Alexithymia and weight loss in obese patients underwent laparoscopic sleeve gastrectomy

  • Emanuela Paone
  • Laura Pierro
  • Angela Damico
  • Paola Aceto
  • Fabio Cesare Campanile
  • Gianfranco Silecchia
  • Carlo LaiEmail author
Original Article



Obesity is a multifactorial disease characterized by genetic, social, cultural and psychological factors. Currently, bariatric surgery represents the gold-standard intervention to treat morbid obesity in order to counteract associated disabling comorbidities. Several studies showed correlation between post-surgery weight loss and psychological factors. Also, the alexithymia may have a role in affecting post-surgery outcomes in bariatric patients, even if there are no studies investigating its role at 12-month follow-up. The purpose of the present study was to investigate the association between alexithymia and the postoperative weight loss 12 months after laparoscopic sleeve gastrectomy.


Seventy-five patients undergoing laparoscopic sleeve gastrectomy were enrolled. The Toronto Alexithymia Scale (TAS-20) was administered to patients. A postoperative weight loss check was performed at 3 and then 12 months after surgery.


The TAS-20 total score was negatively correlated with the percent of excess weight loss (%EWL) at the 12-month follow-up (r = −0.24; p = 0.040). The analysis showed that non-alexithymic patients had a greater weight loss at 12 months after surgery compared to both probably alexithymics (71.88 ± 18.21 vs. 60.7 ± 12.5; p = 0.047) and probably alexithymic patients (71.88 ± 18.21 vs. 56 ± 22.8; p = 0.007). The preoperative BMI was a significant covariate [F(1,70) = 6.13 (p = 0.016)].


In the present study, the patients with higher preoperative BMI and identified as alexithymic showed lower %EWL at 12 months after laparoscopic sleeve gastrectomy. Findings point out the importance to take into consideration possible psychological treatments focused on improving emotional regulations of patients who are seeking bariatric surgery.


Obesity Bariatric surgery Alexithymia Post-surgery outcomes 


Compliance with ethical standards


Emanuela Paone, Laura Pierro, Angela Damico, Paola Aceto, Fabio Cesare Campanile, Gianfranco Silecchia, Carlo Lai declare that no funding source is involved in this study.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual patients included in the study.


