Emotional and External Eating Behaviors Associated with Fat-Free Mass Loss Following Sleeve Gastrectomy

Rapid weight loss after metabolic bariatric surgery may lead to excessive fat-free mass (FFM) loss, potentially reducing the procedure's health benefits. This study aimed to investigate the association between eating behaviors and FFM loss as well as total weight loss (TWL) at midterm (about 2-4 years) following sleeve gastrectomy (SG).

This cross-sectional study included 146 adults assessed approximately 2-4 years post-SG. Eating behaviors were evaluated using the Dutch Eating Behavior Questionnaire. The proportion of FFM loss relative to TWL (%FFML) was calculated, with excessive FFM loss defined as the highest tertile of %FFML (≥ 28%). The associations between eating behaviors and %FFML and %TWL were analyzed using linear regression models. Logistic regression was employed to estimate the odds ratios (95% confidence intervals (CIs)) for excessive FFM loss and suboptimal clinical response (TWL < 20%).

The mean time since SG was 30.8 ± 6.5 months, and 77.4% of participants were women. In the multivariable-adjusted model, emotional eating (B = 1.71; 95% CI 0.17, 3.25) and external eating (B = 1.76; 95% CI 0.01, 3.51) were associated with higher %FFML. The adjusted odds ratio (95% CI) for excessive FFM loss per unit increase was 2.28 (1.41, 3.70) for emotional eating and 1.84 (1.08, 3.15) for external eating. Eating behaviors were not significantly associated with %TWL or suboptimal clinical response.

Emotional and external eating behaviors were independently associated with greater proportional FFM loss and increased odds of excessive FFM loss at midterm post-SG, though they were not linked to %TWL.