Eating disorders and emotional dysregulation are associated with insufficient weight loss after bariatric surgery: a 1-year observational follow-up study

Purpose subjects with obesity, especially those seeking bariatric surgery, exhibit high rates of mental disorders and marked psychopathological traits. The primary objective of this prospective, non-interventional study was to investigate whether the presence of different psychiatric disorders, attention deficit/hyperactivity (ADHD) symptomatology and emotional dysregulation influenced weight loss at 1-year follow-up after surgery. Methods the sample included 99 subjects consecutively referred for pre-surgical evaluation. Psychiatric diagnoses and ADHD symptomatology assessment were made through structured interviews; emotional dysregulation traits were investigated through self-report questionnaires. After surgery, weight and obesity-related comorbidities were monitored during a 1-year follow-up. Results 76 participants underwent surgery, of whom 65 could be reevaluated after 1 year. Subjects with insufficient weight loss (excess body mass index loss ≤ 53%, n = 15) had more frequent lifetime binge eating disorder and comorbid mood and binge eating disorders than subjects with more favorable post-surgical outcome. Additionally, they scored higher on both physician-administered and self-report scales assessing negative emotion dysregulation, which represents a nuclear symptom of ADHD in adults. This latter psychopathological trait was found to be a predictor of reduced weight loss at the logistic regression analysis, along with older age and higher preoperative excess body mass index. Conclusion mood and binge eating disorders, as well as the presence of affective instability and emotional over-reactivity, seem to be associated with a worse outcome after bariatric surgery. To confirm the possible influence of psychopathology on long-term outcome after bariatric surgery, further studies with larger samples and longer follow-up are urgently needed. Level of evidence: V, prospective descriptive study