Trajectories of Depressive Symptoms and Relationships With Weight Loss in the Seven Years After Bariatric Surgery
Open accessAbstract
Introduction While depression generally improves after bariatric surgery, less is known regarding heterogeneity in long-term symptom change. Given that depressive symptoms have been associated with weight change following bariatric surgery, identifying and characterizing subgroups with more severe depressive symptoms may have prognostic utility for understanding post-surgical weight loss. This study sought to characterize patterns of change in depressive symptoms and evaluate associations with weight loss in the seven years following bariatric surgery.Methods Participants were 2308 patients who underwent bariatric surgery as part of the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study. Depressive symptoms (measured by the Beck Depression Inventory) and weight were assessed annually following surgery.Results A group-based trajectory model identified six subgroups that evidenced distinct patterns of change in depressive symptoms, with the majority (87.0%) exhibiting stable low to average levels. Generalized linear mixed models indicated trajectory groups differed in percent total weight loss (%TWL), with trajectories characterized by initial decreases in depressive symptoms over the first two years (5.2% of participants) experiencing the highest %TWL (20.7% vs. 14.9-18.4% in the other trajectories at 7 years).Conclusions Findings demonstrate meaningful heterogeneity in the pattern of changes in depressive symptoms after surgery. While most patients experience relatively low stable levels of depressive symptoms, those who have initial symptom improvement demonstrate the greatest magnitude of weight loss. Further research is necessary to explore the directionality of this association and the time-varying mechanisms by which depression and weight may mutually influence each other.
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As negative emotional states return and the honeymoon period after bariatric surgery ends, patients may find themselves craving food to manage negative emotions.
“Over time, as negative emotional states may return and the “honeymoon period” after having bariatric surgery ends, patients may find themselves craving food to manage negative emotions (43, 44).”
From Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery (2022) · cites this paper as [44]
The Discussion (page unavailable) reports that a small minority of patients had depressive symptoms increase or rebound after an initial decline, supporting the possibility that negative emotional states return. It does not describe a “honeymoon period” ending or patients craving food to manage negative emotions; it instead raises loss of appetite as a possible manifestation of depression in the rebound group. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSymptoms of depression typically improve in the first year after bariatric surgery, but these improvements may erode over time.
“Symptoms of depression typically improve in the first year after having bariatric surgery, but these improvements may erode over time (44), and there is some evidence that many patients increase their antidepressant medications after having bariatric surgery (67).”
From Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery (2022) · cites this paper as [44]
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Cites
An inventory for measuring depression
BECK, A. T. (1961) · Archives of General Psychiatry · doi:10.1001/archpsyc.1961.01710120031004 · Cited by 38,032 · see citing works
The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.03.040 · Cited by 4,973 · see citing works
Group-Based Modeling of Development
NAGIN, D. (2005) · doi:10.4159/9780674041318 · Cited by 4,164 · see citing works
Gender differences in depression
Nolen-Hoeksema, S. (2001) · Current Directions in Psychological Science · doi:10.1111/1467-8721.00142 · Cited by 1,474 · see citing works
