Examining Intuitive Eating Behavior Across Metabolic and Bariatric Surgery and Non-Surgical Patients

Intuitive Eating (IE) scales assess eating behaviors by capturing individuals' tendencies to rely on internal cues - such as hunger and satiety - rather than external influences like emotional factors or dieting mentality. IE data within the context of metabolic and bariatric surgery (MBS) patients seeking obesity management treatment remain limited.

This study aimed to explore changes in Intuitive Eating Assessment Scale-2 (IEAS-2) scores among MBS and non-MBS patients and examine how individual- level factors, including obesity management medication (OMM), may influence these changes.

We retrospectively analyzed 168 IEAS-2 responses from 84 patients at an obesity medicine clinic, including four subscales: (1) Unconditional Permission to Eat, (2) Eating for Physical Rather Than Emotional Reasons, (3) Reliance on Internal Cues, and (4) Body-Food Choice Congruence. Linear mixed-effects models assessed changes from baseline to follow-up and associations with OMM use, MBS status, depression, sleep duration, and physical activity.

Thirty-five non-MBS and 49 MBS patients (25 gastric bypass, 24 sleeve gastrectomy) were included, with a mean age of 47±11.5 years and BMI of 41.5±8.3 kg/m². Total IEAS-2 scores improved marginally over time (p = .054), irrespective of MBS status. OMM use (p < .001), physical activity (p = .019), and sleep (p = .065) were associated with better IE scores, while depression (p < .001) predicted worse outcomes.

Improvements in IE may be influenced more by individual-level factors - such as OMM use, lifestyle behaviors, and mental health - than by treatment modality alone, supporting the importance of interdisciplinary obesity care, integrating medical, psychological, and behavioral support.