Maladaptive Weight-Related Compensatory Behaviours Among Individuals Undergoing Metabolic and Bariatric Surgery

Little is known about maladaptive, weight-related compensatory behaviours (CB) among individuals undergoing metabolic and bariatric surgery (MBS). This brief report examined CB typically associated with restrictive types of eating disorders, including fasting (≥ 8 hours), self-induced vomiting, and misuse of laxatives and diuretics before and 10 years following MBS.

193 participants (76.6% F) aged 44.8 (9.5) years with a BMI of 42.9 (5.4) underwent MBS (94.3% Roux-en-Y gastric bypass). Frequency of weight-related CB at pre- and 10 years post-surgery was assessed and participants were classified as those who (1) never, (2) continued, (3) remitted, or (4) developed CB. Exploratory analyses investigated preoperative and postoperative factors associated with remission, continuation, or development of CB.

Pre-operatively, 26.9% reported fasting, 17.6% diuretic misuse, 11.9% laxative misuse, and 8.3% self-induced vomiting. At 10 years, 8.3% reported fasting, while fewer than 3% reported the other CB. In terms of classification, 55% had never engaged in weight-related CB, 31.1% remitted, 9.8% continued, and 3.6% reported de novo CB. No significant differences in demographic or mental health factors were observed between these groups.

Maladaptive, weight-related CB were relatively common prior to surgery but declined substantially after a decade. Although most participants had never engaged in these behaviours or experienced remission, a minority continued to engage in or developed weight-related CB 10 years after surgery.