Understanding the Overlooked Issue in Obesity Treatment
In the realm of obesity management, eating disorders often remain a “blind spot” that patients tend to omit during consultations. If these disorders are not explored, identified, and addressed, they can significantly hinder the success of prescribed treatments. This was a key point discussed at the XXVIII World Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO 2025), held in Santiago, Chile, from September 9 to 12. At the conclusion of the congress, the international society was renamed the International Federation for the Surgery and Other Therapies for Obesity (IFSO).
The Challenge of Identifying Eating Disorders
María José Leiva, a clinical psychology expert and postgraduate lecturer on obesity and eating disorders at the Faculty of Medicine of the Clínica Alemana-Universidad del Desarrollo in Santiago, Chile, highlighted the difficulty patients face in disclosing behaviors such as secretive eating or purging. “Patients find it hard to admit to eating in secret and then quickly disposing of the evidence or to confess to vomiting. These are deeply personal and embarrassing issues, and why would they share something so intimate with someone they barely know? It’s a blind spot,” Leiva explained.
Eating disorders are prevalent among individuals with obesity, to the extent that they are considered part of a common spectrum. The most common disorder among overweight and obese individuals is binge eating disorder, which can be present in up to 30% of cases and is often “normalized,” according to Leiva. A systematic review and meta-analysis of 85 studies indicate that the combined prevalence of binge eating disorder and bulimia nervosa in adults seeking obesity treatment is 14% and 1%, respectively.
The Impact of Unaddressed Eating Disorders
Binge eating disorder is often underdiagnosed because it tends to go unnoticed. Individuals can live with binge eating disorder for years, even decades, as it becomes their way of coping. “Professionals often don’t inquire about it because patients don’t mention it unless it causes significant problems, and it’s less known among eating disorders. We lack a clear intersection between obesity and eating disorders. Therefore, if you design an interview to get to know the patient and ask general questions, this disorder might not surface,” Leiva told Medscape in Spanish.
Evidence shows that when obesity treatments are designed and implemented without recognizing or addressing the symptoms and risks of eating disorders, not only do the treatments for obesity itself fail, but they can also exacerbate the eating disorder, making it chronic over time.
The Importance of a Multidisciplinary Approach
David Creel, Ph.D., a psychologist, nutritionist, and exercise physiologist from the Department of Endocrinology at the Cleveland Clinic in Columbus, United States, emphasized the importance of a multidisciplinary team. “Doctors who are not sufficiently trained in obesity management may overlook the presence of eating disorders in their patients. That’s why it’s crucial to have a team where people feel comfortable asking these questions and know what to ask.”
Effective Screening and Diagnosis
Leiva stressed the importance of early detection through standardized psychometric questionnaires for quick screening, such as the Binge Eating Scale (BES) and the Eating Disorder Examination Questionnaire (EDE-Q), although the latter is more oriented towards restrictive-type disorders. She also suggested six questions that can aid in diagnosis during consultations.
Addressing eating disorders in consultations is not a luxury but a clinical and ethical necessity. “Recognizing these disorders in time allows us to provide better treatment responses to patients. The goal is not to create a barrier; we don’t want patients with obesity to leave with an additional problem. We aim to broaden the perspective beyond weight loss to offer a treatment that benefits their long-term health and quality of life,” Leiva concluded.
Innovative Tools for Identifying Eating Disorders
Dr. Cristina Segura-García, a Spanish psychiatrist and professor at the Università degli Studi “Magna Græcia” di Catanzaro, Italy, who has been researching and treating eating disorders in patients with obesity referred for metabolic and bariatric surgery for nearly two decades, agreed with Leiva’s perspective.
“Doctors are generally concerned about obesity and its consequences, but many are unaware of eating disorders and do not investigate the possibility of other causes or comorbidities. The problem is that binge eating disorder, food addiction, or night eating can explain the high percentage of patients who start diets and then abandon them or do not respond, making it necessary to evaluate the existence of an underlying eating disorder,” Dr. Segura told Medscape in Spanish.
To identify these disorders, Dr. Segura developed a rapid test in 2022 called the Eating Behaviors Assessment for Obesity (EBA-O). “It was created to be easy to use and interpret by clinicians (doctors, dietitians, nutritionists) who have no specialization in psychiatry, psychology, or eating disorders,” she explained. “The scale also helps educate patients about their eating behavior, so they understand the reasons for their weight gain and difficulty losing it.”
The tool consists of 18 questions that can be answered in a couple of minutes and is designed to assess the presence and severity of five key eating behaviors common in obesity: night eating, food addiction, sweet consumption, hyperphagia, and binge eating. The questionnaire was validated in Italian (original version) and Spanish and has been translated into Chinese, with validations underway in Portuguese, Arabic, and Russian.
Guidelines for Effective Treatment
The identification of these behaviors can guide the pharmacological treatment of obesity, Dr. Segura pointed out. For example, patients with a higher component of hyperphagia may respond better to glucagon-like peptide-1 (GLP-1) receptor agonists, while those with food addiction or binge eating disorder may require naltrexone/bupropion.
The guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) from 2022 also recommend evaluating patients who are candidates for metabolic and bariatric surgery for mental health disorders, including binge eating disorder. “Licensed mental health providers with specialized knowledge and experience in behavioral health in metabolic and bariatric surgery are important for assessing patients for psychopathology and determining the candidate’s ability to cope with the adversity of surgery, body image changes, and necessary lifestyle changes [after the procedure].”
Leiva, Creel, and Dr. Segura have declared no relevant economic conflicts of interest.
🔗 **Source:** https://espanol.medscape.com/viewarticle/cu%C3%A1l-es-punto-ciego-consultas-obesidad-que-puede-2025a1000po4