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The Nature of Food Cravings Following Weight-Loss Surgery

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The Nature of Food Cravings Following Weight-Loss Surgery THE NATURE OF FOOD CRAVINGS FOLLOWING WEIGHT-LOSS SURGERY Heidi Michelle Guthrie Submitted in accordance with the requirements for the degree of Doctor of Clinical Psychology (D. Clin. Psychol. ) The University of Leeds Academic Unit of Psychiatry and Behavioural Sciences School of Medicine July 2008 The candidate confirms that the work submitted is her own and that appropriate credit has been given where reference has been made to the work of others This copy has been supplied o the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. ACKNOWLEDEMENTS I would like to thank the following people: My supervisor Andy Hill for his guidance, support and positive words in times of adversity. Mr Simon Dexter and Ken Clare for all of their help and supportwith recruitment. The peoplewho kindly agreedto give their time to take part in this study. My friends for their ongoing support, patience and ready supply of alcohol. And finally my parents, without whose love and encouragement, I never would have got this far. ABSTRACT Despite the rise in obesity in western society, the nature of food cravings in individuals who have undergone weight-loss surgery has been relatively unstudied. This study aimed to provide a detailed analysis of the experience of food craving comparing groups of participants according to a) time post-surgery and b) type of surgical procedure. Two time groups emerged, those who were 3-8 months post- surgery and those who were one year+ post-surgery. In terms of surgical procedure, those having purely restrictive procedures (i. e. gastric band) were compared with those having both restrictive and malabsorptive procedures (i. e. Roux-en-Y). Twenty one participants completed the study (10 3-8 months post-surgery, 11 one year+ post-surgery) of these, 13 had Roux-en-Y gastric bypass and 8 had a gastric band. All participants completed several questionnaires over a seven-day period. Measures included a food intake dairy, daily questionnaires, food craving records and a background questionnaire. The frequency and intensity of food cravings did not differ significantly between groups but were thought to reflect higher levels than those reported by healthy women in other studies. Antecedents to the craving, target of food craving, situational context, time and interpersonal context did not differ between groups. Differences in the emotional context of craving versus non-craving days were found, some of which interacted with time post-surgery and surgery type. This quasi-prospective study provides preliminary support for the existence of cravings within a group of participants having had weight-loss surgery, which are hunger-reducing experiences, related to negative mood states. It also offers insight into the persistent implication of food cravings in disordered eating symptomology more prevalent within weight-loss surgery groups. CONTENTS AC KN O WLEDE ME NTS................................................................................................ 2 ABSTRACT 3 .................................................................................................................... CONTENTS 4 .................................................................................................................... List tables 6 offigures and ................................................................................................ CHAPTER 1. OVER VIEWAND REVIEW OF THE LITERATURE 7 .............................. Food Cravings 7 ........................................................................................................... Definition Prevalence 7 and ...................................................................................... Measuring food 8 craving ......................................................................................... Theories food 11 of craving ...................................................................................... Overview food 19 of cravings ................................................................................... Obesity 20 ..................................................................................................................... Prevalence to health 20 and cost public .................................................................... Treatments 21 ............................................................................................................ Bariatric Surgery 22 ..................................................................................................... Types 22 of procedures ............................................................................................. Effectiveness 25 of surgery ....................................................................................... Eating 26 changes after surgery ................................................................................ Hormonal changes and their influence following 27 on appetite surgery ................ Food cravings, bariatric 28 restriction and surgery .................................................. Clinical 29 relevance of current study .......................................................................... Background to current study .................................................................................... 31 Study aims ............................................................................................................ 33 CHAPTER 2 METHOD ............................................................................................... 36 Participants ........................................................................................................... 36 Measures .............................................................................................................. 37 Procedure ............................................................................................................. 42 Data analysis ........................................................................................................ 43 CHAPTER 3. RESULTS ............................................................................................... 45 Participant characteristics .................................................................................... 45 Craving 48 characteristics ............................................................................................ Frequency 49 of cravings .......................................................................................... Intensity 51 of cravings ............................................................................................. Hunger 53 and cravings ................................................................................................ Frequency 55 of eating as a result of craving ........................................................... Mood Cravings 55 and .................................................................................................. Daily 56 ratings of appetite and mood ...................................................................... Supplementary 59 analyses........................................................................................... Target food 59 of craving ......................................................................................... Preceding 60 context of craving ............................................................................... CHAPTER 4: DISCUSSION AND CONCLUSIONS 62 ................................................... Overview 62 of results .............................................................................................. Group 62 characteristics ........................................................................................... The frequency intensity 63 and of cravings .............................................................. Frequency ............................................................................................................ 63 Hunger 65 and cravings ............................................................................................ -4- Mood 66 and cravings ............................................................................................... Supplementary 70 analyses...................................................................................... Methodological 72 considerations ................................................................................ Sampling 72 .............................................................................................................. Study design 74 ......................................................................................................... Clinical implications 76 of the research................................................................... Implications for future 77 research.......................................................................... Conclusion 79 ........................................................................................................... REFERENCES 81 ............................................................................................................. APPENDIX 1 87 ............................................................................................................... Participant information 87 sheet .................................................................................. APPENDIX 2 90 ............................................................................................................... Consentform
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