  1. 1.
    James WP (2008) WHO recognition of the global obesity epidemic. Int J Obes 32:S120–S126. doi: 10.1038/ijo.2008.247 CrossRefGoogle Scholar
  2. 2.
    Shi X, Karmali S, Sharma AM, Birch WD (2010) A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 20(8):1171–1177. doi: 10.1007/s11695-010-0145-8 CrossRefPubMedGoogle Scholar
  3. 3.
    Neovius M, Narbro K, Keating C, Peltonen M (2012) Health care use during 20 years following bariatric surgery. JAMA 308:1132–1141. doi: 10.1001/2012 CrossRefPubMedGoogle Scholar
  4. 4.
    Sjöström L, Lindroos AK, Peltonen M et al (2004) Swedish obese study scientific group: lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351:2683–2693. doi: 10.1056/NEJMoa035622 CrossRefPubMedGoogle Scholar
  5. 5.
    Nadalini L, Zenti MG, Masotto L et al (2014) Improved Quality of Life after bariatric surgery in morbidly obese patients. Interdisciplinary group of bariatric surgery of Verona (G.I.C.O.V.). G Chir 35(7–8):161–164. doi: 10.11138/gchir/2014.35.7.161 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lee SY, Lim CH, Pasupathy S, Poopalalingam R, Tham KW, Ganguly S, Wai CHD, Wong WK (2011) Laparoscopic sleeve gastrectomy: a novel procedure for weight loss. Singapore Med J 52(11):794PubMedGoogle Scholar
  7. 7.
    Andersen JR, Aadland E, Nilsen RM, Våge V (2014) Predictors of weight loss are different in men and women after sleeve gastrectomy. Obes Surg 24(4):594–598. doi: 10.1007/s11695-013-1124-7 CrossRefPubMedGoogle Scholar
  8. 8.
    Balsiger BM, Murr MM, Poggio JL et al (2000) Bariatric surgery. Surgery for weight control in patients with morbid obesity. Med Clin N Am 84:477–489. doi: 10.1016/S0025-7125(05)70232-7 CrossRefPubMedGoogle Scholar
  9. 9.
    Courcoulas AP, Christian NJ, Belle SH et al (2013) Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 310:2416–2425. doi: 10.1001/jama.2013.280928 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, Ko CY, Maggard Gibbons M (2012) Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg 22(1):70–89. doi: 10.1007/s11695-011-0472-4 CrossRefPubMedGoogle Scholar
  11. 11.
    Wimmelmann CL, Dela F, Mortensen EL (2013) Psychological predictors of weight loss after bariatric surgery: a review of the recent research. Obes Res Clin Pract 8(4):299–313. doi: 10.1016/j.orcp.2013.09.003 CrossRefGoogle Scholar
  12. 12.
    Semanscin-Doerr DA, Windover A, Ashton K, Heinberg LJ (2010) Mood disorders in laparoscopic sleeve gastrectomy patients: does it affect early weight loss? Surg Obes Relat Dis 6(2):191–196. doi: 10.1016/j.soard.2009.11.017 CrossRefPubMedGoogle Scholar
  13. 13.
    Kinzl JF, Schrattenecker M, Traweger C, Mattesich M, Fiala M, Biebl W (2006) Psychosocial predictors of weight lost after bariatric surgery. Obes Surg 16(12):1609–1614. doi: 10.1381/096089206779319301 CrossRefPubMedGoogle Scholar
  14. 14.
    Van Hout GC, Verschure SK, van Heck GL (2005) Psychosocial predictors of success following bariatric surgery. Obes Surg 15(4):552–560. doi: 10.1381/0960892053723484 CrossRefPubMedGoogle Scholar
  15. 15.
    Lai C, Aceto P, Petrucci I, Castelnuovo G, Callari C, Giustacchini P, Sollazzi L, Mingrone G, Bellantone R, Raffaelli M (2016) The influence of preoperative psychological factors on weight loss after bariatric surgery: a preliminary report. J Health Psychol. doi: 10.1177/135910531677750 CrossRefPubMedGoogle Scholar
  16. 16.
    Sifneos PE (1996) Alexithymia: past and present. Am J Psychiatry 153(7):137–142. doi: 10.1176/ajp.153.7.137 CrossRefPubMedGoogle Scholar
  17. 17.
    Elfhag K, Lundh L (2007) TAS-20 alexithymia in obesity, and its links to personality. Scand J Psychol 48:391–398. doi: 10.1111/j.1467-9450.2007.00583 CrossRefPubMedGoogle Scholar
  18. 18.
    Adami GF, Campostano A, Ravera G, Leggieri M, Scopinaro N (2001) Alexithymia and body weight in obese patients. Behav Med 27:121–126. doi: 10.1080/08964280109595778 CrossRefPubMedGoogle Scholar
