Preoperative Eating Patterns and Their Effect on Post-operative Outcomes in Metabolic and Bariatric Surgery: A Cohort Study of 1550 Patients

Postoperative outcomes after metabolic and bariatric (MBS) can vary due to preoperative behaviors and psychological factors, with several eating patterns (EPs), including eating disorders (EDs), often associated with suboptimal weight loss. Some guidelines even consider EDs a contraindication for MBS. This study examined the impact of EPs on long-term outcomes after MBS. A retrospective analysis was conducted on prospectively collected data from 1550 patients who underwent primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2010 and 2018. Patients were categorized based on preoperative EPs, including binge eating disorder (BED), snacking behavior (SB), sweet eating habit (SEH), fat eating habit (FEH), night eating syndrome (NES), excessive eating habit (EEH), or no present EP. Demographics, morbidity, weight loss, comorbidities, and complications were assessed over 5 years. Outcomes were measured using the SF-BARI score. EPs were common (67.6%), with many patients exhibiting multiple patterns. Patients with EPs were younger (40.8 vs. 43.3 years; p < 0.01) and had higher baseline BMI (44.5 vs. 43.8 kg/m2; p = 0.046) compared to patients with no EP. They showed slightly higher % total weight loss (%TWL) in the first year (31.9% vs. 30.6%; p < 0.01), but differences diminished over time. At 5 years, SF-BARI scores remained slightly higher in the EP group (84.2 vs. 79.1; p = 0.046). RYGB was performed more frequently (69.9%) and yielded better outcomes than SG. Preoperative EPs, including EDs, do not significantly impact postoperative outcomes after MBS, suggesting a need to reassess guidelines on EDs as contraindications.