Are you a grazer?

Bariatric surgery reshapes the anatomical landscape of the digestive system, but the journey doesn't end there. Hormonal adaptations, particularly in ghrelin and peptide YY levels, play a pivotal role in determining the long-term success of the surgery. Ghrelin, the hunger hormone, decreases after surgery. Gastric sleeve surgery in particular reduces ghrelin significantly because it removes a part of your stomach, where grelin is produced. Never the less, over time, in some patients, ghrelin production increases post-surgery, while peptide YY, a hormone responsible for signaling fullness, decreases. This hormonal dance creates a challenging environment, making it difficult for post-bariatric patients to suppress their appetite and paving the way for weight regain.

One manifestation of disordered eating behavior post-bariatric surgery is grazing. This repetitive and unplanned eating of small amounts of food outside of regular meals and snacks becomes a significant hurdle.

Studies reveal a prevalence of grazing ranging from 16.6% to 46.6% in post bariatric surgery patients. The inability to resist the urge to eat, driven by elevated ghrelin levels, forms a critical component in the struggle against weight regain.

Grazing, often observed in varying degrees of severity—mild (1-3 episodes per week), moderate (4-7), and severe (>7)—is a common behavioral shift for post-bariatric surgery patients. Importantly, the prevalence of grazing is not exclusive to a specific type of bariatric surgery, indicating the universality of this challenge across various procedures.

In some cases, those who have binge eaters before surgery, become grazers post surgery, because they are now unable to consume large meals but are able to nibble constantly to satisfy the same urge. Studies show that 60% of patients with Binge Eating Disorder (BED) before surgery become grazers within a year after the procedure. Furthermore, 94% of individuals who exhibited grazing behavior before surgery continue this pattern post-operatively, emphasizing the persistent nature of disordered eating behaviors.

So what is in this for you? How can you fight this and get back on track?

First see if you are a grazer. Complete the questionnaire below and get your answer right now. Second, you must take charge. In the battle against grazing, adopting controlled eating habits becomes a crucial strategy. Chew  slowly, plan meals, increasing meal frequency, and cultivate mindfulness about hunger. Been there, tried that? There is more. Third, it is key to find what is the driver behing grazing and treat it. Certain medications are extremely effective in cutting down the urges to eat. 

Do not let grazing be the obstacle that puts a dent in your goals. You got this!

Our patients are informed about the hormonal changes that lead to disordered eating behaviors and are partners in implementing  a holistic approach that combines medical interventions, behavioral support, and personalized care.  Now you are empowered as well to make the right choices and get back on track and  navigate the post-surgery journey with resilience, ensuring that the transformative impact of bariatric surgery endures for your lifetime.

Check if you are a grazer here:

SHORT INVENTORY OF GRAZING

1. Are you, repeatedly ( more than twice in the same time period during the day) picking or nibbling small amounts of food outside of planned meals and snacks?

• Not at all - 0
• Less than weekly -1
• Once a week- 2
• Two to three times a week - 3
• For to five times a week - 4
• Six to seven times a week - 5
• Eight or more times a week - 6

2. Over the past 3 months, typically how many episodes of grazing with loss of control have you had per week? (This question refers to any occasions of grazing where you felt you have lost control over your eating, feeling you could not avoid going back to graze on food even if trying to resist, or felt compelled or driven to graze).

• Not at all - 0
• Less than weekly -1
• Once a week- 2
• Two to three times a week - 3
• For to five times a week - 4
• Six to seven times a week - 5
• Eight or more times a week - 6

Severity category:

Mild: 1-3 times per week

Moderate: 4-7 times per week

Severe: 8 or more times per week