1. LONG TERM FOLLOW UP BED AND BARIATRIC SURGERY

2. PHASES Preoperative: before surgery Post-operative: after surgery for up to 1.5 years Maintenance: begins 1-1.5 years after surgery

3. LONG TERM FOLLOW UP Anywhere from 1 year to 15 years Uses self reported questionnaire including BMI and lowest weight recorded Eating Disorder Examination - Questionnaire: items are rated on a seven point, forced choice scale ranging from 0 to 6, with higher numbers indicating greater severity or frequency of symptoms (restraint, eating concern, shape and weight concern)

4. LONG TERM WEIGHT LOSS Mean weight loss peaks at about 16 months after operation Most weight regain is done during the weight maintenance phase Binge eating is relatively common in the weight maintenance phase and appears to be a behavioral source of variation in weight regain

5. BED AND LONG TERM OUTCOMES positive overall short-term impact on depression, eating behavior, and attitudes toward eating and body shape and weight in non-binge and binge eaters alike Long term follow up: those who reported binge eating at long-term follow-up also reported gaining more since their preoperative low weight than non- bingers did. BED patients also reported greater concerns related to eating, shape, and weight as well as less cognitive restraint, more disinhibition, and more hunger than non- bingers Patients diagnosed with BED prior to surgery had poorer outcomes than those who did not.

6. WHAT DO WE DO WITH THIS INFORMATION? Most findings suggest that binge eating may be a marker of poorer outcome and an appropriate target for post-surgery intervention. longitudinal research is needed to determine if binge eating is a cause, correlate or consequence of poorer outcomes following surgery.

7. REFERENCES Gastric bypass patient handbook. The Bariatric Center. https://www.mainegeneral.org/Documents/GBPatientHandbook.pdf Kalarchian, M. A., Marcus, M. D., Wilson, G. T., Labouvie, E. W., Brolin, R. E., & LaMarca, L. B. (2002). Binge eating among gastric bypass patients at long-term follow-up. Obesity Surgery, 12(2), 270-275. Mitchell, J. E., Steffen, K. (2009) The interface between eting disorders and bariatric surgery. Eating Disorders Review, 20(1). http://eatingdisordersreview.com/nl/nl_edr_20_1_1.html Mitchell, J. E., Lancaster, K. L., Burgard, M. A., Howell, L. M., Krahn, D. D., Crosby, R. D.,... Gosnell, B. A. (2001). Long-term follow-up of patients' status after gastric bypass. Obesity Surgery, 11(4), 464-468. Scholtz, S., Bidlake, L., Morgan, J., Fiennes, A., El-Etar, A., Lacey, J. H., & McCluskey, S. (2007). Long-term outcomes following laparoscopic adjustable gastric banding: Postoperative psychological sequelae predict outcome at 5-year follow-up. Obesity Surgery, 17(9), 1220-1225.

8. CONTENT QUESTION How does BED effect the long term outcomes of bariatric surgery?