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". 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
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.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
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. 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 Saunders, R. (2004). “Grazing”: A high-risk behavior. Obesity Surgery, 14, 98–102. doi: 10.1381/096089204772787374 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. 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.2014.05.025Conceição, 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.2397Conceição, 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. In 2014, Eva Conceição and colleagues proposed a consensual definition for grazing based on the opinion of various experts in the field.
Grazing seems to be related to loss of control over eating and can be conceptualized on the spectrum of disordered eating behaviors.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 It is considered as a risk behavior for adults undergoing weight loss treatment 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.2014.05.025Conceição, 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.2397Conceição, 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.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 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. due to its associations with Body Mass Index and a great variability on weight-loss trajectories after bariatric surgery.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. It is thought to be present in up to 26.4% of bariatric patients pre‐operativelyColles, 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. and in 46.6% after bariatric surgery.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. 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. 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.2014.05.025Conceição, 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 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.
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.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 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, 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 Portuguese (European and Brazilian),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 and Norwegian.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. References