The Impact of Impulsivity on Weight Loss Four Years After Bariatric Surgery
Open accessAbstract
Bariatric surgery has serious implications on metabolic health. The reasons for a failure of bariatric surgery, i.e., limited weight loss, are multifactorial and include psychological factors. We established a theoretical model of how impulsivity is related to weight loss outcome. We propose that depressive symptoms act as a mediator between impulsivity and pathological eating behavior, and that pathological eating behavior has a direct impact on weight loss outcome. We calculated excessive weight loss (%EWL) and assessed self-reported impulsivity (using the Baratt Impulsiveness Scale (BIS-15) total score), depressive symptoms (the Patient Health Questionnaire (PHQ-9) score), and pathological eating behavior (the Eating Disorder Inventory 2 (EDI-2) total score) in 65 patients four years after laparoscopic sleeve gastrectomy. Regression and mediation analyses were computed to validate the theoretical model. The BIS-15, PHQ-9, and EDI-2 have medium to high correlations between each other, and EDI-2 correlated with %EWL. The mediation analysis yielded that the PHQ-9 represents a significant mediator between BIS-15 and EDI-2. The regression model between EDI-2 and %EWL was also significant. These results support our theoretical model, i.e., suggest that impulsivity has an indirect impact on weight loss outcome after bariatric surgery, mediated by depression and transferred through pathological eating behavior. Thus, the underlying psychological factors should be addressed in post-operative care to optimize weight loss outcome.
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Negative urgency is proposed as a third dimension of impulsivity that potentially contributes to weight regain after bariatric surgery.
“Negative urgency, the tendency to act without thought or effort at self-regulation when in distress, is proposed as a third dimension of impulsivity that potentially contributes to weight regain after having bariatric surgery (64, 66).”
From Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery (2022) · cites this paper as [66]
The Introduction identifies negative urgency as a component of impulsivity and proposes a pathway through depression and pathological eating to weight-loss outcomes after bariatric surgery. The Discussion mentions possible weight regain, but only for impulsivity generally, citing Brandão and colleagues; it does not specifically link negative urgency to regain. The study assessed weight loss rather than weight regain. (LLM, conf=0.83)
Experimental — accuracy not yet measuredBariatric surgery patients who have impulsive personality traits and symptoms of depression also tend to have high levels of reward-based eating after bariatric surgery, which is associated with weight regain.
“Specifically, bariatric surgery patients who have impulsive personality traits and symptoms of depression also tend to have high levels of reward-based eating after having bariatric surgery, which is associated with weight regain (66).”
From Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery (2022) · cites this paper as [66]
The Discussion (page unavailable) links impulsivity and depressive symptoms with pathological eating after bariatric surgery, which it says limits weight loss. The study measured general pathological eating, not specifically reward-based eating, and assessed weight-loss outcome rather than weight regain. Its Discussion says weight regain requires further study. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFood-related reward sensitivity and behavioral disinhibition of food intake are exacerbated by negative mood states, a construct known as "negative urgency."
“That is, food-related reward sensitivity and behavioral disinhibition of food intake are exacerbated by negative mood states, a construct known as “negative urgency.””
From Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery (2022) · cites this paper as [66]
The Introduction (page unavailable) says people with obesity show pathological eating especially in negative mood. The Discussion (page unavailable) defines negative urgency as a tendency to act impulsively in negative mood. The paper does not say that negative mood exacerbates food-related reward sensitivity specifically, and it describes the mood–eating link as suggestive rather than established for all food intake. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe pathway between impulsivity and eating behavior is likely mediated by a negative mood.
“Schag etal. (66) propose that the pathway between impulsivity and eating behavior is likely mediated by a negative mood.”
From Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery (2022) · cites this paper as [66]
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- Authors
- Schag, K., Mack, I., Giel, K., Ölschläger, S., Skoda, E.-M., Von Feilitzsch, M., Zipfel, S., & Teufel, M.
- Affiliations
- University of Tübingen (DE)
- Department of General, Visceral and Transplant Surgery, University of Tübingen, 72076 Tübingen, Germany
- Corresponding author
- Mack, Isabelle
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2016-11-14
- Volume
- 8
- Issue
- 11
- Pages
- 721
- ISSN
- 2072-6643 (ISSN-L)
- PMC
- PMC5133107
- OpenAlex
- W2554653562
- Cited by
- 45
- References
- 39
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 5 · 2020: 4 · 2019: 7 · 2018: 7 · 2017: 2
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nutrients (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Federal Ministry of Education and Research (BMBF) (SEED 01GI1322)
- Deutsche Forschungsgemeinschaft and Open Access Publishing Fund of University of Tübingen
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- impulsivity, bariatric surgery, sleeve gastrectomy, depressive symptoms, excessive weight loss, mediation, psychological factors, postoperative care
- MeSH terms
- Adult, Aged, Depression, Eating, Female, Humans, Impulsive Behavior, Male, Middle Aged, Models, Theoretical, Regression, Psychology, Time Factors, Weight Loss, Treatment Outcome, Bariatric Surgery
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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