Eating behaviors following metabolic bariatric surgery in lower, medium, and higher responders

This study examined eating behaviors over 12 months in lower, medium, and higher responders to metabolic bariatric surgery (MBS).

Eating behaviors were assessed using the Three-Factor Eating Questionnaire, Dutch Eating Behaviour Questionnaire, and Binge-Eating Scale in 112 gastric bypass patients before and at 6 and 12 months after surgery. Body weight, body composition, and metabolic parameters were measured. Based on TWL at 12 months, participants were classified as lower (TWL < 20%, n = 26), medium (20% ≤ TWL < 30%, n = 57), and higher (TWL ≥ 30%, n = 29) responders.

Lower responders exhibited the highest internal hunger and lowest cognitive restraint, while higher responders had the highest baseline restraint. At 12 months, higher responders demonstrated the greatest decreases in rigid control and restrained eating. Hunger and disinhibited eating decreased similarly across groups, but emotional and external eating decreased only in medium and higher responders. Binge-eating declined in all groups, least in lower responders.

Successful weight loss after MBS is marked by lower preoperative hunger, higher cognitive restraint, and postoperative improvements in restraint as well as emotional and external eating. Lower responders show greater hunger, lower restraint, and no improvements in emotional or external overeating. These findings define behavioral signatures of surgical success and highlight targeted opportunities for intervention.