Elfhag, K., & Rössner, S. (2005) · Obesity Reviews · doi:10.1111/j.1467-789x.2005.00170.x · Cited by 1,343 · see citing works
Advances in Group-Based Trajectory Modeling and an SAS Procedure for Estimating Them
Jones, B. L., & Nagin, D. S. (2007) · Sociological Methods & Research · doi:10.1177/0049124106292364 · Cited by 1,206 · see citing works
Carpenter, K. M., Hasin, D. S., Allison, D. B., & Faith, M. S. (2000) · American Journal of Public Health · doi:10.2105/ajph.90.2.251 · Cited by 1,018 · see citing works
Courcoulas, A. P., King, W. C., Belle, S. H., Berk, P., Flum, D. R., Garcia, L., Gourash, W., Horlick, M., Mitchell, J. E., Pomp, A., et al. (2018) · JAMA Surgery · doi:10.1001/jamasurg.2017.5025 · Cited by 699 · see citing works
Kalarchian, M. A., Marcus, M. D., Levine, M. D., Courcoulas, A. P., Pilkonis, P. A., Ringham, R. M., Soulakova, J. N., Weissfeld, L. A., & Rofey, D. L. (2007) · American Journal of Psychiatry · doi:10.1176/ajp.2007.164.2.328 · Cited by 616 · see citing works
Mental Health Conditions Among Patients Seeking and Undergoing Bariatric Surgery: A Meta-analysis
Dawes, A. J., Maggard-Gibbons, M., Maher, A. R., Booth, M. J., Miake-Lye, I., Beroes, J. M., & Shekelle, P. G. (2016) · JAMA · doi:10.1001/jama.2015.18118 · Cited by 579 · see citing works
King, W. C., Hinerman, A. S., Belle, S. H., Wahed, A. S., & Courcoulas, A. P. (2018) · JAMA · doi:10.1001/jama.2018.14433 · Cited by 419 · see citing works
Markowitz, S. M., Friedman, M. A., & Arent, S. M. (2008) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2008.00106.x · Cited by 340 · see citing works
Mitchell, J. E., King, W. C., Chen, J., Devlin, M. J., Flum, D. R., Garcia, L., Inabet, W., Pender, J. R., Kalarchian, M. A., Khandelwal, S., et al. (2014) · Obesity · doi:10.1002/oby.20738 · Cited by 216 · see citing works
Postoperative Behavioral Variables and Weight Change 3 Years After Bariatric Surgery
Mitchell, J. E., Christian, N. J., Flum, D. R., Pomp, A., Pories, W. J., Wolfe, B. M., Courcoulas, A. P., & Belle, S. H. (2016) · JAMA Surgery · doi:10.1001/jamasurg.2016.0395 · Cited by 156 · see citing works
Rapid Response to Psychosocial Treatment for Adolescent Depression: A Two-Year Follow-up
RENAUD, J., BRENT, D. A., BAUGHER, M., BIRMAHER, B., KOLKO, D. J., & BRIDGE, J. (1998) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199811000-00019 · Cited by 139 · see citing works
Courcoulas, A. P., Christian, N. J., O’Rourke, R. W., Dakin, G. F., Dellinger, E. P., Flum, D. R., Kalarchian, P. D. M., Mitchell, J. E., Patterson, E., Pomp, A., et al. (2015) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2015.01.011 · Cited by 126 · see citing works
White, M. A., Kalarchian, M. A., Levine, M. D., Masheb, R. M., Marcus, M. D., & Grilo, C. M. (2015) · Obesity Surgery · doi:10.1007/s11695-015-1631-9 · Cited by 126 · see citing works
Quality of Life, Body Image and Sexual Functioning in Bariatric Surgery Patients
Sarwer, D. B., & Steffen, K. J. (2015) · European Eating Disorders Review · doi:10.1002/erv.2412 · Cited by 120 · see citing works
Group-based modeling of development
(2005) · Choice Reviews Online · doi:10.5860/choice.43-1258 · Cited by 112 · see citing works
Depression and Anxiety: Their Predictive Function for Weight Loss in Obese Individuals
Legenbauer, T., de Zwaan, M., Benecke, A., Mühlhans, B., Petrak, F., & Herpertz, S. (2009) · Obesity Facts · doi:10.1159/000226278 · Cited by 99 · see citing works
Kalarchian, M. A., King, W. C., Devlin, M. J., Hinerman, A. S., Marcus, M. D., Yanovski, S. Z., & Mitchell, J. E. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.01.008 · Cited by 89 · see citing works
Instability of Symptoms in Recurrent Major Depression: A Prospective Study
Oquendo, M. A., Barrera, A., Ellis, S. P., Li, S., Burke, A. K., Grunebaum, M., Endicott, J., & Mann, J. J. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.2.255 · Cited by 84 · see citing works
King, W. C., Hinerman, A. S., White, G. E., Courcoulas, A. P., BuSaad, M. A., & Belle, S. H. (2020) · Annals of Surgery · doi:10.1097/sla.0000000000004456 · Cited by 33 · see citing works
