Levels of post-operative hunger have been associated with weight-loss after LAGB (1,2). Dietary restraint has shown relationships with hunger cues and eating behaviours, as have stress, eating self-efficacy and emotional eating (3,4,5,6). A path analysis model tested how pre-surgical dietary restraint may influence post-operative hunger and how perceptions of hunger affect eating self-efficacy, eating behaviours, and ultimately weight-loss across 24 months.
Participants were 147 patients (127 females, 27 males) about to undertake laparoscopic adjustable gastric banding surgery (LAGB). Questionnaires concerning eating behaviours and cognitions (cognitive restraint, hunger, eating self-efficacy, and emotional eating) and stress were completed prior to and at 12 months post-surgery. Weight was measured prior to and at 12 and 24 months post-surgery.
Results showed a negative relationship between presurgical dietary restraint and post-surgical hunger reduction, such that patients with the lowest pre-surgical restraint experienced the greatest hunger reduction at 12 months post-surgery. Lower hunger then predicted improvement in emotional eating which was partially mediated by eating self-efficacy. Improvement in emotional eating at 12 months post-surgery subsequently predicted better weight-loss between 12 and 24 months. Improvement in emotional eating was not explained by reduced levels of stress.
Improved eating behaviours are important predictors of weight-loss in LAGB. These results suggest that other pre and post-surgical mechanisms such as dietary restraint, hunger, and eating self-efficacy may influence the manner in which eating behaviours are expressed. In order to enhance outcomes for patients, future research should examine the pathways involved in improved eating behaviours after bariatric surgery.