Behavioral and psychological factors associated with suboptimal weight loss in post-bariatric surgery patients

Marjolein M. Geerts, Elske M. van den Berg, Laura van Riel, Jaap Peen, Jaap E. Goudriaan, Jack J. M. Dekker

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Purpose: Bariatric surgery is the most effective long-term treatment for sustained weight loss in obesity. Studies have shown that not all patients lose the expected amount of weight. The aim of this study was to develop a better understanding of which behavioral and psychological factors are associated with suboptimal weight loss. Methods: The present paper describes a cross-sectional study that included 140 participants. The mean follow-up period after bariatric surgery was 3.16 years. Eating disorder pathology (Eating Disorder Examination-Questionnaire), impulsivity (Barratt Impulsiveness scale-II) and depressive symptoms (Beck Depression Inventory) were compared with successful and suboptimal participants. A weight loss of more than or equal to 50% of excess weight, was considered to be successful. Results: More than 81% of the participants met the criterion for successful weight loss. The suboptimal weight loss group reported more symptoms of eating disorder pathology (p =.001), more loss of control over eating (p =.001), and more avoidant behavior due to poor body image (p <.001). The suboptimal weight loss group scored higher on impulsivity (p =.007) and on depression (p <.001). More early weight loss was associated with better weight outcome later on (r =.491). Reporting more eating disorder pathology, a longer follow-up period and pre-operative super-obesity (body mass index ≥ 50 kg/m 2) at the time of surgery were associated with poorer weight loss (p <.001). Conclusion: Eating disorder pathology, loss of control over eating and avoidant behavior due to poor body image, as well as depressive symptoms and impulsivity, (as reported postoperatively) are associated with suboptimal weight loss. Level III: Case–control analytic study.

Original languageEnglish
JournalEating and Weight Disorders
Early online date2020
Publication statusE-pub ahead of print - 2020


  • Bariatric surgery
  • Eating disorder
  • Impulsivity
  • Loss of control over eating
  • Obesity
  • Weight loss

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