  19. 19.
    Morosin A, Riva G (1997) Alexithymia in a clinical sample of obese women. Psychol Rep 80(2):387–394. doi: 10.2466/pr0.1997.80.2.387 CrossRefPubMedGoogle Scholar
  20. 20.
    Da Ros A, Vinai P, Gentile N, Forza G, Cardetti S (2011) Evaluation of alexithymia and depression in severe obese patients not affected by eating disorders. Eating Weight Disord 16(1):24–29. doi: 10.1007/BF03327517 CrossRefGoogle Scholar
  21. 21.
    De Panfilis C, Cero S, Dall’Aglio E, Salvatore P, Torre M, Maggini C (2007) Psychopathological predictors of compliance and outcome in weight-loss obesity treatment. Acta Biomed 78(1):22–28PubMedGoogle Scholar
  22. 22.
    Pinna F, Lai L, Pirarba S, Orrù W, Velluzzi F, Loviselli A, Carpiniello B (2011) Obesity, alexithymia and psychopathology: a case-control study. Eat Weight Disord 16(3):e164–e170. doi: 10.3275/7509 CrossRefPubMedGoogle Scholar
  23. 23.
    Pinaquy S, Chabrol H, Simon C, Louvet JP, Barbe P (2003) Emotional eating, alexithymia, and binge eating disorder in obese women. Obes Res 11(2):195–201. doi: 10.1038/oby.2003.31 CrossRefPubMedGoogle Scholar
  24. 24.
    VanStrien T, Cebolla A, Etchemendy E, Gutie ́rrez-Maldonado J, Ferrer-Garc ́ıa M, Botella C, Ban ̃os R (2013) Emotional eating and food intake after sadness and joy. Appetite 66:20–25. doi: 10.1016/j.appet.2013.02.016 CrossRefGoogle Scholar
  25. 25.
    Zeeck A, Stelzer N, Linster HW, Joos A Hartmann A (2011) Emotion and eating in binge eating disorder and obesity. Eur Eat Disorder Rev 19(5):426–437. doi: 10.1002/erv.1066 CrossRefGoogle Scholar
  26. 26.
    Braden A, Flatt SW, Boutelle KN, Strong D, Sherwood NE, Rock CL (2016) Emotional eating is associated with weight loss success among adults enrolled in a weight loss program. J Behav Med 39(4):727–732. doi: 10.1007/s10865-016-9728-8 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ochner CN, Jochner M, Caruso EA, Teixeira J, Xavier Pi-Sunyer F (2013) Effect of preoperative body mass index on weight loss following obesity surgery. Surg Obes Relat Dis 9(3):423–427. doi: 10.1016/j.soard.2012.12.009 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Contreras JE, Santander C, Court I, Bravo J (2013) Correlation between age and weight loss after bariatric surgery. Obes Surg 23(8):1286–1289. doi: 10.1007/s11695-013-0905-3 CrossRefPubMedGoogle Scholar
  29. 29.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn, Text Revised (DSM-IV-TR). American Psychiatric Association, Washington, DCGoogle Scholar
  30. 30.
    First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS (1997) User’s guide for structured clinical interview for DSM-IV axis II personality disorders (SCID-II). American Psychiatric Association​, Washington, DCGoogle Scholar
  31. 31.
    First MB, Spitzer RL, Gibbon M, Williams JB (1995) Structured clinical interview for DSM-IV axis I disorders. New York State Psychiatric Institute, New YorkGoogle Scholar
  32. 32.
    Fried M,. Yumuk V, Oppert JM, Scopinaro N, Torres A, Weiner R, Yashkov Y, Frühbeck G (2014) Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg 24:42–55. doi: 10.1007/s11695-013-1079-8 CrossRefPubMedGoogle Scholar
  33. 33.
    Bagby MR, Parker JDA, Taylor GJ (1994) The twenty-item Toronto Alexithymia scale. Item selection and cross-validation of the factor structure. J Psychosom Res 38(1):23–32. doi: 10.1016/0022-3999(94)90005-1 CrossRefGoogle Scholar
  34. 34.
    Derogatis LR, Unger R (2010) Symptom checklist-90-revised. In: Corsini encyclopedia of psychology, vol 1–2. Wiley, Hoboken. doi: 10.1002/9780470479216.corpsy0970
  35. 35.
    Scinta W (2012) Measuring success: a comparison of weight loss calculations. BT 9(7):18–20. doi: 10.1016/0022-3999(94)90005-1
  36. 36.
