Cited by 45Bariatric Surgery and OutcomesEating Disorders and BehaviorsNutrition, Health and Food Behavior

The Impact of Impulsivity on Weight Loss Four Years After Bariatric Surgery

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Schag, Kathrin, Mack, Isabelle, Giel, Katrin, Ölschläger, Sabrina, Skoda, Eva-Maria, Von Feilitzsch, Maximilian, Zipfel, Stephan, Teufel, Martin·2016·Nutrients

Abstract

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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Crossref · 10.3390/nu8110721

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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 measured
  • Bariatric 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 measured
  • Food-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 measured
  • The 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.”

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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)
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
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

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