Grazing (human eating pattern)

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Grazing is a human eating pattern characterized as "the repetitive eating of small or modest amounts of food in an unplanned manner throughout a period of time, and not in response to hunger or satiety cues". [1]

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Two subtypes of grazing have been suggested: compulsive and non-compulsive. Compulsive grazing is accompanied by the feeling that the person is not able to resist going back to repetitively snack on the desired food. Non‐compulsive grazing is repetitively eating in a distracted and mindless way, without paying much attention to what is eaten. [1] [2]

Background

The term "grazing" has been widely used by the general population in reference to a repetitive eating pattern. The scientific literature began to investigate this concept because of its extensive use and apparent association with weight gain. [3] [4] Several terms such as picking, nibbling, and snacking have been used indiscriminately in the literature to characterize grazing-type patterns of repetitive eating in humans. [1] [2] [5] In 2014, Eva Conceição and colleagues proposed a consensual definition for grazing based on the opinion of various experts in the field. [1]

Grazing seems to be related to loss of control over eating and can be conceptualized on the spectrum of disordered eating behaviors. [2] It is considered as a risk behavior for adults undergoing weight loss treatment [1] [2] [5] [6] [7] due to its associations with Body Mass Index and a great variability on weight-loss trajectories after bariatric surgery. [8] It is thought to be present in up to 26.4% of bariatric patients pre‐operatively [9] and in 46.6% after bariatric surgery. [10] Specifically, compulsive grazing appears to be linked to eating disorder psychopathology.

Repetitive eating questionnaire

The repetitive eating questionnaire (Rep(eat)-Q) is a 12-item self-report measure developed by Conceição, E. and colleagues to assess grazing eating patterns in adolescents and adults. [1] [6] [11]

The Rep(eat)-Q is based on the consensual definition proposed by the authors and generates two subscales: 1) repetitive eating, and 2) compulsive grazing. [6] Respondents rate the frequency of grazing eating behaviors in the previous month using a Likert scale ranging from 0 (never) to 6 (every day). Scores are calculated as the mean of the scale items and the total Rep(eat)-Q score can range from 0 to 6. The Rep(eat)-Q is worded in English, [1] Portuguese (European and Brazilian), [6] and Norwegian. [12]

Related Research Articles

An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's physical or mental health. These behaviors include eating either too much or too little. Types of eating disorders include binge eating disorder, where the patient keeps eating large amounts in a short period of time typically while not being hungry; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity. People often experience comorbidity between an eating disorder and OCD. It is estimated 20–60% of patients with an ED have a history of OCD.

Orthorexia nervosa is a proposed eating disorder characterized by an excessive preoccupation with eating healthy food. The term was introduced in 1997 by American physician Steven Bratman, who suggested that some people's dietary restrictions intended to promote health may paradoxically lead to unhealthy consequences, such as social isolation, anxiety, loss of ability to eat in a natural, intuitive manner, reduced interest in the full range of other healthy human activities, and, in rare cases, severe malnutrition or even death.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

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<span class="mw-page-title-main">Body dysmorphic disorder</span> Mental disorder

Body dysmorphic disorder (BDD), also known in some contexts as dysmorphophobia, is a mental disorder defined by an overwhelming preoccupation with a perceived flaw in one's physical appearance. In BDD's delusional variant, the flaw is imagined. When an actual visible difference exists, its importance is disproportionately magnified in the mind of the individual. Whether the physical issue is real or imagined, ruminations concerning this perceived defect become pervasive and intrusive, consuming substantial mental bandwidth for extended periods each day. This excessive preoccupation not only induces severe emotional distress but also disrupts daily functioning and activities. The DSM-5 places BDD within the obsessive–compulsive spectrum, distinguishing it from disorders such as anorexia nervosa.