    Figura A, Ahnis A, Stengel A, Hofmann T, Elbelt U, Ordemann J, Rose M (2015) Determinants of weight loss following laparoscopic sleeve gastrectomy: the role of psychological burden, coping style, and motivation to undergo surgery. J Obes. doi: 10.1155/2015/626010 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    De Zwaan M, Bach M, Mitchell JE, Ackard D, Specker SM, Pyle RL, Pakesh G (1995) Alexithymia, obesity, and binge eating disorder. Int J Eat Disord 17(2):135–140. doi: 10.1002/1098-108X(199503)17:2<135::AID-EAT2260170205>3.0.CO;2-7 CrossRefPubMedGoogle Scholar
  38. 38.
    Legorreta G, Bull RH, Kiely M (1988) Alexithymia and symbolic function in the obese. Psychother Psychosom 50:88–94. doi: 10.1159/000288105 CrossRefPubMedGoogle Scholar
  39. 39.
    Marechal V, Loas G, Legrand A, Corcos M (2009) Alexithymia in severely obese patients seeking surgical treatment. Psychol Rep 105:935–944. doi: 10.2466/PR0.105.3.935-944 CrossRefPubMedGoogle Scholar
  40. 40.
    Aceto P, Lai C, Perilli V, Sacco T, Modesti C, Raffaelli M, Sollazzi L (2016) Factors affecting acute pain perception and analgesics consumption in patients undergoing bariatric surgery. Physiol Behav 163:1–6. doi: 10.1016/j.physbeh.2016.04.032 CrossRefPubMedGoogle Scholar
  41. 41.
    Calia R, Lai C, Aceto P, Luciani M, Camardese G, Lai S, Fantozzi C, Pietroni V, Salerno MP, Spagnoletti G, Pedroso JA, Romagnoli J, Citterio F (2015) Emotional self-efficacy and alexithymia may affect compliance, renal function and quality of life in kidney transplant recipients: results from a preliminary cross-sectional study. Physiol Behav 142:152–154. doi: 10.1016/j.physbeh.2015.02.018 CrossRefPubMedGoogle Scholar
  42. 42.
    Calia R, Lai C, Aceto P, Luciani M, Saraceni C, Avolio AW, Agnes S (2011) Psychological risk factors for graft rejection among liver transplant recipients. Transpl Proc 43(4):1123–1127. doi: 10.1016/j.transproceed.2011.01.159 CrossRefGoogle Scholar
  43. 43.
    Calia R, Lai C, Aceto P, Luciani M, Saraceni C, Lai S, Gargiulo A, Citterio F (2011) Preoperative psychological factors predicting graft rejection in patients undergoing kidney transplant: a pilot study. Transpl Proc 43(4):1006–1009. doi: 10.1016/j.transproceed.2011.01.158 CrossRefGoogle Scholar
  44. 44.
    Lai C, Aceto P, Luciani M, Fazzari E, Cesari V, Luciano S, Fortini A, Berloco D, Canulla F, Calia R, Lai S (2016) Externally oriented thinking predicts phosphorus levels in dialyzed patients. Transpl Proc 48(2):309–310. doi: 10.1016/j.transproceed.2015.12.056 CrossRefGoogle Scholar
  45. 45.
    Zijlstraa H, Van Middendorpb T, Devaereb L, Larsenc JK, Van Ramshorstd B, Geenen R (2012) Emotion processing and regulation in women with morbid obesity who apply for bariatric surgery. Psychol Health 27(12):1375–1387. doi: 10.1080/08870446.2011.600761 CrossRefGoogle Scholar
  46. 46.
    Dingemans AE, Martijn C, Jansen AT, Van Furth EF (2009) The effect of suppressing negative emotions on eating behavior in binge eating disorder. Appetite 52:51–57. doi: 10.1016/j.appet.2008.08.004 CrossRefPubMedGoogle Scholar
  47. 47.
    Walfish S (2004) Self-assessed emotional factors contributing to increased weight gain in pre-surgical bariatric patients. Obes Surg 14:1402–1405. doi: 10.1381/0960892042583897 CrossRefPubMedGoogle Scholar
  48. 48.
    Lumley MA (2004) Alexithymia, emotional disclosure, and health: a program of research. J Pers 72:1271–1300. doi: 10.1111/j.1467-6494.2004.00297 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Medical Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Polo Pontino, Bariatric Center of Excellence IFSO-EUSapienza UniversityRomeItaly
  2. 2.Department of Dynamic and Clinical PsychologySapienza University of RomeRomeItaly
  3. 3.Department of Anesthesiology and Intensive CareA. Gemelli University Hospital RomeRomeItaly
  4. 4.Division of SurgeryOspedale San Giovanni Decollato, AndosillaCivita CastellanaItaly

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