Associations between binge eating, depressive symptoms and anxiety and weight regain after Roux-en-Y gastric bypass surgery



Weight regain (WR) after bariatric surgery (BS) is frequent.


The aim of this study was to evaluate whether the occurrence of psychiatric disorders would be associated with short- and long-term WR after BS.


Ninety-six patients (77.6% female, age 40.2 ± 10.1 years, BMI of 50 ± 8.2 kg/m2) from the Obesity and Bariatric Surgery Outpatient Clinic of the Universidade Federal São Paulo completed the Questionnaire on Eating and Weight Patterns-Revised, the Beck Depression Inventory and an anxiety inventory to assess the occurrence of binge eating, depressive symptoms (DS) and anxious symptoms (AS) before and after short-term and long-term BS.


Twenty-four months after BS, the prevalence of binge eating, depression and anxiety decreased from 100 to 13%, 100 to 15% and 43 to 4%, respectively. The mean WR of 35.2 ± 17.3% of weight loss occurred in nine patients after 24 months and was associated with binge eating (p = 0.002) but not with DS or AS. At long-term follow-up (12 ± 1.5 years), 67% had a mean WR of 50.3 ± 24.9%. The prevalence of binge eating, DS and AS were 48%, 46% and 63%, respectively, in this group, and significant associations were observed between WR and binge eating (p = 0.001), DS (p = 0.029) and AS (p = 0.001). Furthermore, the number of psychiatric disorders was inversely associated with the percentage of weight loss (p < 0.05) and positively associated with WR (p < 0.05).


Weight regain was associated with the occurrence of binge eating in the short and long term after BS, whereas the occurrence of depressive and anxious symptoms was associated with WR only in the long term.

Level III

Evidence obtained from well-designed cohort or case–control analytic studies.

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  1. 1.

    Hruby A, Hu FB (2015) The epidemiology of obesity: a big picture. Pharmacoeconomics 33(7):673–689.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Ferreira APDS, Szwarcwald CL, Damacena GN (2019) Prevalence of obesity and associated factors in the Brazilian population: a study of data from the 2013 National Health Survey. Revista Brasileira de Epidemiologia.

    Article  PubMed  Google Scholar 

  3. 3.

    Chooi YC, Ding C, Magkos F (2019) The epidemiology of obesity. Metabolism 92:6–10.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Fruh SM (2017) Obesity: risk factors, complications, and strategies for sustainable long-term weight management. J Am Assoc Nurse Pract 29:3–14.

    Article  Google Scholar 

  5. 5.

    Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, Bengtsson C (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357(8):741–752.

    Article  PubMed  Google Scholar 

  6. 6.

    Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA (2014) The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg 149(3):275–287.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Magro DO, Geloneze B, Delfini R, Pareja BC, Callejas F, Pareja JC (2008) Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg 18(6):648–651.

    Article  PubMed  Google Scholar 

  8. 8.

    Cooper TC, Simmons EB, Webb K, Burns JL, Kushner RF (2015) Trends in weight regain following Roux-en-Y gastric bypass (RYGB) bariatric surgery. Obes Surg 25(8):1474–1481.

    Article  PubMed  Google Scholar 

  9. 9.

    Monaco-Ferreira DV, Leandro-Merhi VA (2017) Weight regain 10 years after Roux-en-Y gastric bypass. Obes Surg 27(5):1137–1144.

    Article  PubMed  Google Scholar 

  10. 10.

    Rogula TG (2015) Weight regain after bariatric surgery—how should it be defined? Population 25(10):1901–1908.

    Article  Google Scholar 

  11. 11.

    Berti LV, Campos J, Ramos A, Rossi M, Szego T, Cohen R (2015) POSITION OF THE SBCBM-NOMENCLATURE AND DEFINITION OF OUTCOMES OF BARIATRIC AND METABOLIC SURGERY. Arquivos Brasileiros de Cirurgia Digestiva: ABCD 28(Suppl 1):02.

    Article  Google Scholar 

  12. 12.

    Karmali S, Brar B, Shi X, Sharma AM, de Gara C, Birch DW (2013) Weight recidivism post-bariatric surgery: a systematic review. Obes Surg 23(11):1922–1933.

    Article  PubMed  Google Scholar 

  13. 13.

    Monpellier VM, Janssen IM, Antoniou EE, Jansen AT (2019) Weight change after Roux-en Y gastric bypass, physical activity and eating style: is there a relationship? Obes Surg 29(2):526–533.

    Article  PubMed  Google Scholar 

  14. 14.

    Sarwer DB, Allison KC, Wadden TA, Ashare R, Spitzer JC, McCuen-Wurst C, Wu J (2019) Psychopathology, disordered eating, and impulsivity as predictors of outcomes of bariatric surgery. Surg Obes Relat Dis.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    van Hout GC, Hagendoren CA, Verschure SK, van Heck GL (2009) Psychosocial predictors of success after vertical banded gastroplasty. Obes Surg 19(6):701–707.

