of eating disorders after bariatric surgery: a case series study. International Journal of Eating Disorders, 46:3.

[2] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

[3] Coughlin, J. (2014). Bariatric surgery and eating disorders. Hopkins Brain Wise.

[4] Public Education Committee (2021). Bariatric Surgery Procedures. American Society for Metabolic and Bariatric Surgery, retrieved from https://asmbs.org/patients/bariatric-surgery-procedures.

[5] Unknown (2022). Definition and facts for binge eating disorder. National Institute of Diabetes and Digestive and Kidney Issues. Retrieved from https://www.niddk.nih.gov/health-information/weight-management/binge-eating-disorder/definition-facts.

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