Trichophagia is a form of disordered eating in which persons with the disorder suck on, chew, swallow, or otherwise eat hair. The term is derived from ancient Greek θρίξ, thrix ("hair") and φαγεῖν, phagein. Tricho-phagy refers only to the chewing of hair, whereas tricho-phagia is ingestion of hair, but many texts refer to both habits as just trichophagia. It is considered a chronic psychiatric disorder of impulse control. Trichophagia belongs to a subset of pica disorders and is often associated with trichotillomania, the compulsive pulling out of ones own hair. People with trichotillomania often also have trichophagia, with estimates ranging from 48-58% having an oral habit such as biting or chewing, and 4-20% actually swallowing and ingesting their hair. Extreme cases have been reported in which patients consume hair found in the surrounding environment, including other people's and animals' hair. In an even smaller subset of people with trichotillomania, their trichophagia can become so severe that they develop a hairball. Termed a trichobezoar, these masses can be benign, or cause significant health concerns and require emergency surgery to remove them. Rapunzel syndrome is a further complication whereby the hairball extends past the stomach and can cause blockages of gastrointestinal system.

<span class="mw-page-title-main">Gastric bypass surgery</span> Type of bariatric surgery

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A food addiction or eating addiction is any behavioral addiction characterized primarily by the compulsive consumption of palatable and hyperpalatable food items. Such foods often have high sugar, fat, and salt contents (HFSS), and markedly activate the reward system in humans and other animals. Those with eating addictions often overconsume such foods despite the adverse consequences associated with their overconsumption.

Bariatrics is a discipline that deals with the causes, prevention, and treatment of obesity, encompassing both obesity medicine and bariatric surgery.

<span class="mw-page-title-main">Sleeve gastrectomy</span> Surgical weight-loss procedure involving reduction of stomach size

Sleeve gastrectomy or vertical sleeve gastrectomy, is a surgical weight-loss procedure, typically performed laparoscopically, in which approximately 75 - 85% of the stomach is removed, along the greater curvature, which leaves a cylindrical, or "sleeve"-shaped stomach the size of a banana. Weight loss is affected not only through the reduction of the organ's size, but by the removal of the portion of it that produces ghrelin, the hormone that stimulates appetite. Patients can lose 50-70 percent of excess weight over the course of the two years that follow the surgery. The procedure is irreversible, though in some uncommon cases, patients can regain the lost weight, via resumption of poor dietary habits, or dilation of the stomach over time, which can require gastric sleeve revision surgery to either repair the sleeve or convert it to another type of weight loss method that may produce better results, such as a gastric bypass or duodenal switch.

Night eating syndrome (NES) is classified as an Other Specified Feeding or Eating Disorder (OSFED) under the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). It involves recurrent episodes of night eating after awakening from sleep or after the evening meal. Awareness and recall of the eating is present, which is a key characteristic that differentiates the disorder from Sleep-Related Eating Disorder (SRED). Although there is some degree of comorbidity with binge eating disorder (BED), it differs from binge eating in that the amount of food consumed in the night is not necessarily objectively large nor is a loss of control over food intake required. The syndrome causes significant distress or functional impairment and cannot be better explained by external influences such as changes in the sleep-wake cycle, social norms, substance use, medication, or another mental or medical disorder.

<span class="mw-page-title-main">Bariatric surgery</span> Surgical procedure for management of obesity

Bariatric surgery is a surgical procedure used to manage obesity and obesity-related conditions. Long term weight loss with bariatric surgery may be achieved through alteration of gut hormones, physical reduction of stomach size, reduction of nutrient absorption, or a combination of these. Standard of care procedures include Roux en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, from which weight loss is largely achieved by altering gut hormone levels responsible for hunger and satiety, leading to a new hormonal weight set point.

Animal psychopathology is the study of mental or behavioral disorders in non-human animals.

<span class="mw-page-title-main">David Sarwer</span>

David B. Sarwer is an American clinical psychologist who serves as the Associate Dean for Research, Director of the Center for Obesity Research and Education, and Professor of Social and Behavioral Sciences in the College of Public Health at Temple University.

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<span class="mw-page-title-main">Anorexia nervosa</span> Type of eating disorder

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

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<span class="mw-page-title-main">Thomas Wadden</span>

Thomas A. Wadden is a clinical psychologist and educator who is known for his research on the treatment of obesity by methods that include lifestyle modification, pharmacotherapy, and bariatric surgery. He is the Albert J. Stunkard Professor of Psychology in Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and former director of the university's Center for Weight and Eating Disorders. He also is visiting professor of psychology at Haverford College.

