A modified inpatient eating disorders treatment protocol for postbariatric surgery patients

patient characteristics and treatment response

Colleen Clarkin Schreyer, Angela S Guarda, Allisyn W. Pletch, Graham Redgrave, Jessica K. Salwen-Deremer, Janelle Coughlin

Research output: Contribution to journalArticle

Abstract

Background: Bariatric surgery is currently the most effective treatment for obesity. However, outcomes vary and disordered eating may persist or emerge postsurgically. Severe postsurgical eating disorders may require inpatient treatment, and guidelines for the modification of inpatient nutritional treatment protocols for this population are lacking. Objectives: This paper describes a modified inpatient nutritional protocol for postsurgical patients with eating disorders treated on a behavioral eating disorders unit, and reports patient characteristics and treatment response. Settings: This research was conducted at a university hospital. Methods: Cases (n = 19) comprised 2% of all eating disorder admissions; 5 were underweight and required weight restoration. Clinical data collected via chart review included disordered eating behaviors, medical and psychiatric co-morbidity, and treatment course. Results: All cases were status post Roux-en-Y gastric bypass (median 5 yr postsurgery). Onset of disordered eating preceded surgery in the majority, and intentional vomiting was the most commonly reported postsurgical disordered eating behavior. The sample was notable for a high level of psychiatric and medical co-morbidity. Patients responded well to the modified treatment protocols, with a majority of patients on the weight gain (60%) and weight maintenance (78%) post-bariatric surgery protocols discharged for clinical improvement. Conclusions: Postsurgical bariatric patients with eating disorders can be successfully treated on a specialized eating disorders unit. Modification of inpatient eating disorder protocols for those who have undergone bariatric surgery is necessary to address the different physiologic needs of this patient population while providing them with effective psychiatric care.

Original languageEnglish (US)
JournalSurgery for Obesity and Related Diseases
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Clinical Protocols
Inpatients
Bariatric Surgery
Psychiatry
Feeding Behavior
Therapeutics
Eating
Morbidity
Bariatrics
Weights and Measures
Gastric Bypass
Thinness
Feeding and Eating Disorders
Population
Weight Gain
Vomiting
Obesity
Maintenance
Guidelines
Research

Keywords

  • Bariatric surgery
  • Behavioral protocol
  • Eating disorders
  • Inpatient treatment
  • Nutritional rehabilitation

ASJC Scopus subject areas

  • Surgery

Cite this

@article{718a0d7fad6e4706961a780573abc8bd,
title = "A modified inpatient eating disorders treatment protocol for postbariatric surgery patients: patient characteristics and treatment response",
abstract = "Background: Bariatric surgery is currently the most effective treatment for obesity. However, outcomes vary and disordered eating may persist or emerge postsurgically. Severe postsurgical eating disorders may require inpatient treatment, and guidelines for the modification of inpatient nutritional treatment protocols for this population are lacking. Objectives: This paper describes a modified inpatient nutritional protocol for postsurgical patients with eating disorders treated on a behavioral eating disorders unit, and reports patient characteristics and treatment response. Settings: This research was conducted at a university hospital. Methods: Cases (n = 19) comprised 2{\%} of all eating disorder admissions; 5 were underweight and required weight restoration. Clinical data collected via chart review included disordered eating behaviors, medical and psychiatric co-morbidity, and treatment course. Results: All cases were status post Roux-en-Y gastric bypass (median 5 yr postsurgery). Onset of disordered eating preceded surgery in the majority, and intentional vomiting was the most commonly reported postsurgical disordered eating behavior. The sample was notable for a high level of psychiatric and medical co-morbidity. Patients responded well to the modified treatment protocols, with a majority of patients on the weight gain (60{\%}) and weight maintenance (78{\%}) post-bariatric surgery protocols discharged for clinical improvement. Conclusions: Postsurgical bariatric patients with eating disorders can be successfully treated on a specialized eating disorders unit. Modification of inpatient eating disorder protocols for those who have undergone bariatric surgery is necessary to address the different physiologic needs of this patient population while providing them with effective psychiatric care.",
keywords = "Bariatric surgery, Behavioral protocol, Eating disorders, Inpatient treatment, Nutritional rehabilitation",
author = "Schreyer, {Colleen Clarkin} and Guarda, {Angela S} and Pletch, {Allisyn W.} and Graham Redgrave and Salwen-Deremer, {Jessica K.} and Janelle Coughlin",
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doi = "10.1016/j.soard.2019.06.042",
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T1 - A modified inpatient eating disorders treatment protocol for postbariatric surgery patients