Flagged first, then by citations
1 of the 24 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Prevalence and Outcomes of Depression After Bariatric Surgery: A Systematic Review and Meta-Analysis
Alyahya, R. A., & Alnujaidi, M. A. (2022) · Cureus · doi:10.7759/cureus.25651 · Cited by 74 · see citing works
An Updated Review of Night Eating Syndrome: An Under-Represented Eating Disorder
Lavery, M. E., & Frum-Vassallo, D. (2022) · Current Obesity Reports · doi:10.1007/s13679-022-00487-9 · Cited by 49 · see citing works
Bariatric surgery alleviates depression in obese patients: A systematic review and meta-analysis
Fu, R., Zhang, Y., Yu, K., Mao, D., & Su, H. (2021) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2021.11.002 · Cited by 47 · see citing works
Sockalingam, S., Leung, S., Ma, C., TOMLINSON, G. A., Hawa, R., Wnuk, S., Jackson, T. D., Urbach, D. R., Okrainec, A., Brown, J. L., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.27099 · Cited by 33 · see citing works
Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery
Ames, G. E., Koball, A. M., & Clark, M. M. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.934680 · Cited by 28 · see citing works
The Effect of Bariatric Surgery on Long-term Depression Treatment in Patients With Obesity
Smith, V. A., Maciejewski, M. L., Berkowitz, T. S. Z., Mitchell, J. E., Liu, C., Bradley, K. A., Olsen, M. K., Livingston, E. H., & Arterburn, D. E. (2022) · Annals of Surgery · doi:10.1097/sla.0000000000005520 · Cited by 23 · see citing works
Nishida, K., Chrétien, B., Dolladille, C., Ebina, T., Aleksić, B., Cabé, N., Savey, V., Onoue, T., & Yatsuya, H. (2025) · Clinical Nutrition · doi:10.1016/j.clnu.2025.06.011 · Cited by 25 · see citing works
The Association Between Bariatric Surgery and Psychiatric Disorders: a National Cohort Study
Becerra, A. Z., Khalid, S. I., Morgenstern, A. S., Rembert, E., Carroll, M. D., Omotosho, P. A., & Torquati, A. (2022) · Obesity Surgery · doi:10.1007/s11695-022-05896-2 · Cited by 19 · see citing works
King, W. C., Hinerman, A. S., & White, G. E. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.31593 · Cited by 19 · see citing works
Self-citationBinge Eating Before and After Bariatric Surgery
Aylward, L., Konsor, M., & Cox, S. J. (2022) · Current Obesity Reports · doi:10.1007/s13679-022-00486-w · Cited by 18 · see citing works
Anxiety predicts reduced weight loss 30 months after bariatric surgery
Aylward, L., Lilly, C. L., Tabone, L. E., Szoka, N. L., Abunnaja, S., & Cox, S. J. (2022) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2022.04.007 · Cited by 18 · see citing works
Woods, R., Moga, A. M., Ribeiro, P. A. B., Stojanovic, J., Lavoie, K., & Bacon, S. (2023) · Obesity Reviews · doi:10.1111/obr.13557 · Cited by 16 · see citing works
Murton, L. M., Plank, L. D., Cutfield, R., Kim, D. S., Booth, M., Murphy, R., & Serlachius, A. S. (2023) · Obesity Surgery · doi:10.1007/s11695-023-06537-y · Cited by 15 · see citing works
McClelland, P. H.-T., Jawed, M. E., Kabata, K., Zenilman, M. E., & Gorecki, P. (2023) · Surgical Endoscopy · doi:10.1007/s00464-023-10366-6 · Cited by 17 · see citing works
Budin, A. J., Brown, W. A., MacCormick, A. D., Caterson, I. D., & Sumithran, P. (2025) · Obesity Reviews · doi:10.1111/obr.13927 · Cited by 17 · see citing works
McLaughlin, A. P., Lambert, E. R., Milton, R., Mariani, N., Kose, M., Nikkheslat, N., Patsalos, O., Ferraro, L., Chamseddine, G., Panagiotopoulos, S., et al. (2023) · Psychological Medicine · doi:10.1017/s0033291723002283 · Cited by 12 · see citing works
Marek, R. J., & Heinberg, L. J. (2024) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2024.08.001 · Cited by 11 · see citing works
Coughlin, J. W., Nauman, E., Wellman, R., Coley, R. Y., McTigue, K. M., Coleman, K. J., Jones, D. B., Lewis, K. H., Tobin, J. N., Wee, C. C., et al. (2022) · Annals of Surgery · doi:10.1097/sla.0000000000005364 · Cited by 6 · see citing works
Role of Well-Being in Bariatric Surgery Treatment for Severe Obesity
