The psychopathological profile of candidates for metabolic bariatric surgery: a transdiagnostic and network approach

Candidates for metabolic bariatric surgery (MBS) experience significantly higher rates of mental disorders compared to the general population. While previous studies have primarily focused on a limited range of mental health conditions, this study expands the scope by studying a broader spectrum of psychopathological symptoms. Our aim was to map the psychopathological profile of candidates for MBS and to test whether individuals higher in general psychopathology exhibit a higher body mass index (BMI) and more severe eating disorder symptoms than those lower in general psychopathology.

A total of 222 candidates for MBS from the Dutch Obesity Clinic completed 16 questionnaires to generate a comprehensive psychopathological profile. Cluster analysis was applied to identify distinct groups based on general psychopathology. The clusters were compared on BMI and eating disorder psychopathology. A cross-sectional network approach was used to explore the complex interconnections between symptoms.

Two clusters emerged: a high psychopathology profile (high PP; 29%) characterized by elevated scores on general psychopathology, and a low psychopathology profile (low PP; 71%) marked by healthier psychological functioning. The high PP cluster exhibited more severe eating disorder psychopathology than the low PP cluster, while the clusters did not differ in BMI. The symptom network revealed that general psychopathology is linked to eating disorder psychopathology through the bridge symptom 'eating concerns.'

Approximately one-third of the individuals presenting for MBS exhibit elevated, transdiagnostic psychopathology with complex connections between symptoms. Notably, BMI was not associated with the severity of symptoms. The symptom network analysis highlights that 'eating concerns' serve as a crucial bridge linking eating disorder symptoms and symptoms of emotional disorders. Future research should focus on the transdiagnostic nature of psychopathology associated with obesity and investigate its potential impact on treatment outcomes, such as weight loss and quality of life.