    Article  PubMed  Google Scholar 

  16. 16.

    Sala M, Haller DL, Laferrère B, Homel P, McGinty JJ (2017) Predictors of attrition before and after bariatric surgery. Obes Surg 27(2):548–551.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, Gibbons MM (2012) Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg 22(1):70–89.

    Article  PubMed  Google Scholar 

  18. 18.

    Meany G, Conceição E, Mitchell JE (2014) Binge eating, binge eating disorder and loss of control eating: effects on weight outcomes after bariatric surgery. Eur Eat Disord Rev 22(2):87–91.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Boan J, Kolotkin RL, Westman EC, McMahon RL, Grant JP (2004) Binge eating, quality of life and physical activity improve after Roux-en-Y gastric bypass for morbid obesity. Obes Surg 14(3):341–348.

    Article  PubMed  Google Scholar 

  20. 20.

    Testa G, Granero R, Siragusa C, Belligoli A, Sanna M, Rusconi ML, Fernández-Aranda F (2019) Psychological predictors of poor weight loss following LSG: relevance of general psychopathology and impulsivity. Eat Weight Disord Stud Anorex Bulim Obes.

    Article  Google Scholar 

  21. 21.

    Pekkarinen T, Mustonen H, Sane T, Jaser N, Juuti A, Leivonen M (2016) Long-term effect of gastric bypass and sleeve gastrectomy on severe obesity: do preoperative weight loss and binge eating behavior predict the outcome of bariatric surgery? Obes Surg 26(9):2161–2167.

    Article  PubMed  Google Scholar 

  22. 22.

    Bakr AA, Fahmy MH, Elward AS, Balamoun HA, Ibrahim MY, Eldahdoh RM (2019) Analysis of medium-term weight regain 5 years after laparoscopic sleeve gastrectomy. Obes Surg.

    Article  PubMed  Google Scholar 

  23. 23.

    Conceição EM, Fernandes M, de Lourdes M, Pinto-Bastos A, Vaz AR, Ramalho S (2019) Perceived social support before and after bariatric surgery: association with depression, problematic eating behaviors, and weight outcomes. Eat Weight Disord Stud Anorex Bulim Obes.

    Article  Google Scholar 

  24. 24.

    Pinto-Bastos A, de Lourdes M, Brandão I, Machado PP, Conceição EM (2019) Weight loss trajectories and psychobehavioral predictors of outcome of primary and reoperative bariatric surgery: a 2-year longitudinal study. Surg Obes Relat Dis.

    Article  PubMed  Google Scholar 

  25. 25.

    Devlin MJ, King WC, Kalarchian MA, Hinerman A, Marcus MD, Yanovski SZ, Mitchell JE (2018) Eating pathology and associations with long-term changes in weight and quality of life in the longitudinal assessment of bariatric surgery study. Int J Eat Disord 51(12):1322–1330.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Karlsson J, Taft C, Ryden A, Sjöström L, Sullivan M (2007) Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes 31(8):1248.

    CAS  Article  Google Scholar 

  27. 27.

    Odom J, Zalesin KC, Washington TL, Miller WW, Hakmeh B, Zaremba DL, Chengelis DL (2010) Behavioral predictors of weight regain after bariatric surgery. Obes Surg 20(3):349–356.

    Article  PubMed  Google Scholar 

  28. 28.

    Scholtz S, Bidlake L, Morgan J, Fiennes A, El-Etar A, Lacey JH, McCluskey S (2007) Long-term outcomes following laparoscopic adjustable gastric banding: postoperative psychological sequelae predict outcome at 5-year follow-up. Obes Surg 17(9):1220–1225.

    Article  PubMed  Google Scholar 

  29. 29.

    Borges MBF, Morgan CM, Claudino AM, Silveira DXD (2005) Validation of the portuguese version of the Questionnaire on Eating and Weight Patterns: revised (QEWP-R) for the screening of binge eating disorder. Braz J Psychiatry 27(4):319–322.

    Article  PubMed  Google Scholar 

  30. 30.

    White MA, Kalarchian MA, Masheb RM, Marcus MD, Grilo CM (2010) Loss of control over eating predicts outcomes in bariatric surgery: a prospective 24-month follow-up study. J Clin Psychiatry 71(2):175.

    Article  PubMed  Google Scholar 

  31. 31.

    Gorenstein C, Andrade LHSG (1998) Inventário de depressão de Beck: propriedades psicométricas da versão em português. Rev Psiq Clin 25(5):245–250

    Google Scholar 

  32. 32.

    Julian LJ (2011) Measures of anxiety: state-trait anxiety inventory (STAI), Beck anxiety inventory (BAI), and Hospital anxiety and Depression scale-anxiety (HADS-A). Arthritis Care Res 63(S11):S467–S472

    Article  Google Scholar 

  33. 33.