Ribeiro, I., de Lourdes, M., Gomes, C., & Conceição, E. (2024) · Springer eBooks · doi:10.1007/978-3-031-62491-9_21 · Cited by 5 · see citing works
Yu, Y. H., Ma, Q., & Groth, S. W. (2022) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2022.07.013 · Cited by 6 · see citing works
Impact of antidepressant use on post-operative weight loss following bariatric surgery
Haugh, S., Cromwell, P., Kirrane, R., & Heneghan, H. (2023) · Irish Journal of Medical Science (1971 -) · doi:10.1007/s11845-023-03482-8 · Cited by 4 · see citing works
Alcohol Use After Bariatric Surgery: A Comprehensive Review of Current Knowledge and Research Gaps
Er, E., Flahault, C., & Etienne, A. (2025) · Clinical Obesity · doi:10.1111/cob.70048 · Cited by 3 · see citing works
Milton, R., McLaughlin, A. P., Mariani, N., Kose, M., Zajkowska, Z., Lombardo, G., Nikkheslat, N., Perucha, E., & Mondelli, V. (2025) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2025.101029 · Cited by 2 · see citing works
Mantzios, M., Bahia, H., Hussain, M., Keyte, R., Egan, H. H., Strachan, R., & Tahrani, A. A. (2024) · Nutrition and Health · doi:10.1177/02601060241281779 · Cited by 2 · see citing works
Long-Term Weight Maintenance and Dietary and Behavioral Management of Weight Recurrence
Grothe, K. B., Koball, A. M., Ames, G. E., & Czerwony, B. A. (2025) · Springer eBooks · doi:10.1007/978-981-96-5099-6_17 · Cited by 2 · see citing works
Nicolau, J., Sanchís, P., Ayala, L., Pascual, S., Pozo, M. I. T., Cifuentes, A., & Masmiquel, L. (2024) · Nutrición Hospitalaria · doi:10.20960/nh.05196 · Cited by 1 · see citing works
Pearl, E. S., Murray, M. F., Haley, E. N., Snodgrass, M., Braciszewski, J. M., Carlin, A. M., & Miller-Matero, L. R. (2024) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2024.11.019 · Cited by 1 · see citing works
Adverse Health Outcomes Associated with Hypoglycemia Following Bariatric Surgery
Yu, Y. H., Ma, Q., Zaman, A., & Groth, S. W. (2025) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2025.0010 · Cited by 1 · see citing works
Early Impact of Bariatric Surgery on Brain Functionality
Fernandes, B. B., da Silva, L. E., Willemann, S. D. S., da Silva, M. R., de Oliveira, M. P., Machado, R. S., Cidral‐Filho, F. J., Porter, P., Martins, D. F., & Rezin, G. T. (2025) · Journal of Metabolic and Bariatric Surgery · doi:10.17476/jmbs.2025.14.2.106
Koball, A., Ames, G. E., Grothe, K., & Kothari, S. (2025) · Bariatric Surgical Practice and Patient Care · doi:10.1177/2168023x251400158
Ansari, W. E., El-Ansari, K., & Hany, M. (2026) · Current Obesity Reports · doi:10.1007/s13679-026-00768-7
- Authors
- Smith, K. E., Mason, T. B., Cao, L., Crosby, R. D., Steffen, K. J., Garcia, L., King, W. C., & Mitchell, J. E.
- Affiliations
- University of Southern California (US)
- University of North Dakota (US)
- North Dakota State University (US)
- Sanford Health (US)
- University of Pittsburgh (US)
- Corresponding author
- Smith, Kathryn E.
- ORCID
- Venue
- Obesity Research & Clinical Practice
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 14
- Issue
- 5
- Pages
- 456-461
- ISSN
- 1871-403X (ISSN-L)
- PMC
- PMC8320367
- OpenAlex
- W3084837803
- Cited by
- 31
- References
- 24
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 5 · 2023: 6 · 2022: 10 · 2021: 1
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obesity Research & Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Cornell University
- University of Washington (U01-DK66585, UL1- RR024153, U01-DK66471)
- Medical Center, University of Pittsburgh (U01-DK66555)
- University of Pittsburgh (U01-DK66667, M01RR-00037, U01-DK66568, UL1-RR024996)
- Oregon Health and Science University (NCT00465829)
- Thomas Harriot College of Arts and Sciences, East Carolina University (U01-DK66526)
- School of Medicine, Oregon Health and Science University
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Keywords
- depressive symptoms, bariatric surgery, weight loss, symptom trajectories
- MeSH terms
- Depression, Female, Humans, Longitudinal Studies, Male, Obesity, Morbid, Weight Loss, Bariatric Surgery
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