T2 - patient characteristics and treatment response

AU - Schreyer, Colleen Clarkin

AU - Guarda, Angela S

AU - Pletch, Allisyn W.

AU - Redgrave, Graham

AU - Salwen-Deremer, Jessica K.

AU - Coughlin, Janelle

PY - 2019/1/1

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N2 - Background: Bariatric surgery is currently the most effective treatment for obesity. However, outcomes vary and disordered eating may persist or emerge postsurgically. Severe postsurgical eating disorders may require inpatient treatment, and guidelines for the modification of inpatient nutritional treatment protocols for this population are lacking. Objectives: This paper describes a modified inpatient nutritional protocol for postsurgical patients with eating disorders treated on a behavioral eating disorders unit, and reports patient characteristics and treatment response. Settings: This research was conducted at a university hospital. Methods: Cases (n = 19) comprised 2% of all eating disorder admissions; 5 were underweight and required weight restoration. Clinical data collected via chart review included disordered eating behaviors, medical and psychiatric co-morbidity, and treatment course. Results: All cases were status post Roux-en-Y gastric bypass (median 5 yr postsurgery). Onset of disordered eating preceded surgery in the majority, and intentional vomiting was the most commonly reported postsurgical disordered eating behavior. The sample was notable for a high level of psychiatric and medical co-morbidity. Patients responded well to the modified treatment protocols, with a majority of patients on the weight gain (60%) and weight maintenance (78%) post-bariatric surgery protocols discharged for clinical improvement. Conclusions: Postsurgical bariatric patients with eating disorders can be successfully treated on a specialized eating disorders unit. Modification of inpatient eating disorder protocols for those who have undergone bariatric surgery is necessary to address the different physiologic needs of this patient population while providing them with effective psychiatric care.

AB - Background: Bariatric surgery is currently the most effective treatment for obesity. However, outcomes vary and disordered eating may persist or emerge postsurgically. Severe postsurgical eating disorders may require inpatient treatment, and guidelines for the modification of inpatient nutritional treatment protocols for this population are lacking. Objectives: This paper describes a modified inpatient nutritional protocol for postsurgical patients with eating disorders treated on a behavioral eating disorders unit, and reports patient characteristics and treatment response. Settings: This research was conducted at a university hospital. Methods: Cases (n = 19) comprised 2% of all eating disorder admissions; 5 were underweight and required weight restoration. Clinical data collected via chart review included disordered eating behaviors, medical and psychiatric co-morbidity, and treatment course. Results: All cases were status post Roux-en-Y gastric bypass (median 5 yr postsurgery). Onset of disordered eating preceded surgery in the majority, and intentional vomiting was the most commonly reported postsurgical disordered eating behavior. The sample was notable for a high level of psychiatric and medical co-morbidity. Patients responded well to the modified treatment protocols, with a majority of patients on the weight gain (60%) and weight maintenance (78%) post-bariatric surgery protocols discharged for clinical improvement. Conclusions: Postsurgical bariatric patients with eating disorders can be successfully treated on a specialized eating disorders unit. Modification of inpatient eating disorder protocols for those who have undergone bariatric surgery is necessary to address the different physiologic needs of this patient population while providing them with effective psychiatric care.

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