    Matos MIR, Aranha LS, Faria AN, Ferreira SR, Bacaltchuck J, Zanella MT (2002) Binge eating disorder, anxiety, depression and body image in grade III obesity patients. Braz J Psychiatry 24(4):165–169.

    Article  Google Scholar 

  34. 34.

    Duarte-Guerra LS, Coêlho BM, Santo MA, Lotufo-Neto F, Wang YP (2017) Morbidity persistence and comorbidity of mood, anxiety, and eating disorders among preoperative bariatric patients. Psychiatry Res 257:1–6.

    Article  PubMed  Google Scholar 

  35. 35.

    Kalarchian MA, King WC, Devlin MJ, Marcus MD, Garcia L, Chen JY, Mitchell JE (2016) Psychiatric disorders and weight change in a prospective study of bariatric surgery patients: a 3-year follow-up. Psychosom Med 78(3):373.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Pinto-Bastos A, de Lourdes M, Brandão I, Machado PP, Conceição EM (2019) Weight loss trajectories and psychobehavioral predictors of outcome of primary and reoperative bariatric surgery: a 2-year longitudinal study. Surg Obes Relat Dis.

    Article  PubMed  Google Scholar 

  37. 37.

    Kofman MD, Lent MR, Swencionis C (2010) Maladaptive eating patterns, quality of life, and weight outcomes following gastric bypass: results of an Internet survey. Obesity 18(10):1938–1943.

    Article  PubMed  Google Scholar 

  38. 38.

    deZwaan M, Hilbert A, Swan-Kremeier L, Simonich H, Lancaster K, Howell LM, Mitchell JE (2010) Comprehensive interview assessment of eating behavior 18–35 months after gastric bypass surgery for morbid obesity. Surg Obes Relat Dis 6(1):79.

    Article  Google Scholar 

  39. 39.

    White MA, Masheb RM, Rothschild BS, Burke-Martindale CH, Grilo CM (2006) The prognostic significance of regular binge eating in extremely obese gastric bypass patients: 12-month postoperative outcomes. J Clin Psychiatry.

    Article  PubMed  Google Scholar 

  40. 40.

    Miller-Matero LR, Bryce K, Saulino CK, Dykhuis KE, Genaw J, Carlin AM (2018) Problematic eating behaviors predict outcomes after bariatric surgery. Obes Surg 28(7):1910–1915.

    Article  PubMed  Google Scholar 

  41. 41.

    Mitchell JE, Lancaster KL, Burgard MA, Howell LM, Krahn DD, Crosby RD, Gosnell BA (2001) Long-term follow-up of patients’ status after gastric bypass. Obes Surg 11(4):464–468.

    CAS  Article  PubMed  Google Scholar 

  42. 42.

    de Zwaan M, Enderle J, Wagner S, Mühlhans B, Ditzen B, Gefeller O, Müller A (2011) Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. J Affect Disord 133(1–2):61–68.

    Article  PubMed  Google Scholar 

  43. 43.

    Booth H, Khan O, Prevost AT, Reddy M, Charlton J, Gulliford MC, King’ s Bariatric Surgery Study Group (2015) Impact of bariatric surgery on clinical depression. Interrupted time series study with matched controls. J Affect Disord 174:644–649.

    Article  PubMed  Google Scholar 

  44. 44.

    Mitchell JE, King WC, Chen JY, Devlin MJ, Flum D, Garcia L, Marcus MD (2014) Course of depressive symptoms and treatment in the longitudinal assessment of bariatric surgery (LABS-2) study. Obesity 22(8):1799–1806.

    Article  PubMed  Google Scholar 

  45. 45.

    Atlantis E, Ball K (2008) Association between weight perception and psychological distress. Int J Obes 32(4):715.

    CAS  Article  Google Scholar 

  46. 46.

    Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, Zitman FG (2010) Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 67(3):220–229.

    Article  PubMed  Google Scholar 

  47. 47.

    Burgmer R, Legenbauer T, Müller A, de Zwaan M, Fischer C, Herpertz S (2014) Psychological outcome 4 years after restrictive bariatric surgery. Obes Surg 24(10):1670–1678.

    Article  PubMed  Google Scholar 

  48. 48.

    Thonney B, Pataky Z, Badel S, Bobbioni-Harsch E, Golay A (2010) The relationship between weight loss and psychosocial functioning among bariatric surgery patients. Am J Surg 199(2):183–188.

    Article  PubMed  Google Scholar 

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Correspondence to Cristina Cardoso Freire.

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Freire, C.C., Zanella, M.T., Segal, A. et al. Associations between binge eating, depressive symptoms and anxiety and weight regain after Roux-en-Y gastric bypass surgery. Eat Weight Disord 26, 191–199 (2021).

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  • Weight regain
  • Bariatric surgery
  • Binge eating
  • Depression
  • Anxiety