Body image disturbance (BID) is a common symptom in patients with eating disorders and is characterized by an altered perception of one's own body.

References

  1. 1 2 3 4 5 6 7 Conceição, E., Mitchell, J., Engel, S., Machado, P., Lancaster, K., & Wonderlich, S. (2014). What is “grazing”? Reviewing its definition, frequency, clinical characteristics, and impact on bariatric surgery outcomes, and proposing a standardized definition. Surgery for Obesity and Related Diseases, 10 (5), pp. 973-982.doi: 10.1016/j.soard.2014.05.025
  2. 1 2 3 4 Conceição, E., Utzinger, L., & Pisetsky, E. (2015). Eating Disorders and Problematic Eating Behaviours Before and After Bariatric Surgery: Characterization, Assessment and Association with Treatment Outcomes. European Eating Disorders Review, 23 (6), 417-425. doi. 10.1002/erv.2397
  3. ↑ Saunders, R., Johnson, L., & Teschner, J. (1998). Prevalence of eating disorders among bariatric surgery patients. Eating Disorders, 6, 309–317.https://doi.org/10.1080/10640269808249267
  4. ↑ Saunders, R. (2004). “Grazing”: A high-risk behavior. Obesity Surgery, 14, 98–102. doi: 10.1381/096089204772787374
  5. 1 2 Conceição, E., Crosby, R., Mitchell, J., Engel, S., Wonderlich, S., Simonich, H., et al (2013). Picking or nibbling: Frequency and associated clinical features in bulimia nervosa, anorexia nervosa, and binge eating disorder International Journal of Eating Disorders, 46 (8), pp. 815-818.
  6. 1 2 3 4 Conceição, E., Mitchell, J., Machado, P.P., Vaz, A., Pinto-Bastos, A., Ramalho, S., Brandão, I., Simões, J, Lourdes, M., & Freitas, A. (2017). Repetitive eating questionnaire [Rep(eat)- Q]: Enlightening the concept of grazing and psychometric properties in a Portuguese sample. Appetite, 117, 351-358.doi:10.1016/j.appet.2017.07.012
  7. ↑ Conceição, E., Mitchell, J., Vaz, R. A., Bastos, P. A., Ramalho, S., Silva, C., Cao, L., Brandão, I., Machado, P. (2014). The presence of maladaptive eating behaviors after bariatric surgery in a cross-sectional study: importance of picking or nibbling on weight regain. Eating Behaviors, 15, 558-562.
  8. ↑ Conceição, E., Mitchell, J., Pinto-Bastos, A., Arrojado, F., Brandão, I., & Machado, P. (2017). Stability of problem eating behaviors and weight loss trajectories following bariatric surgery: A longitudinal observational study. Surgery for Obesity and Related Diseases, 13 (6), pp. 1063-1070.
  9. ↑ Colles, S. L., Dixon, J. B., & O'Brien, P. E. (2008). Grazing and loss of control related to eating: two high‐risk factors following bariatric surgery. Obesity, 16, 615– 622.
  10. ↑ Kofman, M. D., Lent, M. R., & Swencionis, C. (2010). Maladaptive eating patterns, quality of life, and weight outcomes following gastric bypass: results of an internet survey. Obesity, 18, 1938– 1943. doi.10.1038/oby.2010.27.
  11. ↑ Ramalho, S., Saint-Maurice, P., Silva, D., Mansilha, H., Silva, C., Gonçalves, S., Machado, P., & Conceição, E. (2018). APOLO-Teens, a web-based intervention for treatment-seeking adolescents with overweight or obesity: study protocol and baseline characterization of a Portuguese sample. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. Epub ahead of print. https://doi.org/10.1007/s40519-018-0623-x.
  12. ↑ Reas, D., Lindvall Dahlgren, C., Wonderlich, J., Syversen, G., & Lundin Kvalem, I. (2019). Confirmatory factor analysis and psychometric properties of the Norwegian version of the Repetitive Eating Questionnaire: Further evidence for two distinct subtypes of grazing behaviour. Eur Eat Disord Rev, 27(2):205-211.doi: 10.1002/erv.2631.
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